A nurse enters a client's room and discovers a smoldering fire in the drapes. After moving clients to a safe location, which of the following actions should the nurse take next?
Use an extinguisher to put out the fire.
Pull the fire alarm.
Close the doors to client rooms.
Turn off any electrical equipment in the room.
The Correct Answer is B
After moving clients to a safe location, the next action the nurse should take is to pull the fire alarm. This will alert others in the building to the presence of a fire and activate the building's fire suppression systems.
Options a, c, and d are not the next actions the nurse should take. Using an extinguisher to put out the fire may be appropriate if the nurse has been trained to do so and if it is safe to do so. Closing the doors to client rooms can help to contain the spread of smoke and fire, but it is not the next action the nurse should take. Turning off electrical equipment in the room may help to prevent further ignition sources, but it is not the next action the nurse should take.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["F"]
Explanation
f) Skin surrounding the stoma is reddened and appears irritated.
The information that requires intervention by the nurse is that the skin surrounding the stoma is reddened and appears irritated. This may indicate that the client is experiencing skin irritation or breakdown, which can lead to infection or other complications. The nurse should assess the skin and initiate appropriate interventions to prevent further skin damage.
Options a, b, c, d, e, and g do not necessarily require intervention by the nurse. A pink ileostomy stoma and moderate brown liquid stool drainage are normal findings. The client's refusal to look at the stoma or learn about stoma care may be concerning, but it is not an immediate priority for intervention. An intake of 2,200 mL over 24 hours and a urine output of 650 mL over 24 hours are within normal limits.
Correct Answer is B
Explanation
The client's belief that their needs will be met through education is the most likely factor to increase their motivation to learn how to self-administer daily low-dose heparin injections. When a client believes that they will benefit from the education and that it will help them meet their needs, they are more likely to be motivated to learn.
a. The nurse's empathy about the client having to self-inject may help build rapport with the client, but it is not the most important factor in increasing the client's motivation to learn.
c) The client seeking family approval by agreeing to a teaching plan may be a motivating factor for some clients, but it is not the most important factor in increasing the client's motivation to learn.
d) The nurse explaining the need for education to the client may help increase the client's understanding of the importance of learning how to self-administer heparin injections, but it is not the most important factor in increasing the client's motivation to learn.
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