A nurse enters a patient's room and finds that the patient has fallen on the way to the bathroom. What action should be implemented first?
Assess the patient.
File a safety event report
Place the patient on fall precautions.
Get the patient back to bed.
The Correct Answer is A
A. Assess the patient: The priority action is to assess the patient for injuries before taking any further steps.
B. File a safety event report: This is important but should be done after assessing and ensuring the patient’s safety.
C. Place the patient on fall precautions: While necessary, this is a secondary intervention after assessment and ensuring immediate safety.
D. Get the patient back to bed: Moving the patient before assessing for injuries could worsen potential fractures or other injuries.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Educate the patient about hand hygiene with alcohol-based hand sanitizer: Standard precautions apply to all patients, including hand hygiene education. HIV is not transmitted through casual contact.
B. Notify the patient's spouse about the result and arrange for HIV testing: Patient confidentiality must be maintained. The patient should be encouraged to inform their partner, but the nurse cannot disclose the results.
C. Provide information on antibiotic therapy to help control the infection: HIV is a viral infection, not bacterial. Antibiotics do not treat HIV.
D. Initiate contact precautions with gown and gloves: HIV is bloodborne and not spread via casual contact, so contact precautions are not required unless the patient has an open wound or secondary infection.
Correct Answer is A
Explanation
A. Assess the patient: The priority action is to assess the patient for injuries before taking any further steps.
B. File a safety event report: This is important but should be done after assessing and ensuring the patient’s safety.
C. Place the patient on fall precautions: While necessary, this is a secondary intervention after assessment and ensuring immediate safety.
D. Get the patient back to bed: Moving the patient before assessing for injuries could worsen potential fractures or other injuries.
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