A nurse is working in a nursing home.
What is the first priority for the nurse in this situation?
Ensure that all patients are moved out of harm’s way.
Remove all flammable materials from the area and extinguish the fire.
Report to the area of the fire and take measures to extinguish and/or contain it, if possible.
Evacuate all patients from the building immediately.
The Correct Answer is A
The correct answer is Choice A.
Choice A rationale
Ensuring that all patients are moved out of harm’s way is the first priority in a nursing home fire situation. This action aligns with the principles of the ABCs of nursing prioritization, where ensuring safety and preventing harm is paramount.
Choice B rationale
Removing all flammable materials from the area and extinguishing the fire is important, but it comes after ensuring the safety of the patients. The primary focus should be on patient safety.
Choice C rationale
Reporting to the area of the fire and taking measures to extinguish and/or contain it, if possible, is a secondary action. The immediate priority is to ensure the safety of the patients.
Choice D rationale
Evacuating all patients from the building immediately is not always feasible or safe. The priority is to move patients out of immediate harm’s way and then proceed with further evacuation if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is Choice C.
Choice A rationale
Repeating childhood immunizations once in remission is not necessary. Children with HIV should follow the standard immunization schedule with some modifications based on their immune status.
Choice B rationale
The risk of transmission does not significantly decrease after just 2 weeks on zidovudine. Continuous adherence to antiretroviral therapy is essential for reducing viral load and transmission risk.
Choice C rationale
Ensuring the child is tested for tuberculosis every year is important. Children with HIV are at higher risk for TB due to their compromised immune systems.
Choice D rationale
Doubling medications for 6 months is not a standard practice and can lead to toxicity and adverse effects. Medication dosages should be carefully managed by healthcare providers.
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale:
A hoarse voice is consistent with the child’s condition. The child has a frequent cough and stridor, which can cause irritation and inflammation of the vocal cords, leading to a hoarse voice.
Choice B rationale:
Nasal flaring is a sign of respiratory distress. It indicates that the child is working harder to breathe, which is consistent with the observed symptoms of stridor, cough, and mild intercostal retractions.
Choice C rationale:
Increased appetite is not consistent with the child’s condition. The child is refusing to eat or drink and appears fatigued, which is typical in cases of respiratory distress and illness.
Choice D rationale:
Sitting upright and leaning forward is a common position adopted by children in respiratory distress. This position helps to open the airway and makes breathing easier.
Choice E rationale:
Decreased respiratory rate is not consistent with the child’s condition. The child’s respiratory rate has increased from 20/min to 24/min, indicating increased effort to breathe due to respiratory distress.
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