A nurse manager is reviewing a group of incident reports as part of a quality improvement initiative.

Exhibits

For each incident report, click to specify if the findings in the incident report indicate a near miss or an adverse event. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Incident report 1

Incident report 2

Incident report 3

Incident report 4

Incident report 5

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"B"}}

Near miss:

Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.
Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.
Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.
Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

A. "You can place a client in a chair with a table or tray blocking them as an alternative to restraints.": Using furniture to block a client can restrict their movement and may still be considered a form of restraint. Legal guidelines emphasize the importance of promoting client safety and dignity, so alternative measures should be explored that do not involve restricting movement.

B. "Monitoring the client less often than required can be considered negligence.": Monitoring a client in restraints less frequently than required breaches the duty of care and can lead to harm. Proper monitoring is crucial for the safety and well-being of clients, ensuring that their physical and psychological needs are adequately addressed while they are in restraints.

C. "Family members cannot file a lawsuit when restraints are used for clients who have a mental illness.": Family members retain the right to file lawsuits if they believe that the use of restraints was inappropriate or caused harm, regardless of the client's mental health status. Legal rights apply equally to all clients, including those with mental illness, ensuring accountability in the use of restraints.

D. "Chemical restraints are allowed when there is a high client-to-nurse ratio.": The use of chemical restraints is subject to strict regulations and cannot be justified based solely on staffing levels. These restraints should only be used when necessary for the client's safety and must align with established legal and ethical guidelines, ensuring that they are not used as a solution for managing staffing challenges.

A. The client has a do-not-resuscitate (DNR) prescription. B. The client has a continuous IV of lactated Ringer's. C. The client was straight catheterized for 350 mL 2 hr ago. D. The client has Medicare insurance. E. The client lives in a one-story home.

Correct Answer is ["A","B","C"]

Explanation

A. The client has a do-not-resuscitate (DNR) prescription: Including the client’s code status is essential for ensuring that the receiving medical-surgical team follows the appropriate resuscitation plan. This information directly impacts emergency decision-making and aligns with the client's wishes.

B. The client has a continuous IV of lactated Ringer’s: Reporting active IV fluids is necessary for continuity of care, as it affects fluid balance, medication administration, and overall treatment planning. The receiving nurse must be aware of the infusion to monitor for effectiveness and complications.

C. The client was straight catheterized for 350 mL 2 hr ago: Details about recent procedures, such as urinary catheterization, are relevant to ongoing assessment and care. Monitoring urinary output helps evaluate kidney function and fluid status, making it crucial information for the next shift.

D. The client has Medicare insurance: Insurance details are important for administrative and billing purposes but do not directly impact immediate patient care. This information is typically managed by case management or the hospital’s financial services.

E. The client lives in a one-story home: While discharge planning may involve assessing home arrangements, this detail is not immediately necessary for a shift report. Relevant home considerations should be discussed later when planning for discharge and follow-up care.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse manager is leading a discussion on legal guidelines for the use of restraints. Which of the following information should the nurse include?

Correct Answer is B

Explanation

A nurse in an emergency department is preparing change-of-shift report for an adult client who is transferring to a medical-surgical unit using the SBAR communication tool. Which of the following information should the nurse include in the report? (Select all that apply.)

Correct Answer is ["A","B","C"]

Explanation

A case manager is participating in the care of a client. Exhibits The case manager is planning the client's discharge. Which of the following interventions should the nurse include in the client's discharge plan?

A nurse manager is participating in the care of a client. Exhibits Which of the following client statements indicate an understanding of the teaching? Select all that apply.

A newly licensed nurse is giving a change-of-shift report using Introductions, Situation, Background, Assessment, Recommendation (ISBAR) to an oncoming nurse. Which of the following statements by the newly licensed nurse should be included in the "Background" portion of the report?

A staff nurse is challenging a shift assignment with the charge nurse. Which of the following statements made by the charge nurse is an example of smoothing as a strategy to resolve conflict?

A public health nurse is developing guidelines for management of a botulism outbreak. Which of the following information should the nurse include?

A nurse is using the ecologic model for population health to develop interventions to address HIV in a community. Which of the following interventions should the nurse include to address financial factors affecting community health?

After signing an informed consent form, a client states, "I have changed my mind and do not want to have the procedure." Which of the following actions should the nurse take?

A nurse working in a mobile health clinic is assessing a client who is an agricultural worker. Which of the following findings should the nurse identify as the priority?