While making her rounds, a nurse hears a cry for help. Upon entering the room she finds the
patient on the floor at the end of her bed. The side rails were up, the call button was within reach,
and the bed was in its lowest position.
The patient stated, "I needed to use the bathroom and I just
didn't want to bother the nurses.". How should this incident be written in the occurrence report?
A) The patient crawled out of bed attempting to go to the bathroom and fell. The call bell was in
reach, the side rails were up, and the bed was in the lowest position.
B) The nurse found the patient on the floor at the end of her bed. The side rails were up, the bed
was in its lowest position, and the call bell had been within reach.
C) Though instructed to call for help, the patient insisted on ambulating without assistance. She
was found on the floor.
D) The patient was found on the floor. Assisted back to bed. No injuries noted. Instructed to call
the nurse prior to getting out of bed in the future.
B
You might also like to view...
A client with a 4-cm breast mass is scheduled for biopsy with frozen section followed by lumpectomy and possible mastectomy
The client asks the nurse, "Why can't the doctor tell me specifically whether I will need to have my entire breast removed"? Which is the best response from the nurse? A) "The doctor will know which surgery is required, once the tumor is exposed." B) "The frozen section will determine presence of cancer and type of surgery required." C) "You need to trust your doctor to provide you with the best of care." D) "You seem anxious about your upcoming surgery."
The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months
One way to improve morale and decrease stress in the unit would be to: a. Plan a social event and include the agency and traveling nurse staff members. b. Plan unit-based social events for your re-maining permanent staff members. c. Request hospital-based "floating" nurses to substitute for the temporary staff. d. Implement team nursing.
A 56-year-old patient diagnosed with an acute myocardial infarction (heart attack) makes inappropriate sexual comments to the licensed practical nurse (LPN)
The LPN is visibly upset. The registered nurse (RN) assigned to the patient informs the patient his behavior is unacceptable and will not be tolerated. Is the RN demonstrating holistic or mechanistic nursing? ____________________ What will be an ideal response?
A nurse is discussing the side effects of opioid medications with a group of cancer patients. Which signs and symptoms are side effects of chronic opiate use that should be discussed? (Select all that apply)
a. Sedation b. Orthostatic hypotension c. Hypertension d. Nausea e. Diarrhea