Exam 4 QUESTIONS AND
VERIFIED CORRECT
ANSWERS LATEST 2026-2027
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While making rounds, the nurse finds a patient on the floor in the hallway. Which action will the
nurse do first?
-assess the patient for injury
-transfer the patient back to bed
-assist the patient to a wheelchair
-report the patient's condition to the physician - CORRECT ANSWER--assess the patient for
injury
Which action should the nurse take to prevent accidents?
-apply a restraint when the patient is in the wheelchair to keep them from falling
-determine the strength of the patient
-turn all the lights off in the room so the patient can sleep
-provide a cane for walking if the patient is weak - CORRECT ANSWER--determine the strength
of the patient
When caring for a patient who is able to get out of bed independently and safely, the nurse will
-leave one side rail at the foot of the bed up
,-leave one side rail up when there are only two side rails on the bed
-leave both side rails up in a two side rail bed
-leave all four side rails up for all patients at all times - CORRECT ANSWER--leave one side rail up
when there are only two side rails on the bed
The nurse is monitoring for Never Events. Which finding indicates the nurse will report a Never
Event?
-a sponge is left in the patient's incision
-pulmonary embolism after lung surgery
-no blood incompatibility occurs with a blood transfusion
-development of stage II pressure ulcer - CORRECT ANSWER--a sponge is left in the patient's
incision
The nurse discovers a patient on the floor. The patient states that he fell out of bed. The nurse
assesses the patient and finds no apparent changes in the previous assessment. The nurse
assists the patient back to bed. Which action should the nurse take next?
-notify the health care provider
-do nothing, no harm has occurred
-notify the family
-complete an incident report - CORRECT ANSWER--notify the health care provider
The nurse is teaching a group of older adults at an assisted living facility about age related
physiological changes affecting safety. Which question would be most important for the nurse to
ask this group?
-Are you able to taste spices like before?
-Are you able to hear the tornado sirens in your area?
-Are you able to read the newspaper?
-Are you able to open a jar of pickles? - CORRECT ANSWER--Are you able to hear the tornado
sirens in your area?
, The nurse is trying to use diversion rather than restrain a patient. Which finding will cause the
nurse to determine the diversion is working?
-the patient apologizes for being "such a bother"
-the patient folds three washcloths over and over
-the patient gets restless when the sitter leaves for lunch
-the patient continues to get up from the chair at the nurse's station - CORRECT ANSWER--the
patient folds three washcloths over and over
The nurse is caring for a patient who suddenly becomes confused and tries to remove a wound
dressing. Which priority action will the nurse take?
-call the healthcare provider for a restraint order
-gather restraint supplies
-remove the dressing and leave wound open to air
-assess the patient - CORRECT ANSWER--assess the patient
The nurse is providing patient care for a post surgical patient. Which action indicates the nurse
is following the National Patient Safety Goals?
-obtains vital signs prior to sending a patient to surgery
-identifies patient with one identifier prior to transporting to the radiology department
-uses medication bar coding when administering medications
-initiates an IV catheter using clean technique on the first attempt - CORRECT ANSWER--uses
medication bar coding when administering medications
The nurse is caring for a patient with a wrist restraint. Upon assessment, the nurse finds the
fingers a light blue color. Which action will the nurse take next?
-place the hand under a warm blanket
-take the patient's vital signs