Safe and Effective Care Environment Flashcards

An LVN is caring for a post-operative client at high risk for falls. Which intervention is the priority?

Answer: Keeping the bed in the lowest position with side rails up

Keeping the bed in the lowest position and raising side rails reduces fall risk by minimizing fall height and providing support.

When a physical restraint is applied to a client, the LVN must reassess the client at minimum every:

Answer: 2 hours

CMS and The Joint Commission standards require restraint assessment, including circulation and skin integrity checks, at least every 2 hours.

The LVN smells smoke in the hallway. Using the RACE mnemonic, which action comes first?

Answer: Rescue — move clients in immediate danger

RACE stands for Rescue, Alarm, Contain, Extinguish — rescuing clients in immediate danger is always the first priority.

A client who was given a sedative needs to use the restroom. The LVN's best action is to:

Answer: Accompany and assist the client to the restroom

Sedatives impair balance and judgment, so the LVN must accompany and assist the client to prevent falls.

Which client requires the highest priority when assigning rooms in a medical-surgical unit?

Answer: A newly admitted client with active tuberculosis

A client with active TB requires immediate placement in a negative-pressure isolation room to protect other clients and staff.

The LVN finds a sharps container that is three-quarters full. What is the appropriate action?

Answer: Replace the container with a new one

Sharps containers should be replaced when three-quarters full to prevent overfilling, which increases the risk of needlestick injury.

A client in a wheelchair needs to be transferred to bed. To protect both the client and LVN, which is the correct body mechanic principle?

Answer: Use a wide base of support and bend at the knees

A wide base of support and bending at the knees (not the waist) reduces injury risk by using leg muscles instead of the back.