The nurse discovers a patient on the floor the

The nurse discovers a patient on the floor. The patient states that he fell out of bed. The nurse
assesses the patient and places the patient back in bed. Which action should the nurse take
next?
a. Do nothing, no harm has occurred.
b. Notify the health care provider.
c. Complete an incident report.
d. Assess the patient.
ANS: B
Report immediately to physician or health care provider if the patient sustains a fall or an
injury. The nurse must provide safe care and doing nothing is not safe care. The scenario
indicates the nurse has already assessed the patient. After the patient has stabilized,
completing an incident report would be the last step in the process.
When making rounds the nurse observes a purple wristband on a patient's wrist. How will the
nurse interpret this finding?
In 2008 the American Hospital Association issued an advisory recommending that hospitals
standardize wristband colors: red for patient allergies, yellow for fall risk, and purple for do
not resuscitate preferences. Purple does not indicate seizures.
A nurse reviews the history of a newly admitted patient. Which finding will alert the nurse
that the patient is at risk for falls?
The nurse is assessing a patient for lead poisoning. Which patient is the nurse most likely
assessing?