Ethical Nursing Practices and Client Care, Exams of Nursing

Download Ethical Nursing Practices and Client Care and more Exams Nursing in PDF only on Docsity! PrepU Passpoint Coordinated Care After working multiple shifts in the psychiatric intensive care unit, a nurse is becoming more distant and, at times, even irritable. The best action for the nurse to take would be to: - verified answer talk with the charge nurse and seek support from peers on the unit. Explanation: Talking with the charge nurse and the nurse's own peers provides an opportunity for the nurse to express legitimate feelings and receive support and encouragement from others who understand. Although requesting vacation time may be helpful for the nurse in the short term, it isn't the best step to take. Requesting a less-demanding assignment is avoidant and doesn't address the nurse's feelings. Continuing to work without dealing with the feelings doesn't allow the nurse to provide the most therapeutic care to the clients. One of the most important factors in psychiatric nursing is self- knowledge. A nurse is caring for an 8-year-old female with multiple, chronic urinary tract infections. While the nurse helps the child's parent provide morning care, the child states, "My uncle doesn't clean me that way." The parent becomes visibly upset and gives the girl a stern warning not to discuss the matter. What is the priority action for the nurse? - verified answer Notify the nursing supervisor and the authorities of the possibility of abuse. Explanation: The nurse has the legal responsibility to report suspected abuse of a child or an older adult to the nursing supervisor and authorities. The nurse should have the experts continue with an investigation and not ask any more questions. If the nurse suspects abuse, the nurse is obligated to report the suspicion of abuse. The documentation of the event is important but not the priority. A nurse is concerned about a client's ability to retain information during education sessions. Which of the following techniques would enhance the retention of material in presentations? - verified answer using repetition Explanation: Repetition is an effective means of reinforcing critical information and enhancing content retention. The other options will not increase the client's ability to retain information and may actually decrease concentration. The nurse assists the client to the operating room table and supervises the operating room technician preparing the sterile field. Which action, completed by the surgical technician, indicates to the nurse that a sterile field has been contaminated? - verified answer Wetness in the sterile cloth on top of the nonsterile table has been noted. Explanation: Moisture outside the sterile package contaminates the sterile field because fluid can be wicked into the sterile field. Bacteria tend to settle, so there is less contamination above waist level and away from the technician. The outer inch of the drape is considered contaminated but does not indicate that the sterile field itself has been contaminated. The licensed practical nurse (LPN) is caring for a group of clients on a medical-surgical floor. Which client should the nurse attend to first? - verified answer a client whose lower leg is red and swollen Explanation: The LPN should first attend to the client whose lower leg is red and swollen. This client may have deep vein thrombosis caused by immobility, which should be investigated further. An apical pulse rate of 80 beats/minute is within normal limits. The LPN should address the clients' concerns about going home and receiving the breakfast tray; however, those concerns don't take priority. A staffing agency is assigning a licensed practical/vocational nurse (LPN/VN) to cover a shift on a pediatric unit. Because the unit manager is unfamiliar with the nurse's skill level, what assignment is best for the LPN/VN? - verified answer 9-year-old child receiving subcutaneous insulin for diabetes mellitus Explanation: The unit manager should assign the LPN/VN to the child with diabetes mellitus. Because the client is receiving subcutaneous insulin rather than IV insulin, the diabetes is likely stable. Meningitis is an acute condition with the potential to progress into respiratory depression and seizures; this child will require frequent nursing assessments. The child who had a tonsillectomy remains at risk for hemorrhage during the first 24 hours following surgery. Legg-Calve'-Perthes disease is associated with impaired circulation to the femoral capital epiphysis; the child with this condition requires aggressive monitoring. A nurse works with a colleague who consistently fails to use standard precautions or wear gloves when caring for clients. The nurse calls these oversights to the colleague's attention, but the colleague claims that standard precautions and gloves are unnecessary unless the client is known to have tested positive for the human immunodeficiency virus. Which action would be most appropriate for the nurse to take? - verified answer Document the problem in writing for the nurse manager. Explanation: The nurse who has observed the colleague's failure to use standard precautions has spoken to the colleague under the appropriate circumstances, and the colleague's comment indicates the need for further education. Therefore, the appropriate action is to bring the problem to the nurse manager's attention. Talking with other staff members about the situation would be unproductive because they do not have the authority to bring the colleague's practice into compliance. The nurse should never point out to a client that another staff member's practice is not meeting standards. A nurse caring for a client in the home learns from the client's spouse that the client refuses to take medication in the morning. The nurse suggests that the spouse crush and mix the pills in orange client that he may not be able to access the healthcare facility again is an inappropriate response because healthcare is a right and the client can access it whenever necessary. The nurse is caring for a laboring client fluent in English, but the client defers to her mother-in-law when asked to sign the hospital consent forms. Which of the following factors contributes to the challenges the nurse faces in obtaining consent? - verified answer Influence of the extended family Explanation: The influence of the extended family is the cultural factor that is causing the nurse's dilemma. It is common for English-speaking women to defer to an extended family member in both formal and informal decision-making situations. Language barriers may present challenges at times, but translators may be involved in particular when discussing health-related decisions to ensure understanding. A nurse is caring for clients in a subacute unit. Which client care takes priority? - verified answer suctioning a tracheostomy client with oxygen saturation of 90% Explanation: Using Maslow's hierarchy of need, the priority is maintaining airway. If the airway is not maintained, the client can die of asphyxia. Changing a dressing and colostomy are necessary but not emergent. Administering pain medication is the next priority after airway. A client is admitted to the emergency department with a ruptured abdominal aortic aneurysm. No family members are present, and the surgeon instructs the nurse to take the client to the operating room immediately. Which action should the nurse take regarding informed consent? - verified answer Take the client to the operating room for surgery without informed consent. Explanation: All attempts should be made to contact the family, but delaying life-saving surgery is not an option. The other options are not correct because the surgeon can perform surgery without consent if there is a risk of loss of life or limb if the surgery is not performed. The nurse should take the client to the operating room. A nurse is caring for a newborn who has developed sepsis. The health care provider has given the following orders. Which order will the nurse implement first? - verified answer Obtain blood cultures. Explanation: All of the orders that the health care provider initiated are important but the nurse should obtain the blood culture before starting any other interventions—especially before starting the ampicillin. If the culture is obtained after a dose of ampicillin has been given, the results of the culture could be altered and unreliable. A client with metastatic brain cancer is admitted to the oncology floor. According to the Patient Self- Determination Act of 1991 (PSDA), what is the hospital required to do concerning the execution of advance directives? - verified answer Inform the client or legal guardian of his right to execute an advance directive. Explanation: The PSDA of 1991 requires all health care facilities to notify clients upon admission of their right to execute an advance directive. The facility's ethics committee can decide on a treatment plan if the client is unable to do so, and a durable power of attorney hasn't been appointed. Hospitals aren't required by law to respect individuals' moral rights; however, health care professionals should do so as part of their professional responsibility. Health care professionals are sometimes concerned that advance directives prevent treatment that might help the client. However, the hospital shouldn't advise clients not to execute an advance directive. A client with terminal breast cancer is being cared for by a long-time friend who is a physician. The client has identified her sister as the agent in her healthcare power of attorney. The client loses decision-making capacity, and the sister tells the nurse, "A different physician will be caring for my sister now. I've dismissed her friend." In response, the nurse should - verified answer abide by the wishes of the sister who holds the durable power of attorney. Explanation: A healthcare power of attorney transfers an individual's rights regarding healthcare decisions to the designated agent. It's within the sister's power to change the physician caring for the terminally ill client. The dismissed physician has no power to interfere with the wishes of the healthcare power of attorney. It would be inappropriate and unprofessional of the nurse to ignore the wishes of the client's agent. A nurse who's assigned the care of six clients is administering a tube feeding to a client when breakfast trays arrive. A client who needs assistance with meals helps herself to her tray and spills hot coffee on her chest and abdomen. How should the nurse intervene? - verified answer Stop administering the tube feeding and assist the client with changing her wet clothing, assess the burns, and notify the charge nurse. Explanation: The client who spilled the hot coffee needs immediate assistance. Therefore, the nurse should stop administering the tube feeding and attend to the other client immediately. The nurse should assist the client with removing the wet clothing. Then she should assess the burns and notify the charge nurse, who should report the incident to the physician and nursing supervisor. An incident report should also be completed according to facility policy. After the client is attended to, the nurse should resume feeding the other client through the feeding tube. Although it might appear that the client who spilled the coffee was impatient, the nurse shouldn't reprimand her for attempting to be independent. The nurse shouldn't request a replacement tray and remove the wet clothing without assessing the burns and notifying the appropriate staff members of the incident. A nurse is preparing to administer cardiac medications to two clients with the same last name. The nurse checks the medication three times before entering the room to administer medications to the first client. While leaving the room, the nurse realizes they didn't check the client's identification before administering the medication. Which action should the nurse take first? - verified answer Return to the room, check the client's identification against the medication administration record, and complete a variance report if needed. Explanation: The nurse should return to the room to check the client's identification against the medication administration record. If there was an error, the nurse should then complete a variance report in accordance with facility policy and check the remaining medication before administering it to the second client. The client record shouldn't include documentation of a completed variance report. The nurse should inform the charge nurse of the error after confirming that an error has been made. The nurse is working on an ethics committee that is reviewing client-nurse interactions. Which nursing action indicates negligence? - verified answer A nurse forgot to remove the tourniquet after phlebotomy, resulting in tissue injury. Explanation: Negligence is the unintentional failure of a nurse to perform or not perform an act or behave in a way a reasonable nurse would not. Additionally, for a nursing action to be considered negligent, there must be client injury. A reasonable nurse would have removed the tourniquet after obtaining blood, therefore, the unintentional act harmed the client and constitutes negligence. Although the nurse failed to complete a fall risk assessment within an appropriate time frame, there was no client injury; therefore, it is not considered a negligent action. Crushing medication and giving it is intentional and may be within the facility's policy and therefore not negligence. Administering a generic drug instead of a brand-name drug per the pharmacist's orders constitutes no error. A client tells the visiting community health nurse that another client's name and phone number were seen on the call display after the previous day's nurse used the client's home phone. What should the nurse do in response to this conversation? - verified answer Discuss the matter with the other nurse, reminding the other nurse not to use the client's phone because it has a call display feature. Explanation: Leaving personal information in view of other people is a breach of confidentiality. The nurse should inform the other nurse of the incident. The other options are incorrect because they do not protect the client's privacy and do not address the behavior of the other nurse. A newer nurse is assigned to care for several children with advanced cancer. The nurse finds the assignment extremely challenging due to a lack of experience and is considering requesting a potentially life threatening complications for the blood transfusion patient. The telephone call is important for medication changes and to prevent a delay in treatment. Airway management is also a high priority. At this point, the child is compensating with a reasonable oxygen saturation. In this scenario, the most critical situation is the blood transfusion reaction, which requires the quickest intervention to stop potential complications. A nurse is caring for a school-age child who's dying of brain cancer. The parents have requested information about a do-not-resuscitate (DNR) order. Which of the following is the nurse's most appropriate response? - verified answer A DNR order does not mean withholding treatment while the child is alive. It involves not initiating treatment after the child has died. Explanation: Parents will likely have difficulty dealing with end-of-life decisions for their child, but they must be informed of all available treatment options. The health care team members need to educate family members regarding the possible choices, and encourage them to discuss their feelings and explore their wishes for their child. A DNR order does not mean withholding treatment while the child is alive. It involves not initiating treatment after the child has died. Parents are reminded that if a DNR order is chosen, they may revoke the order at any time. The health care providers should assure the family that their child will be cared for and comfort will be maintained regardless of the presence or absence of a DNR order. A nurse receives an assignment to provide care to 10 clients. Two of them have had kidney transplantation surgery within the last 36 hours. The nurse feels overwhelmed with the number of clients. In addition, the nurse has never cared for a client who has undergone recent transplantation surgery. What are the appropriate actions for the nurse to take? Select all that apply. - verified answer Speak to the charge nurse about the assignment. Document all concerns in writing about the assignment. Explanation: When a nurse feels unable to safely perform an assignment, the appropriate action is to speak to the nurse in charge. The nurse should also document the concerns in writing and ask that the assignment be changed. In the event that the manager chooses to leave the assignment as given, the nurse should accept the assignment. The nurse should never abandon the assigned clients by leaving the workplace or asking another nurse to care for them. The nurse may, however, refuse to perform a task outside the scope of practice. A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider? - verified answer incompatibility between the child's history and the injury Explanation: Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. For example, the child may have a skull fracture but the parents state that the child fell off of the sofa. The other criteria also may suggest child abuse but are less reliable indicators. An 80-year-old client has an advance directive that states "do not keep alive by any heroic means." The client suffered a heart attack, and the family is requesting full code. Which nursing action taken by the nurse is correct? - verified answer Use only pain medication to keep the client comfortable. Explanation: Implementing full resuscitation at the family's request violates the client's rights. CPR is considered heroic and should not be implemented. Using pain medication to keep the client pain free and comfortable is humane and does not violate the client's autonomy. Transferring the client to the intensive care unit will involve intubation and other heroic measures. A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as - verified answer moxifloxacin 400 mg daily Explanation: Among the Joint Commission's list of "do not use" abbreviations are Q.D., qd, and OD when denoting a once-per-day drug administration. Because of the potential for misinterpretation and consequent drug errors, the Joint Commission recommends writing "daily" in the order. Which documentation is most important when preparing a preschool-age child for surgery? - verified answer Informed consent Explanation: Making sure that informed consent is documented is most important before surgery. Documenting vital signs and preoperative teaching and medication administration are also important but not as important as informed consent. A client has not had a bowel movement for 2 days and is feeling uncomfortable. The physician writes an order that states, "laxative of choice." How should the nurse proceed with this order? - verified answer Ask the physician to prescribe a specific laxative. Explanation: The physician's order leaves the nurse in the position of prescribing a medication. To be a complete order, the physician must write the drug, dose, frequency, route, and purpose or reason for the drug. The other options are incorrect because they put the nurse in the position of prescribing a medication and not following established professional standards for the administration of medication. A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? - verified answer administering ordered analgesics and monitoring their effects Explanation: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management the priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions do not take priority over pain management. A nurse is reviewing the interdisciplinary plan of care for a client experiencing hallucinations. Which intervention would the nurse most likely identify as being included in the plan? - verified answer providing a competing stimulus that distracts from the hallucinations Explanation: Providing a competing stimulus acknowledges the presence of the hallucinations and teaches the client ways to decrease their frequency. The other nursing actions support and maintain hallucination occurrence or deny its existence. Four clients are assigned to a nurse. Which client should the nurse identify who would benefit the most from hyperbaric oxygen therapy? - verified answer client with a compromised skin graft Explanation: A client with a compromised skin graft could benefit from hyperbaric oxygen therapy because increasing oxygenation at the wound site promotes wound healing. Hyperbaric oxygen therapy is not used to improve the oxygenation status of a client with chronic obstructive pulmonary disease or pneumonia. This type of treatment would not encourage bone healing after a fracture. A nurse is caring for a client who has a brain tumor and increased intracranial pressure (ICP). Which nursing intervention should be included in the client's care? - verified answer Provide rest periods between nursing interventions. Explanation: Nursing interventions for a client with increased ICP should be spaced throughout the day to prevent further increase in ICP, which can occur with any type of stimulation. Coughing increases ICP by increasing intrathoracic pressure and reducing venous return. Keeping the head in midline and avoiding extreme neck flexion prevents obstruction of venous outflow from the brain. Both sensory stimulation and noxious stimuli can increase ICP. Which statement reflects appropriate documentation in the medical record of a hospitalized client? - verified answer "Client's skin is moist and cool." Explanation: