A
Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following?
a. An unintentional tort
b. Assault
c. Invasion of Privacy
d. Battery
Answer: d
Rationale: Battery is the willful touching of a person without permission. Another name for an unintentional tort is malpractice. This situation is an intentional tort because the nurse executed the act on purpose.
Which statement demonstrates the ethical principle of nonmaleficence?
A) "The client is critically ill, and the team is currently doing everything possible to provide the best client care."
B) "I am going to clarify the client's prescription for vancomycin because I have noticed an increase in creatinine since yesterday."
C) "We need to call a meeting of the ethics committee to decide which critically ill client is in the most need of the hospital's last mechanical ventilator."
D) "The client has the right to refuse procedures as long as they demonstrate adequate understanding of the risks and benefits."
Answer: B
This is an example of the ethical principle of nonmaleficence. While the administration of vancomycin is often contraindicated for clients with poor kidney function, the overall benefits versus the risks are weighed when implementing this ethical principle. Acute or chronic kidney issues may be worth the vancomycin administration if it means the client will recover from severe sepsis, an immediate threat to the client’s life.
A nurse administers digoxin (Lanoxin) 0.25 mg instead of the prescribed order of 0.125 mg. The nurse discovers the error while charting the medication. The nurse completes an incident report and notifies the physician of the incident. The nurse takes which additional action?
a) gives the client a copy of the incident report
b) makes a copy of the incident report and sends it to the physician's office
c) documents the incident in the client's record
d) places the incident report in the client's record
Answer:C
Rationale - The incident report is confidential and privileged information. It should not be copied or placed in the chart or have any reference made to it in the client's record. It is the physician's responsibility to sign the incident report before it is sent to the risk-management department. A copy should not be made or sent to the physician's office. The incident report is not a substitute for a complete entry in the client's record concerning the incident. A copy of the incident report is not given to the client; however, the client should be informed of the error, and this is usually done by the client's physician.
The nurse practice acts are an example of civil law.
A. True
B. False
Answer: False
Rationale: Nurse practice acts fall under Statutory law
The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. What factor can increase stress and escalate conflict?
a. The use of avoidance
b. An enhanced nursing workforce
c. Accepting that some conflict is normal
d. Managing the effects of fatigue and error
ANS: A
Avoidance as a conflict-management style prolongs conflict and tends to escalate conflict
The primary care provider wrote a do-not-resuscitate (DNR) order. The nurse recognizes that which applies in the planning of nursing care for this client?
a. The client may no longer make decisions regarding his or her own health care.
b. The client and family know that the client will most likely die within the next 48 hours.
c. The nurses will continue to implement all treatments focused on comfort and symptom management.
d. A DNR order from a previous admission is valid for the current admission
Answer: c
A DNR order only controls CPR and similar life-saving treatments. All other care continues as previously ordered. Competent clients can still decide about their own care (including the DNR order.)
There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing?
1. Autocratic.
2. Bureaucratic.
3. Laissez-faire.
4. Authoritarian.
Answer: 3. Laissez-faire
Rationale: This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptipons of the patients
A case manager is reviewing the records of the clients in the nursing unit. Which of the following documentation, if noted in a client's record, would the nurse indicate as a positive variance?
a) a client in skeletal traction has a temperature of 98.6F and the pin sites are clean and dry b) a postoperative client is performing coughing and deep-breathing exercises every hour
c) a client with congestive heart failure has clear breath sounds
d) a client with pneumonia is discharged to home 1 day earlier than expected
Answer: D
Rationale: Variances are actual deviations or detours from the critical path. Variances are either positive or negative and avoidable or unavoidable, and may be caused by a variety of things. A positive variance occurs when the client has achieved maximum benefits and is discharged earlier than anticipated on her critical path. Option 4 is the only option that specifically identifies a positive variance. Options A, B, and C demonstrate progression on a critical path, but they are not specifically associated with the definition of a positive variance.
As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the
A. Nurse Practice Act (NPA).
B. American Nursing Association (ANA)
C. National Council for Lisensure Examinations
D. State Board of Licensure
Answer: A. Nurse Practice Act (NPA).
After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to:
a. observe to make sure the conflict has been resolved.
b. fire both staff nurses.
c. reassign both staff nurses.
d. reassign the nurse manager.
ANS: A
The nurse leader should follow up to determine if the conflict has been resolved because, in professional practice environments, unresolved conflict among nurses is a significant issue that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient satisfaction and poorer quality in patient care.
Katherine tells one of the staff, “I don’t have time to discuss the matter with you now. See me in my office later” when the latter asks if they can talk about an issue. Which of the following conflict resolution strategies did she use?
A. Soothing
B. Compromise
C. Avoidance
D. Restriction
Correct Answer: C. Avoidance
This strategy shuns discussing the issue head-on and prefers to postpone it to a later time. In effect, the problem remains unsolved and both parties are in a lose-lose situation. Someone who uses a strategy of “avoiding” mostly tries to ignore or sidestep the conflict, hoping it will resolve itself or dissipate.
The nursing student clinical group is attending the first clinical session of the semester. What nursing care delivery model can these students most usually expect to follow?
1. Total patient care model.
2. Functional nursing model.
3. Primary nursing model.
4. Care management model.
Answer: 1. . Total patient care model.
Rationale: Typically, student nurses follow the total patient care model and provide all of the care for a patient while in the clinical area. This model may be altered slightly to accommodate the student's progress in the nursing program or the policies of the facility. For example, the nursing student may provide all care except giving IV meds.
A nurse is performing an admission assessment on a client admitted to the hospital with a diagnosis of fever of unknown origin. The nurse performs interventions based on the nurse practice act when the nurse:
a) enters the information on the client's record
b) writes the information on a worksheet
c) informs the supervisor of the client's vital signs
d) tells another nurse that the client has a high fever
Answer: A
Recording assessment data reflects the requirement of the nurse practice act to maintain adequate records. Verbal information and notes on worksheets are not part of the client's permanent record.
A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role?
1. "The doctor has asked that you sign the consent form."
2. "Do you have any questions about the procedure?"
3. "What were you told about the procedure you are going to have?"
4. "Remember that you can change your mind and cancel the procedure."
Answer: #3
Rationale:
This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)
The nurse is triaging clients from a large disaster. Which client should receive care first?
client w/ large shard of glass piercing chest wall, RR 32
client w/ forearm disfigured w/ protruding bone, finger cap refill 2 seconds
child w/ 3-in. oozing laceration on leg
woman who is 2 months pregnant, partial-thickness burn on forearm
Answer: 1.client w/ large shard of glass piercing chest wall, RR 32
the integrity of the chest wall has been compromised and is becoming a "breathing" problem. The others can wait up to two hours.
A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action?
A. refuse to float in the ICU
B. call the hospital lawyer
C. call the nursing supervisor
D. report to the ICU and identify tasks that can be safely performed
Rationale: D. Floating is acceptable and legal practice. The nurse floated to a unit will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.
The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model?
1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest-ranking member.
2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions.
3. The mission statement of the hospital describes centralized power.
4. A staff nurse mentions that each individual staff member has complete autonomy.
Answer: 2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions.
Rationale: Shared governance increases each nurse's influence over the organization, empowering staff.
A staff nurse makes negative comments about a unit manager's leadership style, and the unit manager overhears the staff nurse. Which action by the unit manager would be appropriate?
a) tell the staff nurse to stop making the comments
b) propose a tentative solution regarding the comments, and discuss it with the staff nurse
c) encourage the staff nurse to discuss the comments
d) persuade the staff nurse to stop being so critical
Answer: C
Rationale Encouraging the staff nurse to discuss the comments will assist in identifying the concerns in a democratic way. Options A and D are autocratic. Option B does not provide the opportunity for the staff nurse to directly share concerns.
A nurse is caring for an elderly male client with terminal cancer. The client's family wants to continue treatment, but the client has told the nurse he would like to discontinue treatment and go home. The nurse agrees to be present while the client tells his family of his wishes. The nurse is supporting which of the following principles?
A) Beneficence for the client
B) Autonomy for the client
C) Nonmaleficence for the client
D) Justice for the client
Answer: B
Explanation: Autonomy refers to the right to make one's own decisions. The nurse is supporting this principle by supporting the client in his decision. Nonmaleficence is the duty to "do no harm." Justice is often referred to as fairness. Beneficence means "doing
Which is an example of a staff nurse functioning in the role of an informal leader?
verifying adequate staff coverage for a shift
filling out a discipline form on a nursing assistant
encouraging a peer to join a committee
attending a hospital-wide policy meeting
Answer: C
Rationale: A leader doesn't always have formal power and authority but influences the success of a unit by being an excellent role model and by guiding, encouraging, and facilitating professional growth and development. A manager has formal power and authority from the status within the organization, and such a power and authority are detailed in the the manager's job description
An older woman is brought to the emergency department for treatment of fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the clients chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives from work. Which is the most appropriate nursing response?
1. "Oh really? I will discuss this situation with your son"
2. " Lets talk about the ways you can manage your time to prevent this from happening?
3. Do you have any friends who can help you out until you resolve these important issues with your son?
4. As a nurse I am legally bound to report abuse. I will stay with you while you give report and help find a safe place for you to stay
Answer: 4
Rationale:
The nurse must report situations related to child or elder abuse, gun shot wounds, and other criminal acts and certain infectious diseases. Cinfidential issues are not to be discussed with nonmedical personal ot the clients family or friends without the clients permission. Clients should be assured that information is kept confidential unless it places nurse under legal obligation.
The manager has asked the staff to participate in the selection of new intravenous pumps for the unit. The manger has provided a list of choices and budget guidelines. This is an example of use of which management strategy?
1. Use of expert power.
2. Use of legitimate power.
3. Empowerment of staff.
4. Management persuasiveness.
Answer: 3. Empowerment of staff.
Rationale: This action enables others to act and provides others with the opportunity to participate and influence decisions.
A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action?
A. refuse to float in the ICU
B. call the hospital lawyer
C. call the nursing supervisor
D. report to the ICU and identify tasks that can be safely performed
Answer: D
Rationale - floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.\
The nurse is caring for a client on a medical-surgical unit. The client complains to the nurse that the physician has refused to treat the client further if the client continues to be noncompliant with the physician's recommendations. Which is the priority nursing action for the nurse?
A) Take the issue to the hospital ethics committee.
B) Advise the client to sue the physician.
C) Have the client contact a consumer agency.
D) Notify the physician of the client's complaints.
Answer: A
Explanation A) Acting as a client advocate and protecting the client's rights, the nurse should enlist the help of the hospital ethics committee. The nurse never advises a client to sue but assists the client to find help resolving the issue. A consumer agency is not appropriate because this is an ethical matter. The nurse should act on behalf of the client, and the best way to do that is by taking the issue to the hospital ethics committee, not to the physician.
Kathleen knows that one of her staff is experiencing burnout. Which of the following is the best thing for her to do?
A. Advise her staff to go on vacation.
B. Ignore her observations; it will be resolved even without intervention.
C. Remind her to show loyalty to the institution.
D. Let the staff ventilate her feelings and ask how she can be of help.
Answer: D. Reaching out and helping the staff is the most effective strategy in dealing with burnout. Knowing that someone is ready to help makes the staff feel important; hence her self-worth is enhanced.