PrepU Accountability Nursing Concept
The health care provider is in a hurry to leave the unit and tells the nurse to give morphine 2 mg IV every 4 hours as needed for pain. What action by the nurse is appropriate? Inform the health care provider that a written order is needed. Write the order in the client's record. Call the pharmacy to have the order entered in the electronic record. Add the new order to the medication administration record.
Inform the health care provider that a written order is needed. Explanation: Verbal orders should only be accepted during an emergency. No other action is correct other than asking the health care provider to write the order. Reference: Chapter 19: Documenting and Reporting - Page 475
A woman wearing hospital scrubs comes to the nursery and states "Mrs. Smith is ready for her baby. I will be glad to take the baby to her." What will the nursery nurse do next? A) Look at the woman's hospital identification badge. B) Determine which hospital unit the woman works on. C )Inform the woman she cannot transport the baby. D )Ask if the client actually sent the woman.
Look at the woman's hospital identification badge. Explanation: Each member of the hospital staff should have an identification badge clearly displayed. The nursery nurse should look at the badge of the woman who is offering to take Mrs. Smith's baby to her as this is the only way to ensure the nurse is allowing an appropriate person to transport the baby. Education and watchful vigilance are the keys to preventing infant abductions. Each facility that cares for newborns should have specific policies and procedures in place that address this problem. The nurse should review these policies and know the protocols for the facility in which the nurse will be working. Reference: Chapter 18: Nursing Management of the Newborn - Page 605
The healthy adult client is given an opioid prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first? A) Immediately have the client sign the consent form. B) Have the client's family member sign the consent form. C) Ask the client if he still wants to proceed with the procedure. D) Notify the physician of the oversight.
Notify the physician of the oversight. Explanation: Do not administer any medications that might alter judgment or perception before the client signs the consent form because many drugs commonly administered as preoperative medications, such as opioids or barbiturates, can alter cognitive abilities and invalidate informed consent. Reference: Chapter 30: Perioperative Nursing - Page 941-942
The nurse manager is reviewing medication order protocols with staff nurses. Which teaching will the nurse include? Select all that apply. Refrain from using abbreviations. Be mindful of look-alike and sound-alike drugs. IU and U are acceptable abbreviations to use. Orders can be carried out without provider signatures. Nurses and health care providers are accountable for drug safety.
Refrain from using abbreviations. Be mindful of look-alike and sound-alike drugs. Nurses and health care providers are accountable for drug safety. Explanation: The nurse manager's teaching will include that health care providers must sign all orders, and care must be taken with look-alike and sound-alike drugs. Abbreviations should not be used. The nurse and health care provider are both accountable for drug safety. Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 28: Medications, p. 762-764. Chapter 29: Medications - Page 762-764
A client reports an onset of pain in the ankle. The ankle is swollen, red, and extremely sensitive to pressure. The health care provider diagnoses secondary gout and the client asks for more information. What disease state(s) could the nurse discuss with the client that are associated with secondary gout? Select all that apply. chronic alcohol ingestion diabetes mellitus osteoarthritis hypercholesterolemia hypothyroidism
chronic alcohol ingestion diabetes mellitus hypercholesterolemia hypothyroidism Explanation: Secondary gout can be associated with drugs such as thiazide diuretics and cyclosporine. Secondary gout can be associated with other diseases such as diabetes mellitus, hypertension, leukemia, myeloma, hypothyroidism, hyperparathyroidism, truncal obesity, polycythemia, renal disease, sickle cell anemia, hypercholesterolemia, and chronic alcohol ingestion. Osteoarthritis does not cause secondary gout. Remediation: Gout (PDF)
The student nurse is learning how to administer medications. The nurse instructor asks, "What are the client's rights when administering medication?" What are the most appropriate response(s) by the student? Select all that apply. "Right to refuse." "Right interpretation." "Right authentication." "Right time or frequency." "Right assessment."
"Right to refuse." "Right time or frequency." "Right assessment." Explanation: The Ten Rights of Medication Administration include the right medication, dose, time/frequency, client, route, education, documentations, refuse, assessment, and evaluation. The right to interpretation and right to authentication are not included in the Ten Rights of Medication Administration. Remediation: Safe Medication Administration Practices, Ambulatory Care (PDF)
On admission to the psychiatric unit, a client with major depression reports that a family member is physically abusive and requests that the nurse not release any personal information to anyone. When the allegedly abusive family member calls the unit and demands information about the client's treatment, what is the nurse's best response? A) "To protect clients' confidentiality, I can't give any information, including whether your relative is receiving treatment here." B) "I can't give you any information. Goodbye." C) "Your family member isn't accepting telephone calls." D) "Your family member didn't sign an information release form with your name on it, so I can't give you any information."
"To protect clients' confidentiality, I can't give any information, including whether your relative is receiving treatment here." Explanation: The client has the right to confidential treatment, and the nurse has a duty to protect the client's confidentiality. Stating that to protect clients' confidentiality no information will be given is a diplomatic response. Although simply telling the caller that information can't be released protects the client's confidentiality, this response isn't as diplomatic as the first response. Stating that the client isn't accepting phone calls or that the client didn't sign an information form with the caller's name on it divulges the client's whereabouts and status, violating confidentiality.
The client who has the chronic condition of diabetes, reports blurry vision, and admits to nonadherence to the diet and medications. The home health nurse checks the client's fasting blood glucose level, which is 412 mg/dL. What phase of the Trajectory Model of Chronic Illness does the nurse assess this client is in? A) Pretrajectory B) Stable C) Acute D) Comeback
Acute Explanation: In the acute phase of the Trajectory Model of Chronic Illness the client has severe and unrelieved symptoms or complications that necessitate hospitalization. The client's blood glucose level is high enough that hospitalization may be required. The pretrajectory phase is one in which lifestyle behaviors place a client at risk for a chronic condition. The stable phase is characterized by symptoms of illness being under control. The comeback phase is one in which there is a gradual recovery to an acceptable way of life. Reference: Hinkle, J. L., Cheever, K. H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing , 14th ed Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2018, Chapter 9: Chronic Illness and Disability, p. 146. Chapter 9: Chronic Illness and Disability - Page 146
A client is being treated for alcoholism. After a family meeting, the client's spouse asks a nurse about ways to help the family deal with the effects of the spouse's alcoholism. The nurse should suggest that the family join which organization? A) Al-Anon B) Make Today Count C) Emotions Anonymous D) Alcoholics Anonymous
Al-Anon Explanation: Al-Anon is an organization that assists family members in sharing common experiences and increasing their understanding of alcoholism. Make Today Count is a support group for people with life-threatening or chronic illnesses. Emotions Anonymous is a support group for people experiencing depression, anxiety, or similar conditions. Alcoholics Anonymous is an organization that helps alcoholics recover by using a 12-step program. Remediation: Alcoholism (Lippincott article/PDF)
The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated? A) Duty B) Breach of duty C) Causation D) Damages
Duty Explanation: Duty refers to an obligation to use due care. The nurse assessed the client and made appropriate interventions and notifications. Breach of duty is the failure to meet the standard of care. An example of breach of duty would be not performing assessments, appropriate interventions, and notifications of the health care provider. Causation is when the breach of duty caused the injury. An example of causation would be failure to perform assessment and appropriate interventions when providing client care, and this caused injury to the client. Damages are the harm or injury that occurred to the client. In this situation, it would be the death of the client. Reference: Chapter 7: Legal Dimensions of Nursing Practice - Page 128
A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle? A) Fidelity B) Nonmaleficence C) Autonomy D) Justice
Fidelity Explanation: Fidelity involves keeping promises and being faithful to the promises made. In this case, the nurse tells the client that she will return in 10 minutes and then follows through with the promise. Nonmaleficence involves doing no harm and avoiding actions that deliberately harm a person. Autonomy refers to the right to make one's own decisions. Justice involves treating each person fairly and without judgment. Reference: Chapter 6: Values, Ethics, and Advocacy - Page 104
A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating? A) Altruism B) Social justice C) Integrity D) Autonomy
Integrity Explanation: The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the nurse reported the occurrence of the missed medication to the charge nurse. The definition of altruism is concern for others; it can best be explained by a nurse concerned about how a client will care for self after discharge. Social justice is a concept of fair and just relations between the individual and society and is related to wealth and distribution of goods in a society. Autonomy is the right to self-determination or acting independently and making decisions. Reference: Chapter 6: Values, Ethics, and Advocacy - Page 101
A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit? A) Negligence B) Malpractice C) Assault D) Battery
Malpractice Explanation: The facility and nurse could be charged with malpractice, which is failing to perform (or performing) an act that causes harm to a client. Administering the medication intravenously instead of orally as prescribed has caused harm to a client. Negligence is failing to perform care for a client. When a person threatens to touch a client without consent, it is assault, whereas battery is carrying out the implied threat (assault). Reference: Chapter 7: Legal Dimensions of Nursing Practice - Page 127
What is true of nursing responsibilities with regard to a physician-initiated intervention (physician's order)? A) Nurses do not carry out physician-initiated interventions. B) Nurses do carry out interventions in response to a physician's order. C) Nurses are responsible for reminding physicians to implement orders. D) Nurses are not legally responsible for these interventions.
Nurses do carry out interventions in response to a physician's order. Explanation: A physician-initiated intervention is initiated in response to a medical diagnosis, but carried out by a nurse in response to a doctor's order. Both the physician and the nurse are legally responsible for these interventions. Although nurses are not responsible for reminding physicians to implement orders, nurses may request a physician to implement an order or question an existing order by the physician if the nurse believes it is in the client's best interests. Reference: Chapter 16: Outcome Identification and Planning - Page 397
A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child? A) Tell the parents to bring toys for the child from home. B) Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. C) There is no way to adequately prepare a child for an impending hospitalization. D) Have another child talk with the child to be hospitalized.
Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. Explanation: The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. Not only is the child's fear reduced but also the child has a better ability to cope. Preparation allows the child a better understanding of what's happening to him or her. Good preparation allows the child to see a hospital room, handle medical equipment and gain an understanding of procedures and hospital sounds. Another child would only give explanations from his or her point of view and that child may describe a negative experience. The child's favorite toy or blanket should come with the child to the hospital as a comfort to the child, but that does not prepare the child for hospitalization. Reference: Chapter 33: Caring for Children in Diverse Settings - Page 1180
A nurse witnesses a peer tell a client, "You are a mother now and you have to do what is best for you baby. You have to breastfeed her!" Which is the best action by the nurse? Approach the client later and provide correct information. Immediately interrupt the conversation and reprimand the nurse. Fill out an incident report to go in the nurse's personnel file. Pull the nurse aside and inquire as to the content of the conversation.
Pull the nurse aside and inquire as to the content of the conversation. Explanation: The nurse overheard just a small portion of the conversation between the client and the peer nurse. The best action would be to inquire as to the content of the conversation and then determine if the peer nurse's comments were appropriate. If the comments were inappropriate, the nurse would then need to fill out an incident report. Reference: Chapter 1: Perspectives on Maternal and Child Health Care - Page 50
A nurse arriving for duty notes that an unlicensed assistive personnel (UAP) has been assigned to a complex client with treatments involving sterile technique. What is the responsibility of the nurse regarding the assignment of the UAP? Make sure the UAP has practiced sterile technique on at least one other occasion. Reassign the UAP to a client requiring basic tasks that the UAP has mastered. Supervise the UAP during the treatments involving sterile technique. Provide the UAP with a list of resources to guide the implementation of care.
Reassign the UAP to a client requiring basic tasks that the UAP has mastered. Explanation: The nurse is accountable for the delegation of tasks to UAPs. The nurse delegates tasks to UAPs consistent with their level of expertise and education, the job description, agency policy, legislation, and personal need. UAPs should not be assigned to clients who are complex or require skills that involve a higher level of knowledge. Based on the choices offered, if the nurse is confident that the UAP has the appropriate knowledge regarding basic tasks, the tasks can be delegated. The other options are incorrect, as they do not ensure that the UAP has the knowledge and skill to provide the care or carry out the task.
The nursing student is having difficulty obtaining a mobile computer for the purpose of administering medications using the electronic medical record. The student has been reprimanded for delivering medications late in the past and wants to ensure timely administration. What action should the student take? Print a copy of the medication record at the nurse's station to use at the bedside in order to administer the medications on time. Use the medication dispensing terminal to prepare the medications, and print a dispensing receipt to use for patient identification at the beside. Speak to the instructor about the unavailability of mobile computers for medication administration, and request assistance in obtaining one. Wait for a mobile computer to become available, and explain to the instructor that the reason for late administration was related to adhering to safety policy.
Speak to the instructor about the unavailability of mobile computers for medication administration, and request assistance in obtaining one. Explanation: When equipment is not readily available, it can be tempting to use work-arounds. Although down-time procedures may exist that allow for printing of the medication record, this is not the problem the student is facing. The student should make every effort to obtain the computer so the electronic medication record can be used appropriately for medication administration. Speaking to the instructor in advance, rather than afterwards, demonstrates superior communication and problem solving skills. Remediation: Documentation (PDF)
A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member? A) Surgeon B) Circulating nurse C) Scrub nurse D) Anesthetist
Surgeon Explanation: The registered nurse first assistant practices under the direct supervision of the surgeon. The circulating nurse works in collaboration with other members of the health care team to plan the best course of action for each patient. The scrub nurse assists the surgeon during the procedure as well as setting up sterile tables and preparing equipment. The anesthetist administers the anesthetic medications. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 18: Intraoperative Nursing Management, The Surgeon, p. 438-439. Chapter 18: Intraoperative Nursing Management - Page 438-439
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? A) Ask the nursing supervisor to contact the hospital lawyer. B) Keep the client in the emergency department until the family is contacted. C) Take the client to the operating room for surgery without informed consent. D) Contact the hospital chaplain to sign the consent on the client's behalf.
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. Remediation: Informed Consent (PDF)
A nurse who is experienced caring only for well babies is assigned to the neonatal intensive care unit (NICU) because of a shortage of nurses in the NICU. The nurse is assigned to an infant on a ventilator who will require blood transfusions during the shift. What is the nurse's most appropriate course of action? A) The nurse should inform the charge nurse that the nurse does not have the experience to properly care for this client. B) The nurse should ask another nurse who was previously assigned to the client for instruction. C) The nurse should request that the blood transfusions be delayed until the next shift. D) The nurse should recognize the necessity of the assignment and provide care to the best of the nurse's ability.
The nurse should inform the charge nurse that the nurse does not have the experience to properly care for this client. Explanation: The nurse should recognize that the nurse lacks the competence to safely care for a client with these complex needs and inform the charge nurse of the fact. This assignment would be an inappropriate delegation on the part of the charge nurse and could cause injury to the client. The other options do not take the safety of the client into consideration. Reference: Chapter 17: Implementing - Page 431
The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? The complexity of the activity, age of the UAP, and predictability of the outcome Predictability of the UAP, the amount of time required for the task, and RN's skill level The stability of the patient's condition, potential for harm, and complexity of the activity The context of the other patient needs, the desired outcome, and autonomy of the patient
The stability of the patient's condition, potential for harm, and complexity of the activity Explanation: RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activity), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs. Reference: Chapter 10: Leadership, Managing and Delegating - Page 227
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? Verify consent. Document the start of surgery. Acquire ordered blood products. Count sponges and syringes.
Verify consent. Explanation: Surgery cannot be performed without consent. Documentation of the start of surgery can only happen once the surgery has started. Blood products must be administered within an allotted time frame and therefore should not be acquired unless needed. The sponge and syringe count is a safety issue that should be completed before surgery and while the wound is being sutured, but if the client has not consented, the surgery should not take place. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia: Wolters Kluwer, 2018, Chapter 18: Intraoperative Nursing Management, p. 438. Chapter 18: Intraoperative Nursing Management - Page 438
The nurse is caring for a client after having various diagnostic tests. The client discusses a proxy being in attendance for the health care provider's diagnosis. The nurse requests a copy for the file, and allows the proxy to be in attendance with what type of document? A) durable power of attorney B) living will C) patient rights D )informed consent
durable power of attorney Explanation: A durable power of attorney for health care appoints a proxy, usually a relative or trusted friend, to make health care decisions on an individual's behalf. The living will, patient rights, and informed consent are not included in the durable power of attorney. A living will is a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Reference: Chapter 9: Legal and Ethical Issues - Page 143
A nurse manager reviews an employee's contribution to the nursing division annually. This process is: interpreting quality indicators. employee's job satisfaction survey. performance appraisal. reward and development survey.
performance appraisal. Explanation: Performance appraisal is typically conducted annually. Each organization determines a reward structure to define and to acknowledge success. Interpreting quality indicators pertains to evaluation of general client care, not of an individual nurse. An employee's job satisfaction survey is a tool that allows the employee to give feedback on the employee's satisfaction with work, not a review of the employee's contribution conducted by the nurse manager. Reference: Chapter 10: Leadership, Managing and Delegating - Page 220
The nurse is caring for a client with a secondary urinary tract infection for which amoxicillin 250 mg PO has been prescribed. The nurse recognizes this as a drug that is routinely administered every 8 hours; however, the prescription does not state the frequency of administration. The health care provider is no longer present. What is the appropriate nursing action? A) Ask the nursing supervisor to validate the frequency as every 8 hours and update the electronic medical record (EMR). B) Input the prescription into the electronic medical record (EMR) to reflect that the drug is given every 8 hours, after verifying with the pharmacy. C) Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription. D) Ask another nurse to validate the frequency as every 8 hours, update the electronic medical record (EMR), flagging the prescription for the health care provider to review and cosign the prescription within 24 hours.
Contact the health care provider to clarify the prescription by reading back to the provider, update the electronic medical record (EMR) while on the phone, then document it was a phone prescription. Explanation: The nurse should always have the health care provider clarify the prescription. The nurse cannot assume that a medication is to be given at certain times, nor should another nurse verify the frequency or clarify the prescription. The nurse should remain on the phone with the provider and read back the entire prescription for verification. Documentation should reflect that it is a phone prescription. Usually the phone prescription has to be reviewed and cosigned by the provider within 24 hours. Reference: Chapter 29: Medications - Page 869
A nurse is having lunch in the break room and overhears the other nurses talking about a difficult client in an inappropriate way. The nurses attempt to engage her in the conversation. Which response by the nurse would best represent behavior that supports the value of human dignity in nursing practice? A) Sharing what the client did to the nurse last week, though the nurse treats the client with dignity B) Getting up and walking out of the break room because the nurse's break is over C) Laughing and joining in the conversation, though the nurse does not believe the client is that bad D) Saying that this discussion is inappropriate and disrespectful to the client and that the nurse does not want to be a part of it
Saying that this discussion is inappropriate and disrespectful to the client and that the nurse does not want to be a part of it Explanation: Theorists describe the value clarification process as having three steps: choosing, prizing, and acting. In this illustration, the response that best represents a value for human dignity is a response in which the nurse goes through all three stages of the values clarification process; the nurse then concludes that the other nurses' behavior is wrong and prizes the human dignity of the client enough to act against the peers by telling them they are wrong. In the other responses, the nurse either wrongly participates in the inappropriate behavior or avoids addressing it with others. Reference: Chapter 6: Values, Ethics, and Advocacy - Page 101-102
The pediatric nurse is preparing to administer ibuprofen to an 8-month-old infant. The infant's weight is listed in the computer as 15 kg (33 lb) and the medication is prescribed to be given 10 mg/kg. The nurse notices that the dose of 150 mg seems high for an infant. The nurse clarifies the prescription with the healthcare provider, who states that it is the correct dose. What should the nurse do? A) Administer the medication as prescribed because the healthcare provider said it is correct. B) Verify child's weight is accurate and, if it is correct, give the medication. C) Notify the healthcare provider's superior about the medication prescription. D) Document the healthcare provider's response on the medical record.
Verify child's weight is accurate and, if it is correct, give the medication. Explanation: Pediatric medication dosages are weight-based. In this scenario, the nurse has already verified the prescription is correct with the healthcare provider, and 10 mg/kg is a safe and standard dose for ibuprofen in pediatric clients. The nurse should verify the child's weight is accurate, because 15 kg (33 lb) for an 8-month-old infant is higher than the 99th percentile and, if it is accurate, the medication should be given as prescribed. The nurse should not just give the medication just because the healthcare provider said it is correct and should not notify a superior unless there is clearly an unsafe situation that cannot be resolved otherwise. The nurse should document the interaction but the priority is verifying the weight and accuracy of the prescription.
