Funds- Issues in Nursing

The nurse enters a clients room and notes that the clients lawyer is present and that the client is preparing a living will. The living will requires that the clients signature be witnessed, and the client asks the nurse to witness the signature. Which is the appropriate nursing action? 1. Decline to sign the will 2. Sign the will as a witness to the signature only 3. Call the hospital lawyer before signing the will 4. Sign the will, clearly identifying credentials and employment agency

1 Rationale: Living wills are required to be in writing and signed by the client. The clients signature either must be witnessed by specified individuals or notarized. Many states prohibit any employee from being a witness, including the nurse in a facility in which the client is receiving care

The nurse finds the client lying on the floor. The nurse calls the RN, who checks on the client and then calls the nursing supervisor and the HCP to inform them of the occurrence. The nurse completes the incident report for which purpose? 1. Providing clients with necessary stabilizing treatments 2. A method of promoting quality care and risk management 3. Determining the effectiveness of interventions in relation to outcomes 4. The appropriate method of reporting to local, state, and federal agencies

2 Rationale: Proper documentation of unusual occurrences, incidents, accidents and the nursing actions taken as a result of the occurrence are internal to the institution or agency. Documentation of the incident reports allows the nurse and administration to review the quality of care and determine any potential risks present

The LPN enters a clients room and finds the client sitting on the floor. The LPN calls the RN, who checks the client thoroughly and then assists the client back into bed. The LPN completes an incident report, and the nursing supervisor and HCP are notified of the incident. Which is the next nursing action regarding the incident? 1. Place the incident report in the clients chart 2. Make a copy of the incident report for the HCP 3. Document a complete entry in the clients record concerning the incident 4. Document in the clients record that an incident report has been completed

3 Rationale: The incident report is confidential and privileged information, and it should not be copied, placed in the chart, or have any reference made to it in the clients record. The incident report is not a substitute for a complete entry in the clients record concerning the incident

Which is a recommended guideline for safe computerized charting? 1. Passwords to the computer system should only be changed if lost 2. Computer terminals may be left unattended during client care activities 3. Accidental deletions from the computerized file need to be reported to the nursing manager or supervisor 4. Copies of printouts from computerized files should be kept on a clipboard at the nurses' station for other nurses to access

3 Rationale: After any inadvertent deletions or permanent computerized records, the nurse should type an explanation into the computer file with the date, time, and his or her initials. The nurse should also contact the nursing manager or supervisor with a written explanation of the situation. Options 1, 2, and 4 represent unsafe charting actions. Only option 3 follows the guidelines for safe computer charting

The nurses arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the pediatric unit. Which is the appropriate nursing action? 1. Call the hospital lawyer 2. Call the nursing supervisor 3. Refuse to float to the pediatric unit 4. Report to the pediatric unit and identify tasks that can be safely performed

4 Rationale: Floating is an acceptable legal practice used by hospitals to solve their understaffing problems. Legally the nurse cannot refuse to float unless a union contract guarantees that the nurse can only work in a specified area or the nurse can prove a lack of knowledge for the performance of assigned tasks. When faced with this situation, the nurse should identify potential areas of harm to the client

An unconscious client, bleeding profusely, is brought to the ED after a serious accident. Surgery is required immediately to save the childs life. With regard to informed consent for the surgical procedure, which is the best action? 1. Call the nursing supervisor to initiate a court order for the surgical procedure 2. Try calling the clients spouse to obtain telephone consent before the surgical procedure. 3. Ask the friend who accompanied the client to the ED to sign the consent form. 4. Transport the client to the OR immediately, as required the the HCP, without obtaining an informed consent

4 Rationale: Generally there are only two instances in which the informed consent of an adult client is not needed. One instance is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second instance is when the client waives the right to give informed consent.

The nurse observes that a client received pain medication 1 hour ago from another nurse, but the client still has severe pain. The nurse has previously observed this same occurrence. Based on the nurse practice act, the observing nurse should plan to take which action? 1. Report the information to the police 2. Call the impaired nurse organization 3. Talk with the nurse who gave the medication 4. Report the information to a nursing supervisor

4 Rationale: Nurse practice acts require reporting the suspicion of impaired nurses. The state board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the board of nursing.

A client has died, and the nurse asks a family member about the funeral arrangements. The family members refuses to discuss the issue. Which is the appropriate nursing action? 1. Show acceptance of feelings 2. Provide information needed for decision making 3. Suggest a referral to a mental health professional 4. Remain with the family member without discussing funeral arrangements

4 Rationale: The family member is exhibiting the first stage of grief (denial), and the nurse should remain with the family member

An older woman is brought to the ED. When caring for the client, the nurse notes old and new ecchymotic areas on both of the clients arms and buttocks. The nurse asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her daughter frequently hits her if she gets in the way. Which is the appropriate nursing response? 1. I have a legal obligation to report this type of abuse 2. I promise I won't tell anyone, but lets see what we can do about this 3. Lets talk about ways that will prevent your daughter from hitting you 4. This should not be happening. If it happens again, you must call the ED

1. Rationale: Confidential issues are not to be discussed with nonmedical personnel or with the clients family or friends without the clients permission. Clients should be assured that information is kept confidential unless it places the nurse under a legal obligation. The nurse must report situations related to the child, older adult abuse, and other types of abuse, depending on state laws; gunshot wounds, stabbings, and certain infectious diseases

A nurse lawyer provides an education session to the nursing staff regarding client rights. The nurse asks the lawyer to describe an example that may relate to the invasion of privacy. Which nursing action indicates a violation of client privacy? 1. Threatening to place a client in restraints 2. Performing a surgical procedure without consent 3. Taking photographs of the client without consent 4. Telling the client that he or she cannot leave the hospital

3 Rationale: Invasion of privacy takes place when an individuals private affairs are intruded on unreasonably. Threatening to place a client in restraints constitutes assault. Performing a surgical procedure without consent is an example of battery. Not allowing a client to leave the hospital constitutes false imprisonment