Safety: Management of Care

After having multiple medication errors, the nurse admits to abusing narcotics to the nurse manager. What are the implications of narcotic abuse for the impaired nurse? Select all that apply. The nursing license can be suspended. The nurse manager will notify the local newspaper of the nurse' s narcotic abuse. The impaired nurse will never be able obtain a future nursing license. The hospital can publish the nurse's license suspension in the hospital newsletter. The State Board of Nursing will publish the nurse's license suspension in a newsletter.

The nursing license can be suspended. The State Board of Nursing will publish the nurse's license suspension in a newsletter. The nurse can have the nursing license suspended from the State Board of Nursing. The State Board of Nursing will publish the nurse's license suspension in a newsletter available for healthcare providers. The impaired nurse will be able obtain a future nursing license after treatment. The hospital cannot publish the nurse's license suspension in the hospital newsletter. The local newspaper will not be notified of the narcotic abuse unless a crime has been committed.

An airplane crash results in mass casualties. The nurse is directing personnel to tag all victims. Which information should be placed on the tag? Select all that apply. triage priority identifying information when possible (such as name and age) medications and treatments administered presence of jewelry next of kin

triage priority identifying information when possible (such as name and age) medications and treatments administered Tracking victims of disasters is important for casualty planning and management. All victims should receive a tag, securely attached, that indicates the triage priority, any available identifying information, and what care, if any, has been given along with time and date. Tag information should be recorded in a disaster log and used to track victims and inform families. It is not necessary to document the presence of jewelry or next of kin.

A client with stage IV Parkinson's disease is admitted to the emergency department with heart failure. The client's advance directive dictates no cardiopulmonary resuscitation, intubation, or artificial feedings. The client is receiving diuretics to treat heart failure. The licensed practical nurse states, "This client shouldn't have come to the hospital because they have an advance directive." Which response by the registered nurse is best?

"Just because the client has an advance directive doesn't mean that we shouldn't treat reversible conditions such as heart failure." Option 3 is the best response; the advance directive doesn't dictate that care be withheld when reversible conditions such as heart failure exist. Option 1 is an inappropriate response. Option 2 is an accurate response; however, it isn't the best response because it doesn't provide an accurate explanation of advance directives. The advance directive covers all irreversible conditions, not just the client's Parkinson's disease.

The nurse is preparing to begin discharge planning with a client whose pulmonary embolism has recently resolved. Which factor should the nurse prioritize during this process?

the client's identified needs and goals The central focus of client teaching and the larger discharge planning process should be the identified healthcare needs of the client and the goals that the client identifies or acknowledges. The nurse's skills and knowledge, the potential for recurrence, and the relevant nursing diagnoses are all elements that may inform the discharge planning process, but they are superseded by the client's goals and expressed needs.

The nurse is caring for an elderly client with a possible diagnosis of pneumonia who has just been admitted to the hospital. The client is slightly confused and is experiencing difficulty breathing. Which activities would be appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply. Obtain vital signs. Initiate oxygen therapy as needed. Apply antiembolic stockings. Assess the client's breath sounds. Keep the client oriented.

Obtain vital signs. Apply antiembolic stockings. Keep the client oriented. It is appropriate for the nurse to delegate obtaining vital signs and applying antiembolic stockings to the UAP. The UAP can also help keep the client oriented to time, person, and place by talking with the client. The registered nurse is responsible for evaluating the quality and character of the client's vital signs, but the assistant may take the vital signs and report readings to the nurse. It is the registered nurse's responsibility to assess the client's need for oxygen therapy and apply as needed in accordance with the health care provider's prescriptions. It is also the registered nurse's responsibility to perform the nursing history and assess the client's breath sounds.

The emergency room nurse is caring for a Hispanic client following an anaphylactic reaction to a bee sting. The client needs education on self-administering an EpiPen for future use. Spanish is the client's primary language. Identify the proper steps the nurse needs to follow in order to correctly teach the client to use an EpiPen. All options must be used. Request a Spanish-speaking interpreter. Have the client take the EpiPen out of the carrying tube. Tell the interpreter to tell the client to remove the outer safety release cap. Demonstrate how to swing and inject firmly into the outer thigh region. Show the client how to press firmly against thigh for 10 seconds and then massage. Reinforce to the client to seek emergency medical attention if stung again.

Request a Spanish-speaking interpreter. Have the client take the EpiPen out of the carrying tube. Tell the interpreter to tell the client to remove the outer safety release cap. Demonstrate how to swing and inject firmly into the outer thigh region. Show the client how to press firmly against thigh for 10 seconds and then massage. Reinforce to the client to seek emergency medical attention if stung again. The nurses priority action when teaching a client whose language is not the same as the nurse is to get an interpreter or use a phone interpreter. The next nursing actions should be teaching the client to use the EpiPen correctly, It is important to demonstrate the steps as well as just verbalize them. First, the client should remove it from the carrying tube, grasps the unit with the tip pointed downward and remove the gray outer safety-release cap. Then the client then holds the black tip near the outer thigh; swings and injects it firmly into the outer thigh until hearing a click with the device perpendicular to the thigh. Next, have the client hold the device firmly against the thigh for about 10 seconds, then removes it and massages the area for 10 seconds. Lastly, the nurse needs to reinforce that the client should always seek emergency medical attention if stung again.

A 15-year-old primiparous client is being cared for in the hospital's birthing center after vaginal birth of a viable neonate. The neonate is being placed for adoption through a social service agency. Four hours postpartum, the client asks if she can feed her baby. Which response would be most appropriate?

"I'll bring the baby to you for feeding." After birth, the client should make the decision about how much she would like to participate in the neonate's care. Seeing and caring for the neonate commonly facilitates the grief process. The nurse should be nonjudgmental and should allow the client any opportunity to see, hold, and care for the neonate. The health care provider (HCP) does not need to be contacted about the client's desire to see the baby, which is a normal reaction. The social worker and the adoptive parents do not need to give the client permission to feed the baby.

Four months ago, the adult children of a client who was in a vegetative state gave consent for a feeding tube and agreed to long-term care placement. Nurses in the long-term care facility note that the adult children have recently become more distraught over their parent's condition. One day while visiting together, the children approach the nurse about having the feeding tube removed. Which statement by the nurse best explains the legal rights of individuals in this situation?

"Legally, there are no time constraints on previous decisions made." Telling the client's children that there are no time constraints on previous decisions made best explains the legal rights of the family in this situation. Next, the nurse should notify the physician of the family's request so measures can be initiated to withdraw care. Telling the family that nothing can be done gives incorrect information about the family's legal rights. Expressing empathy is a therapeutic response; however, it doesn't address the family's legal rights. Asking the family if they're looking for other means of nutritional support is an inappropriate response that doesn't address the family's concerns.

When cleaning the skin around an incision and drain site, what should the nurse do?

Clean the incision and drain site separately. When cleaning the skin around an incision and drain, the nurse should clean the incision and drain separately to avoid contaminating either wound. This is applying the principle of working from the least contaminated area to the most contaminated area. In this case, both areas are fresh wounds and should be kept separate.

A hospital uses the SOAP method of charting. Within this model, which of the nurse's statements would appear at the beginning of a charting entry?

Client reporting abdominal pain rated at 8/10." The SOAP method of charting (Subjective data, Objective data, Assessment, Plan) begins with the information provided by the client, such as a report of pain. The nurse's objective observations and assessments follow, with interventions, actions, and plans later in the charting entry.

A nurse is caring for a postsurgical client with two types of drains. Which activities can the nurse delegate to the unlicensed assistive personnel (UAP)? Select all that apply. Assess the drainage of an open drainage system, such as a Penrose drain. Document drain site and surrounding tissue status. Stabilize an open drainage system, such as a Penrose drain. Empty a closed drainage system, such as a Jackson-Pratt drain or Hemovac drain. Record the output from a closed-drainage system, such as a Jackson-Pratt drain or Hemovac drain.

Empty a closed drainage system, such as a Jackson-Pratt drain or Hemovac drain. Record the output from a closed-drainage system, such as a Jackson-Pratt drain or Hemovac drain. The nurse may delegate to the UAP emptying the closed drainage system and recording the output to the unlicensed assistive personnel. A closed drainage system, such as a Jackson-Pratt drain or Hemovac drain is anchored to the skin with one or more sutures. However, open-drainage systems, such as the Penrose drain, are not anchored to the skin. For this type of drain, it is important for the nurse to care for the drain so as to prevent inadvertent dislodgment. Assessing and documenting the drain site is a nursing responsibility.

When reviewing an older adult client's care and treatment plan, which physiological changes does the nurse evaluate as a concern for medication management due to a prolonged drug half-life? Select all that apply. decreased hydrochloric acid production decreased liver mass increased fat layer decreased kidney function decreased liver perfusion increased thirst

decreased liver mass increased fat layer decreased kidney function decreased liver perfusion Explanation: The nurse must understand the aging body when managing care and particularly when managing medications. With aging, body fat increases and total body water as well as lean body mass decrease affecting drug half-life. Also, hepatic and renal changes reduce biotransformation of medications and glomerular filtration. Decreased hydrochloric acid production does not provide the opportunity for a prolonged drug-half life. Thirst is not increased in the older adult client.