Princeton Review Management of Care Drill 3
The nurse is caring for a client who is refusing a treatment that has limited benefit. The family asks the nurse to try to convince the patient to begin the treatment. Which action by the nurse is consistent with ethical practice? Decline to convince the client to begin treatment Correct Answer Encourage the family to try to convince the client Inform the physician that the family would like the client to begin treatment Ask the client if they are sure of their decision
A Rationale: The Code of Ethics for Nurses states that the nurse promotes, advocates for, and protects the rights of the client. This includes the right to make decisions that the nurse or family may not agree with. The nurse's primary commitment is to the patient, and they should not encourage others to persuade the client to change their mind.
A nurse is providing care to a client with diverticulitis who is refusing all medical treatment. The client tells the nurse "I want to leave the hospital. I know how to manage my condition at home." Which action does the nurse perform next? Contact the healthcare provider, and explain the risks of leaving against medical advice Inform the charge nurse, and tell the client they cannot leave until medically stable Tell the client they are not ready to be discharged, and document refusal of treatment in the medical record Discontinue the client's intravenous access, and escort the client out of the facility
A Rationale: An alert, competent client has the right to refuse treatment and leave the facility against medical advice. However, the nurse must first inform the healthcare provider and discuss the risks of leaving without completing medical treatment. The nurse cannot hold the client in the facility against their wishes. The determination of when a client is ready for discharge is not the sole decision of the nurse. The client must first be informed of the risks of leaving against medical advice prior to discontinuing intravenous access and escorting them out of the facility.
The nurse attended an education conference about ethics in nursing practice. Which statement by the nurse indicates an understanding of nonmaleficence? "In my nursing practice, I will follow protocols and policies to prevent harm to my clients." "When providing care, I will act fairly towards my client regardless of culture or race." "When I tell a client I will be back in an hour, I will make every effort to do so." "I will provide my clients with necessary information, so they can make decisions."
A Rationale: Nonmaleficence is the ethical principle to do no harm. A nurse who demonstrates nonmaleficence will follow protocols and policies that are in place to prevent harm or injury to clients. Fidelity is the ethical principle of faithfulness, or keeping promises, such as returning to the client when stated. The nurse demonstrates autonomy for clients when providing the necessary information to make decisions. Beneficence refers to taking positive actions to help others.
A nurse is providing care to a client with a complex abdominal wound. The client tells the nurse, "My healthcare provider told me I was going to be discharged soon, but I don't think I can afford all of my wound supplies." How does the nurse respond to the client's concern? "Your social worker will be informed of your needs prior to discharge." "A list of wound care supply stores will be given to you at discharge." "Is there anyone in your family who can help you purchase wound supplies?" "How will you be obtaining the medications necessary for your wound care?"
A Rationale: Social workers can assist clients with finding financial resources for their medical care. The nurse refers the case to the client's social worker prior to discharge. Providing the client with a list of wound care supply stores does not address the client's financial difficulties. The nurse should refer the client to a social worker prior to suggesting the purchase of wound care supplies by the family. Asking the client how they will be obtaining their medications does not address the client's financial concerns.
The nurse is caring for a client diagnosed with a left hemisphere cerebrovascular accident. The client has a new prescription for ambulation. Which team member should the nurse collaborate with to promote an optimal outcome? Physical therapist Case manager Occupational therapist Unlicensed assistive personnel
A Rationale: The nurse should collaborate with the physical therapist, who can assess the client and determine the amount of assistance required to safely ambulate the client. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other healthcare personnel who provide care, and insurance companies. That is not the appropriate team member for this particular need. The occupational therapist can assist this client to complete activities of daily living (ADLs) but not ambulation. The unlicensed assistive personnel may be needed to assist with ambulation, but this is not the first person the nurse would collaborate with.
A nurse receives admission prescriptions for a client with suspected sepsis. Which prescribed intervention will the nurse perform first? Initiation of intravenous fluids Collection of blood cultures Insertion of an indwelling urinary catheter Administration of a prophylactic anticoagulant
A Rationale: The nurse should initiate intravenous fluids as soon as possible. Priority interventions for a client with suspected sepsis include fluid resuscitation and antibiotic administration. Obtaining blood cultures is an important intervention for determining the suspected source of infection. However, fluid resuscitation is the priority intervention. Insertion of an indwelling catheter and administration of prophylactic anticoagulants are routine interventions for a client with suspected sepsis. However, fluid resuscitation is the priority.
The nurse overhears nursing students talking on the elevator and describing a client who was admitted to the unit. One of the nursing students starts to disclose the client's medical information. What is the first action by the nurse? Stop the conversation in the elevator Contact the nursing students' instructor Report the incident to the nurse manager Inform the client about the privacy violation
A Rationale: The nursing students are violating HIPAA and confidentiality requirements, and the nurse should act immediately to stop the conversation. The nurse may contact the nursing students' instructor and report the behavior and report the incident to the nurse manager, but these are not the first actions the nurse should make if overhearing this conversation on an elevator. The nurse should not tell the client about the breach of confidentiality.
A nurse is assessing a client with a left lower extremity fracture who has been prescribed crutches for ambulation. Which observation indicates the client may benefit from a referral to physical therapy? The client asks for assistance before getting out of bed and uses one crutch to stand. The client takes frequent breaks during ambulation and uses a four-point gait. The client grabs the hand grips and places their body weight on the axillae while ambulating. The client flexes their elbows and leans forward while holding the crutches.
B Rationale: Crutches are prescribed to prevent the client from placing weight on the affected extremity. A four-point gait indicates the client is placing weight on both lower extremities and might benefit from a referral to physical therapy for alternative options. Using one crutch to stand decreases balance. The client should be instructed to hold both crutches while standing. Weight should not be placed on the axillae while using crutches. The nurse should emphasize placing the weight on the hand grips. Leaning forward decreases balance. The client should be instructed to stand up straight while holding the crutches.
The nurse is reviewing the laboratory data for a client with aplastic anemia and notes a white blood cell count of 3000 mcL. The nurse should understand that the client is at risk for which condition? Leukocytosis Neutropenia Phagocytosis Erythropenia
B Rationale: Neutropenia is caused by a decrease in the production of neutrophils or increased destruction of these cells. This can be caused by several medical conditions, such as aplastic anemia. Leukocytosis is an elevation of white blood cell count. Phagocytosis is the ingestion of bacteria and ameboid protozoans. Erythropenia is a reduction in the number of red blood cells.
The nurse is working to improve patient satisfaction on the preoperative unit after having poor scores over the last quarter. A new bedside tool was implemented six months ago, and the results have been compiled for review. The nurse recognizes the processes as which acronym? SBAR PDSA EBP STEPPS
B Rationale: The PDSA model stands for plan, do, study, act. This is a cycle used for testing change in the work setting by following the steps strategically. The project should be implemented on a small scale to observe the change effect. SBAR is used for communication. EBP is the acronym for evidenced-based practice. STEPPS is a framework with five key principles and is based on a team structure.
The healthcare provider has called and asked the nurse to have the client sign the consent form to have a surgery scheduled for tomorrow. When approached, the client states, "I haven't spoken to my doctor yet." What action by the nurse is appropriate? Obtain the signature, and tell the client that the healthcare provider will be in to speak with them Do not obtain the signature, and inform the healthcare provider that they need to engage in the informed consent discussion Provide the client with the risks, benefits, and alternatives to the surgery, and obtain their signature on the informed consent document Document this as an informed consent refusal, and notify the healthcare provider
B Rationale: The cornerstone of the informed consent process is the discussion between the client and the healthcare provider. A client has the right to consent (or not) to any recommended procedure or treatment. The patient also has the right to enough information to give informed and meaningful consent. The client should be informed by the healthcare provider performing the procedure, not the nurse. In this case, the nurse should not obtain a signature and should inform the provider that they need to meet with the client. The client has not refused the procedure in this scenario.
The charge nurse observes staff members arguing about their client assignments. Which action by the charge nurse is appropriate at this time? Let the staff members work it out amongst themselves Ask the staff members about their concerns Adjust the staff members' client assignments Notify management about the staff members' incivility
B Rationale: The nurse should ask the staff member about their concerns to gather more information about the cause of their disagreement before making any changes. Allowing the staff members to work it out amongst themselves might be appropriate if they were not already having an argument. There is not enough information presented to determine if incivility is taking place.
A performance improvement (PI) nurse is auditing client records and notes a client's chart is missing documentation on advance directives. The PI nurse addresses the findings with the bedside nurse. Which statement by the bedside nurse indicates further teaching on advance directives is required? "The client denies having an advanced directive, and the information will be charted shortly." "The client's spouse is the healthcare power of attorney and is bringing the legal documentation." "The client is only being admitted for observation, so the information is unnecessary." "The client requested more information and is currently considering their options."
C Rationale: Information on advance directives should be requested from every client who is admitted to a healthcare facility regardless of the length of stay. The client's health status can change abruptly and healthcare providers should be aware of advance directives. Real-time charting is encouraged. However, the client has been appropriately assessed for advanced directives by the bedside nurse. A copy of the legal documentation should be included in the chart as soon as possible. Clients who do not have an advance directive should be provided with information that outlines their health care decision rights.
The nurse is caring for a group of clients with neurological disorders. Which task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel? Teaching Crede's maneuver to a client needing to void Administering tube feeding to a quadriplegic client Assisting with bowel training by placing the client on the bedside commode Observing the client for correct self-catheterization
C Rationale: The Five Rights of Delegation are right task, right circumstance, right person, right directions and communication, and right supervision and evaluation. Professional nurses are responsible for delegating nursing activities, but although RNs may delegate elements of care, they may not delegate the nursing process itself. Nursing care or tasks that should never be delegated, except to another RN, include initial and ongoing nursing assessment, determination of the diagnosis and plan of care, evaluation, and client education. The UAP can assist the client to the bedside commode. All other tasks should be completed by an individual with licensure.
The nurse is planning out the daily tasks for assigned clients. Which of the following actions by the nurse should be completed first to manage time effectively? Explain the procedures to each client Gather all necessary supplies for interventions Review the client's prescriptions in the medical record Request that the nursing supervisor assist with tasks
C Rationale: The nurse should first review all of the client's prescriptions before beginning to complete tasks. This action allows the nurse to plan what interventions can be clustered together and/or what tasks need to be prioritized. Gathering supplies and explaining procedures would occur after the nurse has reviewed the medical record and requesting help from the nursing supervisor might occur if the nurse realizes that assistance is needed.
The experienced nurse is precepting a graduate nurse who reports having difficulty completing tasks on time. Which action by the graduate nurse would require follow-up by the experienced nurse? Asks for help with dosage calculation Requires two attempts to start a peripheral IV site Performs all tasks without delegation to nursing personnel Struggles with making staffing assignments
C Rationale: Under-delegating is a frequent cause of ineffective time management seen in the new nurse. The nurse would need to intervene and review the scope of practice, prioritization, and delegation of care with the graduate nurse. When in doubt, the nurse should always ask for assistance with dosage calculations. Intravenous (IV) insertion is a skill that develops with experience and time. New graduates are not in charge of running the unit or making staffing assignments.
A nurse is providing care to a 15-year-old client who arrives at the clinic requesting an abortion. The client states that the parents are unaware of the pregnancy and would like to keep the treatment confidential. How does the nurse respond to the client's request? "We cannot perform this procedure without your parent's consent." "I will inform the healthcare provider of your wishes." "Are you aware of all of the risks involved with terminating your pregnancy?" "How did you arrive to the decision to terminate your pregnancy?"
D Rationale: The nurse must explore the adolescent client's ability to make their own decisions. Asking the client how they arrived at their decision assesses the presence, or lack of, social support systems. Telling the client that the procedure cannot be performed without the parent's consent will cause a loss of rapport with the client and may influence the client to terminate the pregnancy by other means. The healthcare provider should be informed of the client's wishes after the nurse considers the ethical implications of the client's request. Discussing the risks of terminating the pregnancy does not address the ethical concern and is not an independent nursing action.
The client admitted for an invasive procedure asks the nurse about informed consent. Which statement best describes the role of the nurse to ensure informed consent? "I will give a detailed description of the risks and benefits of the procedure." "I will give an explanation of each step of the procedure." "I will offer alternative options to this procedure." "I will ask questions to determine that you understand what you are signing."
D Rationale: The nurse's responsibilities related to informed consent include ensuring the consent form is completed with signatures from the client, serving as a witness to the signature process, and determining whether the client understands what they are signing by asking pertinent questions. The healthcare provider is responsible for informing the client about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, its potential risks and benefits, and alternative methods available.
A nurse reviews a discharge home prescription for a client with a traumatic brain injury. The client is unable to perform activities of daily living independently and lives with elderly parents. Which action does the nurse perform? Coordinates the client's transportation home after discharge Provides discharge instructions to the client's parents Instructs the client's parents to hire a caregiver upon discharge Requests a consult to social work for discharge placement
D Rationale: The nurse's role as an advocate is to assess the safety of a client's discharge. A client who is unable to perform activities of daily living independently is not safe to discharge home with elderly parents who may be unable to provide safe care. The nurse requests a consult to social work for possible discharge placement. The client's transportation home is not the priority issue at this time. Providing discharge instructions to the client's parents finalizes the discharge. The nurse must first assess discharge safety. The nurse should coordinate with the healthcare team to provide available resources to the client and their family upon discharge.
The hospice nurse is planning care for a new client with terminal cancer. Which statement by the nurse would best assess the client's needs? "How is your family coping with your diagnosis?" "Can you describe your spiritual beliefs?" "Do you have any questions about your care?" "What are your goals that you would like met?"
D Rationale: When a client is new to care, such as with hospice, the nurse should identify the client's needs by assessing for goals. The goals a client would like met will guide the nurse in developing a plan of care that focuses on interventions to meet the goals. Asking the questions about their care or describing spiritual beliefs are important but does not address the client's needs. While asking how the client's family is coping is important, it does not address the client's needs.
