Issues in Nursing
A nurse is evaluating different situations related to addressing different levels of client needs. According to Maslow's hierarchy of needs, in which order should the nurse prioritize his or her actions? 1. Encouraging the client to talk about his or her fears and feelings 2. Praising the client for administering insulin accurately 3. Providing a warm bath to the client to promote a good night's sleep 4. Assisting the client in getting out of bed to join family members for meals
3, 1, 4, 2 According to Maslow's hierarchy of needs, the basic needs of the client should be addressed first before moving toward the highest level of need. Thus, providing a warm bath to promote a good night's sleep addresses the physiological (basic) need of the client. The next level of need is the safety and security need. The nurse encourages the client to talk about his or her fears and feelings to meet this need. The next level is the love and belonging need. The nurse assists the client in getting out of bed and joining family members for meals meets this need. Finally the nurse addresses the self-esteem need by praising him or her for administering insulin accurately.
A nursing student is listing points that make nursing a profession and not just a job. Which points have been correctly stated? Select all that apply. 1 "Nursing provides a specific service." 2 "Nursing requires a basic liberal foundation and an advanced education." 3 "Nursing has a theoretical body of knowledge leading to defined skills, abilities, and norms." 4 "Members of a profession do not have any autonomy in decision-making and practice." 5 "The profession as a whole lacks a code of ethics for practice and simply follows the state rules and regulations."
correct Ans: 1, 2, 3 Nursing is considered a profession because it provides a specific service. Nursing has a basic liberal foundation and requires advanced education. Nursing has a theoretical body of knowledge used to define skills, abilities, and norms of practice. Members of the nursing profession have autonomy in decision-making and practice. The profession of nursing follows a code of ethics for practice and abides by the rules and regulations of the state.
A nurse is prioritizing client-care by using Maslow's hierarchy of needs. Which situation should the nurse address to meet the self-actualization needs of the client? 1 A client says, "I want to be a world class athlete." 2 A client says, "I do not want to go home because no one there cares." 3 A client says, "I am not feeling good. Can you please check if I have fever?" 4 A client says, "Whatever I do for my family or for my loved ones does not actually help them."
correct ans: 1 According to Maslow's hierarchy of needs, self-actualization is the desire to reach one's full potential. In the given scenario, the nurse should address the client who wants to be a world class athlete to address self-actualization needs. When a client says that he/she does not want to go back home as there is no one there that cares, this comes under love and belonging needs. When a client says that he/she is feeling feverish, this comes under physiological needs, which address the basic requirements of an individual. When a client says that whatever he/she does for his/her family and loved ones do not actually help them, it is an example of low self-esteem. Here, the nurse should address the self-esteem needs of the client.
A nurse is educating a client about the tertiary level of prevention. What information should the nurse provide? Select all that apply. 1 Tertiary prevention focuses on preventing complications of illness. 2 Tertiary prevention helps clients achieve as high a level of functioning as possible. 3 Tertiary prevention aims at minimizing the effects of long-term disease or disability. 4 Tertiary prevention is applied when the client is physically and emotionally healthy. 5 Tertiary prevention activities are aimed at diagnosis and treatment instead of rehabilitation.
correct ans: 1, 2, 3 Tertiary prevention is also known as preventive care since it aims at preventing further disability or reduced functioning in the clients. Even though clients may have developed limitations due to illness or impairment, tertiary prevention helps in achieving as high a level of functioning as possible. Tertiary prevention makes use of interventions that prevent complications and deteriorations in order to minimize the effects of long-term disease or disability. Tertiary prevention is applied when the client has a defect or disability that is permanent and irreversible. Tertiary prevention activities focus on rehabilitative care instead of diagnosis and treatment.
A nurse is teaching about near-miss events to a group of nursing students. What is appropriate for the nurse to include in the education? Select all that apply. 1 They do not cause actual harm to the client. 2 They may cause moderate harm to the client. 3 They are caused by a variation in standard care. 4 They are caused by impaired immune functioning. 5 Their cause can be analyzed by failure mode effective analysis.
correct ans: 1, 3, 5 The medical errors that cause no harm to the client are described as near-miss events. These events do not reach the client and do not cause severe complications because the interventions to avoid them or correct the damage are instituted. They are caused by a variation in standard care. The nurse can analyze the cause of these events by the failure mode effective analysis (FMEA) system while reporting them. Adverse events cause moderate harm to the client. Such events are caused by the fault of the system or health care professionals. Near miss events are not caused by impaired functioning of the immune system.
What information should the nurse provide when explaining the benefits of illness prevention activities to a client? 1 "These activities aim to teach people how to care for their own health." 2 "These activities enable people to maintain or enhance their health levels." 3 "These activities help protect clients from actual or potential health threats." 4 "These activities encourage people to reach an optimal state of physical, mental, and social well-being."
correct ans: 3 Illness prevention activities help protect clients from actual or potential health risks and threats. Nurses impart wellness education to people to teach them to care for themselves in a healthy way. Health promotion activities enable clients to maintain or enhance their health levels. These activities also help people to reach an optimal state of physical, mental, and social well-being. Routine exercise and good nutrition are examples of health promotion activities.
A nurse withholds a prescribed opioid medication from a client requesting to be treated for intractable pain because the nurse fears the client will become addicted. In this situation, the nurse is adhering to which ethical principle? 1 Veracity 2 Autonomy 3 Paternalism 4 Beneficence
correct ans: 3 Paternalism occurs if the nurse interferes with the individual's autonomy by disregarding the client's choices; the client has requested to be treated with a medication that has been prescribed by the healthcare team and the nurse is refusing to give it because of unfounded personal beliefs. The client's priority is pain relief and the nurse should be working with other health team members to achieve this objective. Veracity is defined as telling the truth. Autonomy, as an ethical principle, means that the nurse respects the client and the choices that are made. Beneficence commonly is referred to as "doing good;" it is related to the nurse's duty to help clients further their legitimate interest within the boundaries of safety.
Which nursing action is not likely to cause legal issues? 1 Using restraints on a non-cooperative client 2 Refraining from reporting suspected child abuse 3 Refraining from leaving the client during a staffing shortage 4 Allowing nursing assistive personnel (NAP) to administer medications
correct ans: 3 The nurse should not abandon clients if there is a staffing shortage. This action helps to avoid legal complications. Using restraints without the order of the primary healthcare provider may lead to battery and false imprisonment charges. The nurse should always report cases of suspected child abuse. A nurse should never allow nursing assistive personnel (NAP) to administer medications because this action may lead to malpractice charges.
Which nursing action is legally required? 1 Providing health teaching regarding family planning 2 Offering first aid at the scene of an automobile collision 3 Reporting incidents of suspected child abuse to the appropriate authorities 4 Administering resuscitative measures to an unconscious child pulled from a swimming pool
correct ans: 3 The reporting of possible child abuse is required by law, and the nurse's identity can remain confidential. The nurse is functioning in a professional capacity and therefore can be held accountable. Although the Good Samaritan Act protects health professionals, the nurse is still responsible for acting as any reasonably prudent nurse would in a similar situation.
Which clients are ideal candidates for interpreter service in order to prevent contributing health disparities? Select all that apply. 1 An English-speaking client with a speech disorder 2 An African American client with a hearing impairment 3 A non-English-speaking client in the emergency department 4 A Spanish-speaking client ready to be discharged from the facility 5 An Indian American who does not speak the language used at the facility
correct ans: 3, 4, 5 The health care facility should provide an interpreter to limit communication barriers that contribute to health disparities. A non-English-speaking client in the emergency department should have an interpreter to ensure all aspects of care. While providing discharge instructions to a client who speaks Spanish, the nurse should have the help of a language interpreter. The nurse should use an interpreter for an Indian American client who does not speak the language used at the facility. When caring for an English-speaking client who has a speech disorder, an interpreter is not required. Instead, the nurse can communicate using other adaptations appropriate for the disorder. When caring for an African American client who has a hearing impairment, sign language or a hearing aid may be required.
A geriatric client with hypertension and diabetes mellitus is taking propranolol (Inderal) and insulin (Humulin N) therapy. Which interventions by health care professionals help prevent client medication errors according to the Leapfrog Group? 1 Scheduling regular follow-up visits 2 Prescribing low dosage of medication 3 Using computer physician order entry 4 Closely monitoring the client for 24 hours
i put 1 ans: 3 The Leapfrog Group suggests using computer physician order entry (CPOE) to prevent medication errors. CPOE provides immediate information to the primary healthcare providers and nurses about the medications prescribed to the clients and helps prevent drug interactions and adverse effects. Scheduling regular follow-up visits helps prevent the side effects of the medication, but not medical errors. The Leapfrog Group does not suggest the dosage guidelines for geriatrics. Therefore the Leapfrog Group does not prescribe low dosage of medication. Closely monitoring the client for just 24 hours will not help prevent medication errors, drug interactions, and other adverse effects.
An ostomy specialist nurse is required to 'float' to the obstetric department. The nurse realizes that he or she lacks the required level of expertise to care for the clients in the unit. What course of action should the nurse take to deal with the situation? 1 Notify the nursing supervisor. 2 Refrain from taking the assignment. 3 Learn the policies of the institution regarding floating. 4 Perform necessary interventions using self-knowledge.
i put 2 ans: 1 If a nurse who 'floats' lacks the required expertise to care for the assigned clients, he or she should immediately notify the nursing supervisor. This helps in providing competent care. The nurse should not refuse the assignment as this may be seen as insubordination. The nurse should learn about the policies of the institution regarding floating before accepting employment. If the nurse lacks the required knowledge to provide specific client-care, he or she should not perform any interventions as it may harm the clients.
A client with rheumatoid arthritis of the knee has undergone knee replacement surgery. What actions by the nurse and other members of the health care team help to provide efficient client care? Select all that apply. 1 Provide financial assistance to the client. 2 Follow interventions to reduce hospital stay. 3 Encourage the client to use herbal therapy. 4 Provide cost-effective treatment to the client. 5 Help the client in making health care decisions.
i put 2, 4, 5 ans: 2 & 4 Health care professionals should measure and grade the quality of care and treatment that they provide to the client. This helps improve their services and provide best care to the client. If health care professionals follow interventions to reduce hospital stay and provide cost-effective treatment, they deliver efficient care to the clients. Health care professionals need not provide financial assistance to the client; rather, they can try to provide cost-effective care. Health care professionals should not help the client in making decisions because that reduces the client's self-esteem and decision-making ability. Health care professionals should not encourage the client to use herbal therapy because it is not clinically tested and may cause adverse effects in the client.
When might a nurse be charged with client abandonment? 1 If a nurse refuses to accept an assignment 2 If a nurse walks out when staffing is inadequate 3 If a client suffers an injury due to the nurse's inattention 4 If a nurse makes a written protest to the nursing administrators
i put 3 ans: 2 The nurse should never walk out when staffing is inadequate because this action may result in client abandonment. If a nurse refuses to accept an assignment, then he or she is considered insubordinate. If a client suffers an injury due to inattention and the nurse had already brought this to the attention of the nursing supervisor, then the caregiver was attempting to act reasonably. If a nurse has to accept unreasonable assignments, he or she needs to make written protests to nursing administrators.
A nursing student is evaluating different examples of variables that influence the health beliefs and practices of clients. Which scenario is an example of an external variable? 1 A client feels traumatized at the mere thought of receiving an injection. 2 A client considers organ transplants to be sinful because this activity goes against God's wishes. 3 A client relies heavily on the Internet to obtain information regarding health care practices. 4 A client stops taking medications after the disappearance of symptoms to cut down on medical bills.
i put 3 ans: 4 Socioeconomic factors are external variables often influence the health beliefs and practices of clients. A client facing economic constraints might stop taking medications after the disappearance of symptoms in order to cut down on medical bills. This situation is an example of an external variable. Emotional factors are internal variables that influence a client's health beliefs and practices. Feeling apprehensive about injections is an example of an emotional factor. Spiritual factors are also internal variables that influence clients. A client believing that organ transplants are sinful is an example of spiritual factors influencing health beliefs. A client's intellectual background is an internal variable. Relying on the Internet for education regarding healthcare practices is an example of the influence of intellectual backgrounds on health beliefs and practices.
