Prep U- Advocacy

A client states, "I have never taken a yellow pill before for my blood pressure. Why are you giving me this pill?" After verifying that the nurse has prepared the correct medication, which statement by the nurse would be accurate?

"This is the same medication that you take at home but in generic form." Explanation: Once the nurse has verified that the medication is correct, the client can be informed that it looks different because it is in generic form. The other options may hinder the development of trust in the nurse. Stating that the client can refuse the medication is not appropriate in this situation.

A nurse observes a consent form signed by a client indicating permission for the insertion of a feeding tube before the beginning of chemotherapy. One hour before the procedure, the client states, "I changed my mind and now don't want the feeding tube." What would be the most appropriate response by the nurse?

"You have a right to withdraw consent. Can you share more about your decision?" Explanation: The nurse understands that a client must give consent for a procedure and may withdraw that consent if the client chooses. This answer demonstrates that the client's change of decision is worth exploring.

Paternalism

is doing tasks for a person that the person can do for his or herself.

A nurse is caring for a 17-year-old pregnant teenager who needs to obtain assistance with essential baby items such as a crib. The client mentions not having any income from a job. The nurse should encourage the client to go to a:

social welfare office. Explanation: Nurses must be advocates for vulnerable populations such as pregnant teenagers. Advocacy involves community care coordination. The nurse should be familiar with available community resources, including those that can provide financial assistance to clients. The aim is to link clients with these resources in the community to enhance their well-being, to improve information exchange, and to reduce fragmentation and duplication of services. The best way to do that in this scenario is to refer the client to a social welfare office. The other answers would not meet the client's need for financial assistance.

Which nursing action would be most beneficial to a client and her spouse who state they wish to go through labor without the use of analgesics or anesthetic agents?

Act as an advocate for the couple and verbalize their wishes to nurses and physicians. Explanation: Nurses are ethically responsible for giving childbearing families the autonomy to make informed choices about the care they receive. This also fosters a collaborative relationship with the family. Nurses must advocate for clients to have autonomy in decision making and provide respect and informed choice to ensure that clients and their families are empowered to take responsibility to make decisions. It is the nurse's role to guide and support choices rather than direct. A client should never be left alone in labor. Providing information about or encouraging the use of drugs may leave the client and family feeling as though the nurse is not supportive of the couple's choices by encouraging actions that are contradictory to the family's birth plan.

A nurse is caring for a client who is a practicing Jehovah's Witness. The health care provider prescribes two units of packed red blood cells based on the client's low hemoglobin and hematocrit levels. The nurse states to the health care provider that it is unethical to go against the client's beliefs even though the client's blood counts are very low. What is the best description of the nurse's intentions?

Acting in the client's best interest

The nurse prepares to administer medication to the patient. The patient states, "I would prefer not to take that medication until I speak with my physician." The nurse honors the patient's desire to make decisions, following which common ethical principle? Autonomy Beneficence Fidelity Paternalism

Autonomy Explanation: This word autonomy is derived from the Greek words autos ("self") and nomos ("rule" or "law") and therefore refers to self-rule. In contemporary discourse, it has broad meanings, including individual rights, privacy, and choice. The principle of autonomy entails the right of patients to receive adequate and accurate information so that they have the ability to make a choice free from external constraints.

A nurse was informed that a family member was involved in a car accident and transported to the emergency department in the same facility. What action by the nurse best demonstrates understanding of client privacy?

Calling the client information desk to find out the room number of the family member Explanation: Getting information from other health care providers violates client privacy. Health care workers must follow the same guidelines to accessing health information on people not assigned to their care.

The nurse is caring for a client who wishes to stop medical treatment. Which action by the nurse best demonstrates the role of the nurse as a client advocate?

Communicate the client's wishes to the healthcare provider. Explanation: Nurses advocate on a client's behalf when a change needs to be made in the plan of care. Communicating the client's wishes to the healthcare provider is the best example of client advocacy. Nurses must act as advocates even when they disagree with the client's decisions, so the nurse would not encourage the client to continue with medical treatment. Asking the client what lead to the decision may influence the client's decision. Informing family members of the decision violates the client's right to privacy.

The mother of a 13-year-old child with special needs reports concerns with her child's requests to eat lunch in the cafeteria at school with the rest of the children as opposed to eating in the nurse's office. What information should be contained in the nurse's response? "There are problems monitoring your child's intake if she eats in the cafeteria so this practice should be discouraged." "Efforts should be made to accommodate your child's request." "Perhaps the school will allow your child to have a few friends to eat in the nurses' office with her." "Maybe you or another family member could go to the school and eat with your child so she is not forced to eat alone."

"Efforts should be made to accommodate your child's request." Explanation: Children have a desire to interact with their peers and to have the same privileges. The child's mother should be encouraged to work toward honoring this request, as much as it's possible. Forcing the child to eat in the nurses' office promotes isolation. Having a few other children eat with her in the nurses' station has minimal impact on meeting the overall request.

The charge nurse has just completed an inservice with a group of nursing students. One nurse student asks, "Why do I have to know how to give medications in different ways. I thought the unlicensed assistive personnel (UAP) performs those skills?" What is best response by the charge nurse?

"Entry-level nurses will perform basic skills appropriate to the scope of practice and that includes administering medications through various routes." Explanation: The administration of medications to clients is a core nursing function that involves skillful technique and consideration of the client's development, health status, and safety. Also, the nursing process is often applicable to the skills of medication administration. Informing the new nurse that this profession may not be the one for them is not professional and does not foster respect for the person or the question raised. Professionalism is expected with each interaction with clients, family members and other health care members, including nursing students.

A nurse who cares for a family and child with special needs will be acting in the role as advocate when making which statement?

"I understand you are considering physical therapy. I will let your physician know as well." Explanation: The nurse is being an advocate for the client/family when the nurse supports decisions the family has made and works to communicate the decisions to the health care team. Barriers to communicate and hindering the role of the nurse include recommending a specific physician (unethical), giving false reassurance, giving advice, and questioning the parents' choices with a "why" response.

A client with newly diagnosed seizures asks about stigma associated with epilepsy. The nurse will respond with which of the following statements?

"Many people with developmental disabilities resulting from neurologic damage also have epilepsy."

The nurse overhears two nursing assistants saying that they think it is ridiculous that a female client of the Islamic culture insists that only female nurses care for her. What should the nurse do? Select all that apply.

Correct response: Speak to the nursing assistants about the importance of culturally competent care on the unit. Explain to the nursing assistants that it is wrong in the client's culture for a male to touch a female that is not their wife. Remind the nursing assistants that it is inappropriate to talk about clients in any way that does not involve them providing care.

A client with severe and persistent depression is debating undergoing electroconvulsive therapy (ECT). The client's family asks a nurse to convince the client that this treatment would be beneficial. In educating the family about the client's situation, what statement about client rights should the nurse make?

Correct response: "The client, treatment team, and family can meet to discuss this treatment option." Explanation: When a client is undecided about treatment, the best approach is to assemble the client, family, and appropriate healthcare providers to discuss what option serves the client's best interests while acknowledging the client's right to refuse treatment. Because the client has the right to refuse treatment, there's no need for the family to obtain legal counsel or for the client to sign any refusal-of-treatment forms. Neither family members nor healthcare providers should coerce the client to reconsider the decision under the guise of addressing the ethical aspects of treatment.

A nurse is caring for a client with advanced heart failure. The client can't care for themself and hasn't been able to eat for the past week because of dyspnea. The client doesn't want a feeding tube inserted and expresses their desire for "nature to take its course." The client's family is pleading with the client to have a feeding tube inserted. What is the most appropriate action for the nurse to take?

Correct response: Talk with the client's family about the client's right to decide for themself. Explanation: Advocating for a client's wishes is a key nursing role. It's especially important when a client's family disagrees with the client's wishes. The nurse should be sure that the client has all the information needed to make an informed decision. Then the nurse should support the client's decision. The nurse shouldn't contact a clergyman without the client's consent, call a family conference, or schedule intubation in violation of the client's wishes.

A new mother who is breastfeeding her baby has developed a deep vein thrombosis and needs to be started on a heparin drip for treatment. The client states, "I need to nurse my baby." How would the nurse respond to this client?

Explain the importance of the heparin in resolving the thrombosis and examine ways the baby could room in with the mother with assistance. reflects a response to the client's psychosocial needs as well as physical needs.

Pt. states, "The doctor says my chemotherapy isn't working anymore. They can only treat my symptoms now. I don't want to die in the hospital, I want to be in my own bed."R. Daly, RN A nurse is caring for a client with advanced cancer. Based on the accompanying nursing progress notes, what should be the nurse's next intervention?

Explain the use of an advance directive to express the client's wishes. Explanation: An advance directive is a legal document used as a guideline for life-sustaining medical care of a client with an advanced disease or disability who can no longer indicate their own wishes. This document can include a living will, which instructs the healthcare provider to administer no life-sustaining treatment, and a durable power of attorney for health care, which names another person to act on the client's behalf for medical decisions if the client cannot act for self. By explaining the use of an advanced directive to the client at this time, the client has the opportunity to document future wishes. The document on client rights does not specifically address the client's wishes regarding future care. - Calling the spouse is a breach of the client's right to confidentiality - Stating that only a hospital can provide adequate pain relief in a terminal situation demonstrates inadequate knowledge of the resources available in the community through hospice and home care agencies in collaboration with the client's healthcare provider.

Beneficence

Is the duty to do good and the active promotion of benevolent acts (e.g., goodness, kindness, charity). It also entails taking positive action to prevent patients from harming themselves or others, including society as a whole

A nurse is assessing available support systems for a client in the community mental health clinic. The client is divorced, has no siblings, and both parents died last year. The client has contact with once-supportive former in-laws; however, the client describes a strained relationship since the divorce. With regard to the relationship with the in-laws, what knowledge does the nurse use to plan care?

Low-quality support relationships often negatively affect coping in a crisis. - Strong social support enhances mental and physical health, providing a significant buffer against distress. Relationships of low-quality support are known to impact a person's coping effectiveness negatively.

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

Medicaid may be available to low-income parents and their children. Explanation: Medicaid is a joint federal and state program that provides health insurance to low-income parents and their children. It is state-administered, and each state has its own set of guidelines.

The nurse hears an unlicensed assistive personnel (UAP) discussing a client's allergic reaction to a medication with another UAP in the cafeteria. What is the priority nursing action?

Remind the UAP about the client's right to privacy. Explanation: The nurse should first remind the UAP about the client's right to privacy. All other actions are appropriate, but do not immediately protect the client's privacy.

The nurse is trying to establish a trusting relationship with a client experiencing pain. When the client asks for pain medication, the nurse notes that it is not time to give the medication. What is the best action by the nurse to facilitate a trusting relationship?

Tell the client when the medication is due and return promptly at that time. Explanation: When the nurse follows through on a commitment made to a client, it fosters trust within the therapeutic relationship. Trust is a foundational quality within the therapeutic nurse-client relationship.

When developing a teaching plan for a client with syphilis, which of the following would be most important to include?

With proper treatment, the disease can eventually be cured. Explanation: For a client with syphilis, proper treatment will improve the symptoms of skin lesions and other sequelae of infection, with serology eventually reflecting a cure. Typically, early syphilis or early latent syphilis is treated with a one-time intramuscular dose of penicillin G benzathine; three injections at one week intervals are used for clients with late latent or latent syphilis of unknown duration. Condoms significantly reduce the risk of transmission of syphilis and other sexually transmitted infections. Sexual contact is avoided until previous or current partners have been treated.