Unit 4 - Communication, Clinical Decision-Making and Professionalism

Accurately documenting client care on the client record

A client accuses a nurse of negligence when he trips when ambulating for the first time since hip replacement surgery. Which action is the best defense against allegations of negligence? Accurately documenting client care on the client record Documenting client data on the flow sheet Keeping an accurate medication record Notifying the nursing team of the client's condition

Autonomy

A client aged 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. The nurse communicates the client's wish to the family and health care team. This is an example of what ethical principle? Nonmaleficence Veracity Autonomy Justice

Fidelity

A client rings the call bell to request pain medication. On performing the pain assessment, the nurse informs the client that the nurse will return with the pain medication. After a few moments, the nurse returns with the pain medication. The nurse's returning with the pain medication is an example of which principle of bioethics? Autonomy Fidelity Nonmaleficence Justice

"What questions do you have about the surgery?"

A client scheduled to have hip replacement surgery states, "I am so scared of the surgery and of the anesthetic." What is the best response by the nurse? "Your wife will be in the surgery waiting room the entire time." "What questions do you have about the surgery?" "What will happen if you don't have surgery?" "You really don't have anything to worry about."

"Client is reporting abdominal pain is rated at 8/10."

A hospital utilizes the SOAP method of charting. Within this model, which of the nurse's statements would appear at the beginning of a charting entry? "Client has a history of recent abdominal pain." "Client is guarding the abdomen and occasionally moaning." "2 mg hydromorphone hydrochloride PO was administered with good effect." "Client is reporting abdominal pain is rated at 8/10."

Refusing to administer pain medication as prescribed

A nurse has a duty of nonmaleficence. Which action would be considered a contradiction to that duty? Providing comfort measures for a terminally ill client Assisting the client with activities of daily living Providing all information related to procedures Refusing to administer pain medication as prescribed

Unprofessional, incompetent, unethical, or illegal physician practice

A nurse in a physician's office has noted on several occasions that one of the physicians frequently obtains forms for writing prescriptions for controlled substances. The physician reports that the physician's spouse has chronic back pain and requires pain medication. One day the nurse enters the physician's office and sees the physician take a pill out of a bottle. The physician mentions having migraines and that the spouse's pain medication alleviates the pain. What type of nurse-physician ethical situation is illustrated in this scenario? Conflicts regarding the scope of the nurse's role Claims of loyalty Disagreements about the proposed medical regimen Unprofessional, incompetent, unethical, or illegal physician practice

"My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital."

A nurse is calling a physician to communicate a change in the client's condition. According to the ISBARR format for handoff communication among health care personnel, which is the most appropriate way to begin the conversation? "My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." "Good morning, I am calling about Mrs. Jones, who is a client of yours." "My name is Sue, and I am calling about Mrs. Jones, a client of yours at Jefferson Hospital." "I have a client of yours at Jefferson Hospital who is experiencing a change in condition and needs to be seen immediately!"

Confidentiality

A nurse is caring for a client who is a celebrity in the area. A person claiming to be a family member inquires about the medical details of the client. The nurse reveals the information but later comes to find out that the person was not a family member. The nurse has violated: confidentiality. veracity. autonomy. fidelity.

Examine goals of the relationship to determine whether they were achieved

A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase? Make formal introductions Examine goals of the relationship to determine whether they were achieved Create a contract regarding the relationship Provide assistance to achieve goals

Write a narrative note in the designated nursing section. Source-oriented records have separate sections for each discipline to document their own information. Therefore, the nurse would not document in the respiratory section or find the lab results under the physician section. Critical pathways are not used to document physical assessments.

A nurse is documenting care in a source-oriented record. What action by the nurse is most appropriate? Review the laboratory results under the physician section. Use a critical pathway to document the physical assessment. Write a narrative note in the designated nursing section. Place the narrative note chronologically after the respiratory therapist's note.

Continuing intravenous fluids for a client who wants to die

A nurse is most likely to experience ethical distress in which client situation? Administering pain medication as ordered Continuing intravenous fluids for a client who wants to die Turning and positioning a client every hour Ambulating a client who is postoperative from a hip replacement

Confidentiality

A nurse is sitting with friends in a coffee shop while working on a plan of care for a client. The client's name is written at the top of the plan. Which ethical responsibility is the nurse violating? Informed consent Trust Accountability Confidentiality

offering a hospice consultation to a client who is terminally ill.

A nurse shows client advocacy by: offering a hospice consultation to a client who is terminally ill. insisting that a medication be taken. refusing to allow a spouse to stay by the bedside. sending a client home with verbal discharge instructions.

Kinesthetic

A nurse touches a client's hand to indicate caring and support. What channel of communication is the nurse using? Auditory Visual Kinesthetic Olfactory

Nonmaleficence

A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as? Autonomy Nonmaleficence Fidelity Justice

"Tell me more about the aspects that make you feel as if it happened yesterday."

A nurse visits a female victim of sexual assault. During the visit the client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse? "In reality, the sexual assault did not occur yesterday; it has been over one month now." "We should move on from the strong feelings associated with this incident." "Tell me more about the aspects that make you feel as if it happened yesterday." "Can you do something to alleviate the fear of being assaulted again?"

ask the client "Can you tell me more about what is worrying you?"

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is nervous about the surgery. The best response by the nurse is to: state "Everyone is nervous before surgery." ask the client "Can you tell me more about what is worrying you?" look directly at the client and state, "You are nervous about the surgery." ask the surgeon to come to the bedside to reassure the client.

nonverbal

During an annual performance review with an employee, the nurse manager does not maintain eye contact and seems concerned about the time and the next appointment. What type of communication is the manager exhibiting? Nonverbal Verbal Consistent Clarifying

Recommendations

In SBAR, what does R stand for? Response Recommendations Report Reinforcing data

Integrity

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value? Social justice Altruism Integrity Human dignity

Taking a picture of a client with the nurse's cell phone

Nurses must maintain the privacy of clients. Which example is a breach in privacy and would pose an ethical problem? Taking a picture of a client with the nurse's cell phone Participating in a hand-off report at the end of the shift Documenting the care in the client's record Talking to the family when they visit the client

Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights.

Several nurses on the same hospital unit communicate on the same social networking site. A nurse posts the following statement to the social networking page, "The lady in room 34 with heart failure was a train wreck!" In which manner has the nurse failed to apply the principles of confidentiality? The nurse did not fail to apply the principles of confidentiality because the hospital's name was not mentioned. The nurse did not fail to apply the principles of confidentiality because the client's name was not used. Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights. Sharing information about the client's diagnosis is unacceptable because it is viewed by the general public and not just other nurses.

False reassurance

The client is an 18-month-old in the pediatric intensive care unit. The client is scheduled to have a subgaleal shunt placed tomorrow, and the client's mother is quite nervous about the procedure. The nurse tells the client's mother, "The surgeon has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication? Being moralistic False reassurance Rescue feelings Giving advice

"Tell me the reason you do not want the surgery."

The health care provider has recommended the client have a surgical procedure performed. The surgery would allow the client's problem to resolve quicker. Without surgery, healing would be delayed. The client states, "I do not want the surgery done." What is an appropriate response by the nurse? "I would want the surgery done in order to heal sooner." "The health care provider believes the surgery is necessary." "You should have the surgery performed. You will get better quicker." "Tell me the reason you do not want the surgery."

"Myocardial infarction."

The health care provider tells the client, "You are experiencing an MI," and leaves the room. The client asks the nurse what an MI stands for. What response by the nurse is most accurate? "Mitochondria inflammation." "Myocardial infarction." Myopia instability." "Muscle infection."

Inform the provider, to ensure safety for the client, it must be read back

The nurse is calling a health care provider to give an update on a client's condition. The nurse receives a telephone order and, when requests that the order be read back to the provider for confirmation, the provider states, "I don't have time for this." What is the most appropriate action by the nurse? Inform the provider, to ensure safety for the client, it must be read back Proceed with the order since the nurse heard it the first time Don't follow through with the order, and delete it from the record Ask the secretary to call the provider back and take the order

"Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Are you ready to get out of bed?"

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply. "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Are you ready to get out of bed?" "What sorts of things do you do for fun?" "What plans do you have after you are discharged?"

Incident Report

The nurse is documenting a variance that has occurred during the shift. This report will be used for quality improvement to identify high-risk patterns and, potentially, to initiate in-service programs. This is an example of which type of report? Incident report Telemedicine report Nurse's shift report Transfer report

urine output 100 ml

The nurse is preparing a SOAP note. Which assessment findings are consistent with objective client data? pain rating of 4 on a scale of 0-10 describes wound as itchy concerned with feeling tired urine output 100 ml

Written Communication

The nurse is providing education to a client who sometimes has difficulty remembering information. Which form of communication will be most helpful for this client? Written communication Metacommunication Nonverbal communication Verbal communication

"What brought you to the hospital this morning?"

The nurse must use appropriate interviewing techniques to elicit accurate and complete health information. Which statement is an example of an open-ended question or comment? "Are you having pain right now?" "I'll be back in 30 minutes to check on your pain relief." "You seem upset today. Are you?" "What brought you to the hospital this morning?"

ISBAR

The nurse notes that the blood glucose level of a client has increased and is planning to notify the health care provider by telephone. Which technique would be most appropriate for the nurse to use when communicating with the health care provider? SOAP EMAR ISBAR CBE

The client has decided to stop chemotherapy treatments.

The principle of autonomy by a client is applied in which situation? The client has decided to stop chemotherapy treatments. A hospice consult is ordered by the nurse. The family of a client is discussing care with the physician. An order for an antibiotic is being written in the chart.

The nurse suspecting that a client is being abused or neglected

What situation would permit the nurse to disclose information without the client's approval? The nurse revealing the address of the client's place of residence The nurse informing the client's relatives of the client's noncompliance with treatment The nurse suspecting that a client is being abused or neglected The nurse sharing details of the client's wills and loans

"The thought of having surgery is keeping you awake."

When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is: "The thought of having surgery is keeping you awake." "It sounds as if your surgery is a pretty scary procedure." "You shouldn't be nervous. We perform this procedure every day." "You have a great surgeon. You have nothing to worry about."

The nurse is administering medication to a client the nurse addressed as "Ms. Taylor."

Which action by the nurse demonstrates respect for the client as an individual? The nurse is administering medication to a client the nurse addressed as "Ms. Taylor." The nurse asks the aide to provide a bath for "the motor vehicle accident (MVA) client." The nurse is giving report to another nurse about "the gallbladder client." The nurse is providing care to an older adult client and calls the client "Mom."

Intake and output graphic sheet

Which flow sheet provides the health care provider with information on an ongoing record of fluid loss? Vital signs graphic sheet Critical care flow sheet Intake and output graphic sheet Health assessment flow sheet

"Why did the health care provider prescribe this medication for you?"

Which is an open-ended question? "Do you take this medication daily?" "When was the last time you had your prescription refilled?" "Why did the health care provider prescribe this medication for you?" "How many tablets do you take at one time?"