Management of Care 3 (HESI)

. A client with terminal cancer signs a do-not-resuscitate (DNR) order upon admission to the hospital. When the client goes into respiratory arrest a week later, the client is not resuscitated. Which factor does the nurse determine is most relevant to the legal aspects of a DNR order?

Policies of the agency establish the status of DNR orders. Policies relative to DNR orders vary among hospitals, and the nurse must adhere to the policies of the institution. The policies of an institution generally reflect the parameters of DNR orders associated within the state. Age is not the important factor in the decision not to resuscitate; the wish of the client is the deciding factor. The decision regarding a DNR order resides with the client, not the healthcare provider. Although rules associated with DNR orders may vary from state to state (Canada: province and territory) and agency to agency, a client has the right to add or rescind a DNR order.

A nurse is working in a hospital that receives most of its payment from Medicare and Medicaid services. In the annual assessment of The Joint Commission, the hospital had not met all the standards set forth in the Centers of Medicare and Medicaid Services. Which action does the nurse expect to be taken?

The Joint Commission would conduct an unannounced follow-up survey in the hospital. The hospital has failed to meet the standards of the Centers of Medicare and Medicaid Services. Therefore before any action is taken, an unannounced follow-up assessment is performed by The Joint Commission. The hospital accreditation may be lost if the hospital fails to meet the standards during the follow-up survey. The hospital may also stop receiving its payment from the Centers of Medicare and Medicaid Services if the hospital does not follow the standards during the follow-up survey. The Centers of Medicaid and Medicare Services do not analyze the quality of care provided by hospitals.

The nursing student is learning about the common causes of hypothermia. Which statements made by the nursing student demonstrate adequate knowledge about the etiology of hypothermia? Select all that apply.

"Administration of blood causes hypothermia." "Administration of neuromuscular blocking agents causes hypothermia." Administration of blood and neuromuscular blocking agents can cause hypothermia. Administration of amphetamines, β-Adrenergic blockers, and tricyclic antidepressants can cause hyperthermia.

A client is admitted to the hospital for acute pain in the hip, and a total hip replacement surgery is scheduled. The client was diagnosed recently with early dementia. The client appears oriented and alert and responds appropriately when interviewed. When the nurse is providing preoperative teaching, the client says, "I don't want to have that surgery." The client's spouse voices a desire to proceed with the surgery to provide relief for the client. How should the nurse respond?

Ask the client if a power of attorney for health care has been established. Consent for surgery should be given by the client; the spouse cannot do this unless he or she has power of attorney for health care. Although it is important to discuss feelings with the client, this does not address the legal issue. The legal issue needs to be clarified first. If the client does not want surgery, preoperative teaching probably will not be effective, because the client will not be receptive. The legal issue needs to be clarified first.

When a client enters the emergency department in a psychiatric emergency, the nurse should perform an assessment in an organized manner. Place the following interventions in their order of priority, beginning with the highest priority.

In Order: 1 Collect identifying information. 2. Obtain the chief complaint. 3. Identify presenting clinical findings. 4. Explore the previous psychosocial history. 5. Document collected information on the clinical record. A brief collection of demographic information, particularly the client's name, should be part of the beginning of the nurse-client relationship. The client's perspective of the situation should be obtained after demographic information is collected. While talking with the client, the nurse assesses the client's presenting physical, emotional, and mental status. A psychosocial history is the least important of the assessments. Documentation may be done last. Continuous documentation may interfere with the nurse-client relationship.

A client who was sexually assaulted and is aware of the possible legal implications decides to seek prosecution of the rapist. The nurse carefully listens and documents all assessments. This is done because with a charge of rape the burden of proof has which implication?

The burden of proof rests with the criminal justice system in collaboration with the victim. When the person who has been sexually assaulted chooses to seek prosecution of the rapist, the prosecutor must prove that rape occurred; the accused is innocent until proven guilty. The medical team may be asked to provide evidence at the trial, but the state, with the victim's help, must prove that the rapist is guilty. The defendant tries to establish innocence in a rape case. Guilt or innocence will be established by a jury, with the burden of proof placed on the victim.