Nokea
A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the healthcare provider ordering:
- A. Pulmonary embolectomy
- B. Vena caval interruption
- C. Increasing the coumadin therapy to achieve an INR of 3-4
- D. Thrombolytic therapy
Correct Answer: B
Rationale: The correct answer is B: Vena caval interruption. In this scenario, the client has a history of recurrent pulmonary embolism, indicating a high risk for further episodes. Vena caval interruption, such as with an inferior vena cava filter, is a preventive measure to reduce the risk of pulmonary embolism recurrence by trapping blood clots before they reach the pulmonary circulation. This intervention is indicated when anticoagulation alone is not sufficient to prevent further emboli. Pulmonary embolectomy (A) is a surgical procedure to remove a clot from the pulmonary artery and is typically reserved for massive, life-threatening embolisms. Increasing coumadin therapy (C) to achieve a higher INR may increase bleeding risk without necessarily preventing future emboli. Thrombolytic therapy (D) is reserved for acute, large emboli causing hemodynamic instability.
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A client has volunteered to take part in a research study. After participating for two months, he decides that he can no longer tolerate the study and decides to leave. What are the client's rights in this situation?
- A. The client has a right to be released from the study but must reimburse the researchers for charges incurred
- B. The client has a right to be released from the study without any liability
- C. The client has a right to be released from the study but is prohibited from participating in any future studies
- D. The client does not have the right to be released from the study; he must finish his participation
Correct Answer: B
Rationale: The correct answer is B: The client has a right to be released from the study without any liability. This is based on the principle of voluntary participation in research studies. Participants have the right to withdraw from a study at any time without facing any consequences or liabilities. It is essential to uphold ethical standards and respect participants' autonomy. Choice A is incorrect because participants should not be financially penalized for withdrawing. Choice C is incorrect as it restricts the client's future participation based on their decision to withdraw. Choice D is incorrect as participants always retain the right to withdraw from a study voluntarily.
What does the 'B' in the SBAR acronym stand for?
- A. Background
- B. Basic
- C. Beginning
- D. Break
Correct Answer: A
Rationale: The correct answer is A: Background. In the SBAR communication technique used in healthcare, the 'B' stands for Background, which involves providing relevant information about the patient's history, current situation, and any other contextual details. This step helps to give a comprehensive understanding of the patient's condition to ensure effective communication between healthcare providers. The other choices (B: Basic, C: Beginning, D: Break) are incorrect as they do not accurately represent the purpose of the 'B' in the SBAR acronym.
Which method is most appropriate for managing moral distress in the workplace?
- A. Recognizing that life is unfair and nurses cannot meet every need of every client
- B. Declining to act when clients or visitors make requests that are not justifiable
- C. Developing a new policy that would address the problematic situation
- D. Both A and B
Correct Answer: C
Rationale: The correct answer is C. Developing a new policy is the most appropriate method for managing moral distress in the workplace because it addresses the root cause of the problematic situation. By creating a policy, organizations can provide clear guidelines and procedures to handle ethical dilemmas, thus empowering healthcare professionals to navigate moral challenges effectively.
Choice A is incorrect as it encourages acceptance of unfairness and could lead to moral disengagement. Choice B is also incorrect as declining to act in unjustifiable situations can compromise patient care and violate ethical principles. Choice D is incorrect as it combines two flawed approaches that do not effectively address moral distress. Developing a new policy is the most proactive and systematic approach to managing moral distress in the workplace.
At the beginning of her shift in a long-term care facility, which of the following clients should a nurse check on first?
- A. A 91-year-old man who needs help eating breakfast
- B. An 86-year-old man who has been incontinent in his bed
- C. An 82-year-old woman who needs IV antibiotics
- D. A 75-year-old man who is recovering from an injury and needs an ice pack
Correct Answer: C
Rationale: The correct answer is C: An 82-year-old woman who needs IV antibiotics. Checking on this client first is crucial because IV antibiotics are time-sensitive and require proper administration to ensure the effectiveness of treatment. Delaying or missing a dose can have serious consequences for the client's health. The other choices, while important, can be prioritized after attending to the client needing IV antibiotics. A: The 91-year-old man needing help eating breakfast can wait a bit longer. B: The 86-year-old man who has been incontinent can be addressed after the client needing IV antibiotics. D: The 75-year-old man recovering from an injury and needing an ice pack can also be attended to after the client requiring IV antibiotics.
Mr. W has orders for a physical therapy consult. The nurse contacts the appropriate department but 12 hours later, no one has come to see the client. Which is the most appropriate action of the nurse?
- A. Call the supervisor and file a complaint against the physical therapy department
- B. Contact the physician to notify him that the orders were not carried out
- C. Assess the client's activity level by assisting with ambulation using a gait belt
- D. Contact the physical therapy department again and repeat the order
Correct Answer: D
Rationale: The most appropriate action for the nurse in this scenario is to contact the physical therapy department again and repeat the order (Choice D). This is the correct answer because it directly addresses the issue of the consult not being completed within a reasonable timeframe. By contacting the department again, the nurse ensures that the order is not overlooked or forgotten. This action shows proactive communication and follow-up to expedite the process and ensure the client receives the necessary care in a timely manner.
The other choices are incorrect:
A: Calling the supervisor and filing a complaint is premature without first attempting to resolve the issue directly with the department.
B: Contacting the physician is not the nurse's role in this situation. The focus should be on coordinating with the appropriate department.
C: Assessing the client's activity level is important but does not address the primary issue of the physical therapy consult not being completed.
Overall, choice D is the most appropriate course of action in this scenario.