Nokea
A nurse is assisting a newly licensed nurse with delegating tasks to an assistive personnel on the unit. Which of the following statements by the nurse explains the purpose of delegation?
- A. Delegation provides appropriate resources for the client.
- B. Delegation promotes discharge teaching activities for clients.
- C. Delegation permits a designated individual to meet a goal on your behalf.
- D. Delegation decreases health care costs.
Correct Answer: C
Rationale: Rationale: Answer C is correct because delegation allows a designated individual to accomplish a specific task or goal on behalf of the delegator. This ensures efficient and effective delivery of care while maximizing resources. Option A is incorrect as it refers to resource allocation, not delegation's purpose. Option B is incorrect as delegation is not solely for discharge teaching. Option D is incorrect as while delegation may contribute to cost-effectiveness, it is not its primary purpose.
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A nurse is caring for a client who is refusing a blood transfusion due to religious beliefs. Which of the following actions should the nurse take?
- A. Administer the transfusion after obtaining a court order.
- B. Document the client's refusal and inform the provider.
- C. Convince the client to accept the transfusion for their health.
- D. Ask the client's family to persuade the client.
Correct Answer: B
Rationale: Documenting the refusal and informing the provider respects the client's autonomy and ensures appropriate follow-up, while adhering to ethical and legal standards.
A nurse is caring for a client who is dying. The nurse should incorporate the principle of nonmaleficence into practice by taking which of the following actions?
- A. Withholding a dose of narcotic pain medication when the client has respiratory depression
- B. Discussing advance directives with the client and the client's family
- C. Providing comfort care measures to the client
- D. Allowing the client's family unlimited visitation at the time of death
Correct Answer: A
Rationale: Correct Answer: A
Rationale: Nonmaleficence is the ethical principle of doing no harm. In this scenario, withholding a dose of narcotic pain medication when the client has respiratory depression aligns with this principle as administering the medication could further compromise the client's respiratory status and potentially harm them. By withholding the medication, the nurse is prioritizing the client's safety and well-being.
Summary of Incorrect Choices:
B: Discussing advance directives is important but does not directly relate to nonmaleficence in this context.
C: Providing comfort care measures is essential but does not specifically demonstrate the principle of nonmaleficence.
D: Allowing unlimited visitation may support emotional well-being but does not directly address the principle of nonmaleficence.
A charge nurse is making assignments for nursing personnel who will be caring for clients during the oncoming shift. Which of the following factors should the charge nurse consider?
- A. The physiologic status of the clients on the unit
- B. Social relationships between nurses working the oncoming shift
- C. Personal comfort level in making the assignments
- D. The most experienced nurse receives the more complex clients
Correct Answer: A
Rationale: The correct answer is A. The charge nurse should consider the physiologic status of the clients on the unit when making assignments to ensure that each client receives appropriate care based on their health condition. This factor is crucial for patient safety and outcomes. Choice B is incorrect as social relationships between nurses should not influence patient assignments. Choice C is incorrect as personal comfort level should not drive assignment decisions, rather patient needs should. Choice D is incorrect as assigning more complex clients based solely on experience may not always be the best approach, as other factors like workload and skill mix should also be considered.
A nurse manager has received information from the facility's risk management department that a former client is pursuing a lawsuit. The nurse manager should anticipate a deposition will be required during which phase of the legal process?
- A. Discovery phase
- B. Decision phase
- C. Trial phase
- D. Complaint phase
Correct Answer: A
Rationale: The correct answer is A: Discovery phase. During the discovery phase of a legal process, both parties exchange information and evidence relevant to the case. A deposition is a part of the discovery phase where witnesses are questioned under oath. In this scenario, the nurse manager would be required to participate in a deposition to provide information related to the lawsuit.
Option B: Decision phase is incorrect as it typically refers to the phase where a judgment or verdict is made. Option C: Trial phase is incorrect as it involves the actual court proceedings. Option D: Complaint phase is incorrect as it is the initial phase where a formal complaint is filed to initiate the legal process.
A nurse and an assistive personnel (AP) are providing care for four clients who were admitted to the medical-surgical unit on the previous shift. The nurse should delegate meal assistance for which of the following clients to the AP?
- A. A client who has Guillain-Barre syndrome
- B. A client who has a lumbosacral spinal tumor
- C. A client who has systemic sclerosis
- D. A client who has amyotrophic lateral sclerosis (ALS)
Correct Answer: B
Rationale: The correct answer is B. A client with a lumbosacral spinal tumor may need assistance with meals due to potential mobility limitations or weakness. The nurse can delegate this task to the AP as it falls within their scope of practice. Clients with Guillain-Barre syndrome (choice A) may have muscle weakness and difficulty swallowing, requiring skilled nursing assessment during mealtime. Clients with systemic sclerosis (choice C) may have gastrointestinal involvement, necessitating careful monitoring during meals. Clients with ALS (choice D) have progressive muscle weakness, making it crucial for a nurse to assess their ability to eat safely. Delegating meal assistance for these clients to an AP may compromise their safety.