Nokea
"A patient with end-stage renal disease has a potassium level of 5 mEq/L. Based on this laboratory result, the nurse interprets which symptom as significant prompting which action?
- A. Drowsiness, stimulate the patient every 30 minutes
- B. Confusion, ask the patient to state their name and date of birth
- C. Irregular heartbeat, evaluate the patient's capillary refill
- D. Muscle cramps, elevate the affected limb"
Correct Answer: C
Rationale: Rationale for Correct Answer C: Irregular heartbeat is a significant symptom of hyperkalemia, which can be life-threatening. The nurse should evaluate capillary refill to assess perfusion. High potassium levels can affect cardiac function, leading to arrhythmias. Monitoring capillary refill provides insight into tissue perfusion, helping to assess the severity of the condition and guide appropriate interventions.
Summary of Incorrect Choices:
A: Drowsiness is not a typical symptom of hyperkalemia. Stimulating the patient every 30 minutes does not address the underlying issue.
B: Confusion is not a common symptom of hyperkalemia. Asking the patient to state their name and birthdate does not address the cardiac implications of high potassium levels.
D: Muscle cramps may occur with hyperkalemia but are not as critical as irregular heartbeat. Elevating the affected limb is not the priority in this situation.
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An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as:
- A. diagnosis-related groups (DRGs).
- B. subjective symptom management.
- C. acuity classification system.
- D. organized managed care.
Correct Answer: A
Rationale: The correct answer is A: diagnosis-related groups (DRGs). This classification system assigns a fixed price to specific diagnoses or procedures, such as pneumonia, for reimbursement purposes. DRGs aim to standardize payment based on patient diagnosis and treatment, promoting efficiency and cost containment in healthcare.
B: Subjective symptom management is not a classification system for reimbursement but rather a method of addressing patient symptoms.
C: Acuity classification system refers to determining the level of care a patient needs based on severity, not reimbursement.
D: Organized managed care involves coordination of healthcare services and providers, not specific classification for reimbursement.
Customer satisfaction is primarily based on:
- A. access to modern, up-to-date facilities.
- B. availability of an extensive menu selection.
- C. personal interactions with employees.
- D. having to undergo fewer invasive procedures.
Correct Answer: C
Rationale: The correct answer is C: personal interactions with employees. Customer satisfaction is primarily influenced by the quality of interactions with employees as it shapes the overall experience. Positive interactions build trust, rapport, and a sense of care which directly impact satisfaction levels. This human element creates a more personalized and engaging experience for customers, leading to higher satisfaction rates. Access to modern facilities (A) and an extensive menu selection (B) may enhance the overall customer experience but do not directly address the core factor of personal interactions. Having to undergo fewer invasive procedures (D) is not relevant to customer satisfaction in this context.
A nurse is charged with battery after helping an invalid patient back to bed and not calling for help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and extended stay. In this case, the:
- A. patient is the plaintiff.
- B. nurse can be charged with forcefully restraining the patient without orders.
- C. nurse is accountable due to the decreased level of staffing.
- D. charge of invasion of privacy may be withheld.
Correct Answer: C
Rationale: The correct answer is C because the nurse is accountable due to the decreased level of staffing. The nurse's decision not to call for help despite knowing the reduced staffing level directly contributed to the patient's injuries. The nurse had a duty of care to ensure the patient's safety, and failing to do so resulted in harm to the patient. The nurse's actions were negligent and breached the standard of care expected in this situation.
Choices A, B, and D are incorrect because the focus of the question is on the nurse's accountability for the patient's injuries due to staffing levels, not on the patient being the plaintiff, forcefully restraining the patient without orders, or invasion of privacy. These options are not directly related to the nurse's negligence in failing to provide proper care to the patient.
Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (select all that apply)
- A. Animal
- B. Child
- C. Alcohol
- D. Infant
Correct Answer: B
Rationale: The correct answer is B: Child abuse. Nurses are mandated reporters of child abuse, meaning they are legally required to report any suspected or witnessed cases to the appropriate authorities. Failure to report can result in fines and imprisonment. Child abuse is a serious issue that requires immediate intervention to protect the safety and well-being of the child.
Explanation for incorrect choices:
A: Animal abuse - While animal abuse is also a serious concern, nurses are not legally required to report it in the same way as child abuse.
C: Alcohol abuse - Nurses may provide assistance and support for individuals struggling with alcohol abuse, but it is not a mandatory reporting requirement.
D: Infant abuse - While abuse of infants falls under the category of child abuse, the specific term "infant abuse" is not a separate reporting requirement for nurses.
A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patient's signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as:
- A. privacy.
- B. confidentiality.
- C. security.
- D. data capture.
Correct Answer: C
Rationale: The correct answer is C: security. The scenario describes measures to protect the patient records system from unauthorized access, such as requiring consent, assigning passwords, and conducting audits. Security specifically refers to safeguarding information from unauthorized access, ensuring data integrity and availability. Privacy (A) is about controlling access to personal information, while confidentiality (B) is about keeping information private. Data capture (D) refers to the process of collecting data, not protecting it from unauthorized access. In this case, the focus is on security measures implemented to protect patient records, making it the most appropriate choice.