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After an interdisciplinary team meeting regarding the client's request to die a natural death, the primary healthcare provider refuses to write the do-not-resuscitate instructions. Which action should the nurse take?
- A. Facilitate a palliative care meeting with the client and healthcare provider.
- B. Remind the client that new treatments are being developed daily.
- C. Provide the healthcare provider with a copy of the client's bill of rights.
- D. Initiate a review of the situation by the hospital's ethics committee.
Correct Answer: D
Rationale: An ethics committee review mediates conflicts and protects client rights when the provider opposes the client's wishes. Palliative meetings, mentioning treatments, or providing rights are less effective in resolving the ethical dilemma.
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The charge nurse needs to determine if an additional nurse should be called to help staff the unit for the next shift. Which information is most important for the charge nurse to consider when making this decision?
- A. The acuity level of the clients on the unit.
- B. The physicians' plans to perform procedures on the unit.
- C. The number of clients leaving the unit for diagnostic tests.
- D. The skill level of the personnel staffing the unit.
Correct Answer: A
Rationale: Client acuity determines the intensity of care needed, directly impacting staffing requirements. Procedures, diagnostic tests, and staff skills are secondary considerations.
In assigning client care to a nurse and a practical nurse (PN), it is most important to assign which client to the nurse?
- A. The client two days post-thyroidectomy and is unable to speak clearly due to laryngeal nerve damage.
- B. The client newly diagnosed with hypothyroidism and who is to receive the first dose of levothyroxine.
- C. The client with diabetes and has an elevated serum glycosylated Hgb (Hgb A1C).
- D. The client exhibiting signs of Addison's crisis after corticosteroids were discontinued.
Correct Answer: A
Rationale: Laryngeal nerve damage post-thyroidectomy risks airway obstruction, requiring RN monitoring. Hypothyroidism, diabetes, and Addison's crisis can be managed by a PN under supervision.
The nurse receives a change-of-shift report from the prior nurse assigned to a group of clients on a post-surgical unit. Which client requires the most immediate intervention by the nurse?
- A. A client who had an abdominal-perineal resection 3 days ago has no drainage on the dressing and is reporting chills.
- B. A client who fell from a ladder and has a collapsed left lower lung with 100 mL drainage in a chest tube collection container.
- C. A client who was admitted 4 hours ago with a gunshot wound and has a dressing with 2 cm-sized dark red drainage.
- D. A client who is post-mastectomy 2 days ago and has 50 mL of serosanguineous fluid in a Jackson-Pratt drain.
Correct Answer: A
Rationale: The client with no drainage and chills may have an infection or sepsis, which are life-threatening complications requiring immediate assessment and physician notification. The chest tube drainage is normal, the gunshot wound drainage is not excessive, and the mastectomy drain output is expected, making these less urgent.
A client is admitted with shortness of breath and hemoptysis. After several tests, the healthcare provider informs the client that the medical diagnosis is stage 4 breast cancer. The client tells the nurse about the decision not to inform the family about the diagnosis. Which intervention should the nurse implement?
- A. Notify the health department of the client's condition.
- B. Advise the client to weigh all possible outcomes prior to the decision.
- C. Suggest to the family the value of genetic screening.
- D. Explain that the family has a right to know of potential health problems.
Correct Answer: B
Rationale: Advising the client to consider outcomes respects her autonomy while encouraging informed decision-making. Notifying the health department, suggesting screening, or asserting family rights violate confidentiality or autonomy.
Several nurses who work on a postoperative surgical unit have reported to the charge nurse their concerns about a particular surgeon's treatment of clients during invasive procedures. Adult clients are often in tears after this particular physician performs central IV line insertions or other invasive procedures. After the charge nurse confronts the healthcare provider who dismisses the concerns, the charge nurse reports the surgeon's behavior to the nurse manager who listens but does nothing about the situation. What action is most important for the charge nurse to take?
- A. Confront the nurse manager as a group and ask why nothing has been done to change the surgeon's behavior.
- B. Attend procedures performed by the surgeon and demand halting the procedure if the client becomes distressed.
- C. Document client reactions to invasive procedures performed by the physician in their medical record.
- D. Report the physician's lack of concern for clients' pain during invasive procedures to the Director of Nursing.
Correct Answer: D
Rationale: Reporting the physician's lack of concern to the Director of Nursing is the most effective action as it escalates the issue to a higher authority with the power to investigate and implement corrective measures, ensuring client safety and welfare. Confronting the nurse manager as a group may create conflict without resolving the issue. Attending procedures and intervening directly could be seen as insubordination and may compromise client safety. Documenting reactions is important but does not address the root cause of the surgeon's behavior.