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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.
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A nurse is performing an end-of-shift count of narcotics kept in the locked cabinet. The narcotic log states there should be 26 oxycodone pills left, but there are only 24 in the drawer. What is the first action of the nurse?
- A. Perform the count again
- B. Contact the pharmacy to determine if the narcotic log is incorrect
- C. Check with the last nurse to sign out narcotics from the system
- D. Notify the house supervisor that narcotic medications are missing
Correct Answer: A
Rationale: The correct answer is A: Perform the count again. The nurse should double-check the count to ensure accuracy before taking further action. Performing the count again helps to rule out any possible errors in the initial count. This step ensures that the discrepancy is not due to a simple mistake or oversight. Contacting the pharmacy (B), checking with the last nurse who signed out narcotics (C), or notifying the house supervisor (D) should be done after confirming the discrepancy through a recount. The first action should always be to verify the count internally before involving external parties or escalating the issue.
A client is refusing to undergo any more treatments in the hospital and wants to leave against medical advice. When the nurse requests the client to sign an AMA order, the client refuses and leaves. What is the next action of the nurse?
- A. Call security to hold the client until he signs the order
- B. Notify the physician to convince the client to stay
- C. Speak with the client's spouse to persuade him to stay
- D. Allow the client to leave and document the refusal in his chart
Correct Answer: D
Rationale: The correct answer is D: Allow the client to leave and document the refusal in his chart. This is the appropriate action because every individual has the right to refuse medical treatment, even if it is against medical advice. By allowing the client to leave and documenting the refusal in the chart, the nurse respects the client's autonomy and ensures legal and ethical considerations are met. Calling security to hold the client (choice A) would violate the client's rights. Notifying the physician to convince the client (choice B) may not be effective and goes against the client's autonomy. Speaking with the client's spouse (choice C) is irrelevant as the decision lies with the client.
A nursing unit is implementing a new electronic charting program for the nursing staff to use. Which of the following best describes a disadvantage of using electronic charting?
- A. The information is more likely to be lost or used inappropriately.
- B. Any provider in the unit can have access to the client's medical records.
- C. The system diminishes communication between nurses and providers.
- D. The program may be confusing and difficult to implement.
Correct Answer: D
Rationale: The correct answer is D: The program may be confusing and difficult to implement. Implementing a new electronic charting program may be challenging due to the complexity of the software and the learning curve for staff. It can take time and resources to train employees on how to effectively use the program, leading to potential confusion and resistance to change. This disadvantage could result in delays in charting, errors, and frustrations among staff members.
Other choices are incorrect because:
A: The information is more likely to be lost or used inappropriately - Electronic charting systems often have built-in security measures to prevent data loss and unauthorized access.
B: Any provider in the unit can have access to the client's medical records - Electronic charting systems have role-based access control to limit who can view specific patient information.
C: The system diminishes communication between nurses and providers - Electronic charting can actually improve communication by allowing real-time access to patient information.
Which of the following is an example of whistle-blowing?
- A. A nurse contacts administration about a colleague who takes supplies to use for a mission trip
- B. A client sues a nurse because she failed to call the physician about his wound infection
- C. A nursing assistant calls for help when a client falls out of bed
- D. A client developed a sacral pressure ulcer when he was not turned in bed for over four hours
Correct Answer: A
Rationale: The correct answer is A because whistle-blowing involves reporting unethical or illegal behavior within an organization to higher authorities. In this scenario, the nurse is reporting a colleague's misuse of supplies for personal gain, which is unethical. Choice B involves a client suing a nurse for malpractice, not whistle-blowing. Choice C is a standard response to a client falling and does not involve reporting unethical behavior. Choice D describes a case of neglect, not whistle-blowing.
A client in the emergency room enters the care area to start an IV. He finds a man sitting on the table, hunched over, and attempting to take deep breaths. He states, 'my chest hurts so much!' His wife is sitting on a chair in the corner, crying. Which of the following is the first action of the client?
- A. Bring the IV kit and quickly start an IV
- B. Assess his breathing and provide oxygen, if necessary
- C. Administer medication to control chest pain
- D. Talk with his wife and find out why she is crying
Correct Answer: B
Rationale: The correct answer is B: Assess his breathing and provide oxygen if necessary. This is the first action the client should take because the patient is presenting with chest pain and difficulty breathing, which could indicate a serious medical condition like a heart attack or pulmonary embolism. By assessing the patient's breathing and providing oxygen if needed, the client can help stabilize the patient's condition and ensure proper oxygenation. Starting an IV or administering medication should come after assessing and stabilizing the patient's respiratory status. Talking with the wife, while important for gathering information, is not the priority in this situation.