Nokea
The acute care clinic nurse administers a prescribed narcotic for a client with renal colic and then discharges the client without ensuring that the client has a designated driver. The client is subsequently involved in a motor vehicle accident causing injury to self and others. Which ethical principle did the nurse violate?
- A. Autonomy
- B. Nonmaleficence
- C. Paternalism
- D. Veracity
Correct Answer: B
Rationale: Nonmaleficence (do no harm) was violated by discharging the client under narcotic influence without ensuring safe transport, leading to harm. Autonomy, paternalism, and veracity are not primarily affected.
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Medication administration record
Allergies: None
Medications Time
Gabapentin: 300 mg orally, every 8 hours 0700, 1500, and 2300
Hydrocodone/acetaminophen: (5 mg/325 mg) orally, every 4 hours Every 4 hours prn
Acetaminophen: 1,000 mg IV, every 6 hours 0600, 1200, 1800, and 2400
Phenytoin: 100 mg orally, every 12 hours 0700 and 1900
The practical nurse on the neurosurgery step-down unit is assisting the registered nurse in the care of a stable client with a closed head injury who is 1 day post-craniotomy. The practical nurse prepares to administer the 7:00 AM medications and reviews the client’s medication administration record. Which prescription prompts the practical nurse to contact the prescribing health care provider for clarification?
- A. Acetaminophen 1,000 mg IV, every 6 hours
- B. Gabapentin 300 mg orally, every 8 hours
- C. Hydrocodone/acetaminophen (5 mg/325 mg) orally, every 4 hours PRN
- D. Phenytoin 100 mg orally, every 12 hours
Correct Answer: A
Rationale: Acetaminophen 1,000 mg IV is unusual for routine post-craniotomy pain and risks overdose if combined with oral hydrocodone/acetaminophen, requiring clarification. Other medications are standard.
The nurse is preparing the sterile field and supplies for a wet-to-damp dressing change. Which of the following actions by the nurse would require follow-up?
- A. Drop sterile gauze on the sterile field from 6 inches (15cm ) above
- B. Keeps the sterile field and sterile gloved hands within view at all times
- C. Places sterile gauze 2 inches (5 cm) inside the outer edge of the sterile drape
- D. Pours sterile saline solution from a recapped bottle opened 30 hours ago
Correct Answer: D
Rationale: Using saline from a bottle opened 30 hours ago risks contamination, as sterile solutions are typically discarded after 24 hours. Keeping the field in view and placing gauze appropriately maintain sterility.
The nurse is caring for an 8-month-old client with suspected acute otitis media. Which of the following findings would be consistent with the condition? Select all that apply.
- A. Frequent pulling on the affected ear
- B. Purulent drainage from the affected ear
- C. Refusal to eat
- D. Restlessness and irritability
- E. Retracted tympanic membranes
Correct Answer: A,C,D
Rationale: Ear pulling, refusal to eat, and irritability are common in otitis media due to pain and inflammation. Purulent drainage is less common unless the eardrum ruptures, and tympanic membranes are typically bulging, not retracted.
A client who had a bowel resection 5 days ago says, 'I felt like I split open when I coughed.' The nurse finds the incision edges separated and bowel protruding through the wound. Which of the following actions are appropriate? Select all that apply.
- A. Administer 1 oral tablet of oxycodone prescribed PRN for pain
- B. Collect a full set of vital signs
- C. Cover the viscera with sterile dressings saturated in normal saline solution
- D. Notify the health care provider immediately
- E. Place the client in the low Fowler position with knees slightly flexed
Correct Answer: B,C,D,E
Rationale: Vital signs, sterile saline dressings, provider notification, and low Fowler with flexed knees manage dehiscence and evisceration. Oxycodone is inappropriate during this emergency.
The nurse is reinforcing teaching regarding home oxygen use for a client with emphysema who is using nasal cannula and portable oxygen tank. Which of the following statements by the client would require follow-up? Select all that apply.
- A. I can continue to cook on my gas stove.
- B. I can use a humidifier if my nostrils feel dry.
- C. I need to keep a working fire extinguisher in my home.
- D. I should use a wool blanket on my bed instead of cotton.
- E. I can increase the oxygen flow rate whenever I feel short of breath.
Correct Answer: A,D,E
Rationale: Oxygen therapy is commonly prescribed to improve oxygenation for clients with (or at risk for) hypoxia (eg, emphysema) and to promote comfort in clients receiving palliative/hospice care. Clients requiring long-term oxygen therapy may be prescribed portable oxygen delivery (ie, home oxygen therapy) to allow increased independence in daily life.