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Which of these statements is true regarding advance directives?
- A. They must be reviewed and re-signed every 10 years in order to remain valid.
- B. An advance directive is legally valid in every state, regardless of the state it was created in.
- C. A physician must determine when a client is unable to make medical decisions for themselves.
- D. They cannot be honored by EMTs (emergency medical technicians) unless signed by a doctor.
Correct Answer: D
Rationale: The correct statement is that advance directives cannot be honored by EMTs unless they are signed by a doctor. EMTs are required to provide emergency care to a client, irrespective of their advance directive status, unless the directive has been signed by a doctor. When a client is brought to the hospital, physicians will assess the client and implement the advance directive if necessary. Advance directives do not need to be reviewed and re-signed every 10 years to remain valid; they remain in effect until changed. While advance directives are legally valid in most states, some states may not honor those created in other states, so it's advisable to check the new state's policies if a client moves. Additionally, it typically requires two physicians, not just one, to determine if a client is unable to make medical decisions for themselves.
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Which of the following is not an advanced directive?
- A. informed consent
- B. living will
- C. durable power of attorney for health care
- D. health care proxy
Correct Answer: A
Rationale: Informed consent is the process of obtaining permission from a patient before conducting a healthcare intervention. It is not considered an advanced directive. A living will is a legal document that outlines a person's preferences for medical treatment if they are unable to communicate. A durable power of attorney for health care designates a person to make medical decisions on behalf of the patient. A health care proxy, which is another term for a durable power of attorney for health care, also involves appointing someone to make healthcare decisions for an individual if they become unable to do so. Therefore, the correct answer is 'informed consent,' as it is not an advanced directive but rather a different aspect of patient care.
An example of a process standard on a med-surg unit is:
- A. a procedure for changing IV tubing.
- B. a policy for staffing.
- C. the job description of the CEO (chief executive officer).
- D. a procedure for checking waveforms on a client being treated with an intra-aortic balloon pump.
Correct Answer: D
Rationale: Process standards define the actions and behaviors required by staff to provide care on a med-surg unit. A procedure for changing IV tubing is a critical psychomotor skill necessary for safe and effective patient care in this setting. Choice B, a policy for staffing, pertains more to organizational management rather than specific care processes on the unit. Choice C, the job description of the CEO, delineates the responsibilities of the organization's top executive and is not a process standard for frontline staff. Choice D, a procedure for checking waveforms on a client with an intra-aortic balloon pump, is more specific to a cardiac care unit and not typically performed on a med-surg unit.
A client with cancer is transported to the radiology department for a bone scan to determine whether the cancer has metastasized to bone. While the client is in the radiology department, the client's wife arrives for a visit and asks what test is being performed on the client. What should the nurse tell the wife?
- A. A bone scan is being performed.
- B. She can read the client's medical record to determine what the health care provider prescribed.
- C. The radiology department is not clear as to which test has been prescribed.
- D. She will have to discuss the prescribed test with the client.
Correct Answer: D
Rationale: In healthcare, confidentiality is crucial. Without the client's consent, nurses cannot disclose confidential information to anyone else, even to family members. Therefore, the appropriate response is to inform the client's wife that she will have to discuss the test with the client directly. It is not appropriate to disclose sensitive medical information without the client's permission. Offering the wife to read the medical record is a violation of privacy and confidentiality. Indicating that the radiology department is unclear about the prescribed test is inaccurate and does not uphold confidentiality. Moreover, it is not the responsibility of another department to disclose medical information; it is the duty of the healthcare provider and the client to discuss such matters.
The LPN needs to delegate a task to the nurse aide who is new to the unit. Which of these is the best option for the nurse to choose in proceeding?
- A. Delegate the task to the nurse aide, confirm understanding, and follow up to ensure the task was safely and correctly done.
- B. Delegate the task to the nurse aide, watch them perform the task without them seeing you, and follow up to ensure the task was done safely and accurately.
- C. Delegate the task to the nurse aide, supervise if needed, and check in after the task to see if help is needed.
- D. Delegate the task to the nurse aide, ensure understanding of the task, and supervise the task being performed.
Correct Answer: B
Rationale: Delegation is transferring responsibility for a task but sharing its accountability. It is the delegator's responsibility to ensure that the delegatee understands the task before it is performed and to follow up afterward to ensure it was completed correctly and safely. Option B is the best choice because it allows the nurse to observe the nurse aide performing the task without pressure, which can provide insights into the aide's abilities and understanding. This method also allows for immediate feedback and correction if needed.
Choice A is incorrect because confirming understanding alone may not provide a complete picture of the aide's competence in performing the task. Choice C is incorrect as it suggests supervising only if needed, which may not provide adequate oversight for a new nurse aide. Choice D is incorrect because supervising the task being performed does not allow for an objective assessment of the aide's abilities and understanding.
The client asks the nurse not to tell anyone outside of the care team about his positive HIV diagnosis. What response is most appropriate?
- A. "I have to inform all clients on the unit of your diagnosis as it is transmissible."?
- B. "I will not communicate your diagnosis to anyone without your permission."?
- C. "Because this is a communicable disease, it may need to be reported to the CDC."?
- D. "You should not be concerned with who I share your diagnosis with."?
Correct Answer: C
Rationale: The most appropriate response is C: "Because this is a communicable disease, it may need to be reported to the CDC."? It is important to uphold patient confidentiality, but in the case of certain communicable diseases like HIV, there are legal requirements for mandatory reporting to public health authorities such as the CDC. Option A is incorrect because it violates patient confidentiality and does not consider legal obligations. Option B, while respecting the client's wishes, may not align with the legal requirement for reporting certain communicable diseases. Option D is inappropriate as it dismisses the client's concerns and rights regarding their health information.