Nokea
Which statements describe the characteristics of team nursing? Select all that apply.
- A. A registered nurse leads a team of staff members.
- B. Each nurse assumes responsibility for a specific task.
- C. Team members provide direct care to groups of clients.
- D. Unlicensed assistive personnel are given a client assignment.
- E. The registered nurse assumes responsibility for a caseload of clients over time.
- F. Team nursing maintains continuity of care across nursing shifts, days, and home care visits.
Correct Answer: A,C,D
Rationale: In team nursing, a registered nurse (RN) leads a team that is composed of other RNs, licensed practical or licensed vocational nurses, and unlicensed assistive personnel and technicians. The team members provide direct client care to groups of clients under the direct supervision of the RN team leader. In this model, unlicensed assistive personnel are given client assignments rather than being assigned particular nursing tasks. In functional nursing, tasks are divided, with one nurse assuming responsibility for specific tasks. Primary nursing is a model in which the RN assumes responsibility for a caseload of clients over time. In primary nursing, continuity of care across nursing shifts, days, and home care visits is maintained.
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After receiving detailed information about a colonoscopy from the primary health care provider (HCP), the nurse asks the client to sign the informed consent form and discovers that the client cannot write. Which is the best intervention for the nurse to implement?
- A. Contact the provider to obtain informed consent.
- B. Obtain a verbal informed consent from the client.
- C. Have two nurses witness the client sign with an X.
- D. Clarify information to the client with another nurse.
Correct Answer: C
Rationale: Nurses are responsible to ensure that the signed informed consent form is in the client's medical record before a procedure and for clarifying facts that have already been presented by the HCP. Nonetheless, the person performing the procedure obtains informed consent and provides the explanations to the client. Informed consent can be obtained verbally, but that is also the responsibility of the HCP. Clients who cannot write may sign an informed consent with an X in the presence of two witnesses. Nurses can serve as a witness to the client's signature but not to the fact that the client is informed.
The nurse manager is developing an educational session for nursing staff on the components of informed consent and the information to be shared with a client to obtain informed consent. Which information should the nurse manager include in the session? Select all that apply.
- A. The client needs to be informed of the prognosis if the test, procedure, or treatment is refused.
- B. The client cannot refuse a test, procedure, or treatment once the test, procedure, or treatment is started.
- C. The name(s) of the persons performing the test or procedure or providing treatment should be documented on the informed consent form.
- D. A description of the complications and risks of the test, procedure, or treatment, as well as anticipated pain or discomfort, needs to be explained to the client.
- E. The nurse is responsible for obtaining the client's signature on an informed consent form even if the client has questions about the test, procedure, or treatment to be performed.
Correct Answer: A,C,D
Rationale: Informed consent is a person's agreement to allow something to happen based on full disclosure of risks, benefits, alternatives, and consequences of refusal. The primary health care provider (HCP) is responsible for conveying information and obtaining the informed consent. The nurse may be the person who actually ensures that the client signs the informed consent form; however, the nurse does this only after the HCP has instructed the client, and it has been determined that the client has understood the information. The following factors are required for informed consent: a brief, complete explanation of the test, procedure, or treatment; names and qualifications of persons performing and assisting in the test, procedure, or treatment; a description of the complications and risks, as well as anticipated pain or discomfort; an explanation of alternative therapies to the proposed test, procedure, or treatment, as well as the risks of doing nothing; and the client's right to refuse the test, procedure, or treatment even after it has been started.
The nurse has a prescription to administer foscarnet sodium intravenously to a client with a diagnosis of acquired immunodeficiency syndrome (AIDS). Before administering this medication, which measure should the nurse implement?
- A. Obtain a sputum culture.
- B. Obtain folic acid as an antidote.
- C. Place the solution on a controlled infusion pump.
- D. Ensure that liver enzyme levels have been drawn as a baseline.
Correct Answer: C
Rationale: Foscarnet sodium is an antiviral agent used to treat cytomegalovirus (CMV) retinitis in clients with AIDS. Because of the potential toxicity of the medication, it is administered with the use of a controlled infusion device. A sputum culture is not necessary. Folic acid is not an antidote. Foscarnet sodium is highly toxic to the kidneys, and serum creatinine levels are measured frequently during therapy, not liver enzymes.
The nurse receives a telephone call from a client who states that he wants to kill himself and has a loaded gun on the table. Which intervention best assures the client's safety?
- A. Encouraging him to unload the gun and go to the hospital
- B. Telling the client that suicide is not the way to deal with his problem
- C. Using therapeutic communication techniques, especially the reflection of feelings
- D. Engaging the client while another staff member contacts the police for their assistance
Correct Answer: D
Rationale: In a crisis, the nurse must take an authoritative, active role to promote the client's safety. A loaded gun in the home of the client who says that he wants to kill himself is a crisis. The client's safety is of prime concern. Keeping the client on the phone and getting help to the client is the best intervention. Option 1 lacks the authoritative action stance of securing the client's safety. Option 2 is not a helpful strategy and may block communication. Using therapeutic communication techniques is important, but overuse of reflection may sound uncaring or superficial and is lacking direction and a solution to the immediate problem of the client's safety.
A pregnant client tests positive for the hepatitis B virus. The client asks the nurse if she will be able to breast-feed the baby as planned after delivery. Which therapeutic response should the nurse communicate to the client?
- A. You will not be able to breast-feed the baby until 6 months after delivery.
- B. Breast-feeding is not advised, and you should seriously consider bottlefeeding the baby.
- C. Breast-feeding is not a problem, and you will be able to breast-feed immediately after delivery.
- D. Breast-feeding is allowed if the baby receives prophylaxis treatment at birth and scheduled immunizations.
Correct Answer: D
Rationale: The pregnant client who tests positive for hepatitis B virus should be reassured that breast-feeding is not contraindicated if the infant receives prophylaxis at birth and remains on the schedule for immunizations. Therefore, options 1, 2, and 3 are incorrect.