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While receiving report on a group of patients, the nurse learns that a patient with terminal cancer has granted power of attorney for health care to her brother. How does this affect the course of the patients care?
- A. Another individual has been identified to make decisions on behalf of the patient.
- B. There are binding parameters for care even if the patient changes her mind.
- C. The named individual is in charge of the patients finances.
- D. There is a document delegating custody of children to other than her spouse.
Correct Answer: A
Rationale: A power of attorney is said to be in effect when a patient has identified another individual to make decisions on her behalf. The patient has the right to change her mind. A power-of-attorney for health care does not give anyone the right to make financial decisions for the patient nor does it delegate custody of minor children.
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Critical thinking and decision-making skills are essential parts of nursing in all venues. What are examples of the use of critical thinking in the venue of genetics-related nursing?
- A. Notifying individuals and family members of the results of genetic testing
- B. Providing a written report on genetic testing to an insurance company
- C. Assessing and analyzing family history data for genetic risk factors
- D. Identifying individuals and families in need of referral for genetic testing
- E. Ensuring privacy and confidentiality of genetic information
Correct Answer: C,D,E
Rationale: Nurses use critical thinking and decision-making skills in providing genetics-related nursing care when they assess and analyze family history data for genetic risk factors, identify those individuals and families in need of referral for genetic testing or counseling, and ensure the privacy and confidentiality of genetic information. Nurses who work in the venue of genetics-related nursing do not notify family members of the results of an individuals genetic testing, and they do not provide written reports to insurance companies concerning the results of genetic testing.
An audit of a large, university medical center reveals that four patients in the hospital have current orders for restraints. You know that restraints are an intervention of last resort, and that it is inappropriate to apply restraints to which of the following patients?
- A. A postlaryngectomy patient who is attempting to pull out his tracheostomy tube
- B. A patient in hypovolemic shock trying to remove the dressing over his central venous catheter
- C. A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode
- D. A patient with depression who has just tried to commit suicide and whose medications are not achieving adequate symptom control
Correct Answer: C
Rationale: Restraints should never be applied for staff convenience. The patient with urosepsis who is frequently ringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior that will not result in patient harm. The other described situations could plausibly result in patient harm; therefore, it is more likely appropriate to apply restraints in these instances.
A recent nursing graduate is aware of the differences between nursing actions that are independent and nursing actions that are interdependent. A nurse performs an interdependent nursing intervention when performing which of the following actions?
- A. Auscultating a patients apical heart rate during an admission assessment
- B. Providing mouth care to a patient who is unconscious following a cerebrovascular accident
- C. Administering an IV bolus of normal saline to a patient with hypotension
- D. Providing discharge teaching to a postsurgical patient about the rationale for a course of oral antibiotics
Correct Answer: C
Rationale: Although many nursing actions are independent, others are interdependent, such as carrying out prescribed treatments, administering medications and therapies, and collaborating with other health care team members to accomplish specific, expected outcomes and to monitor and manage potential complications. Irrigating a wound, administering pain medication, and administering IV fluids are interdependent nursing actions and require a physicians order. An independent nursing action occurs when the nurse assesses a patients heart rate, provides discharge education, or provides mouth care.
An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. The patient is to have a lumbar puncture performed, and the nurse is doing preprocedure teaching with the child and the mother. The nurses action is an example of which therapeutic communication technique?
- A. Informing
- B. Suggesting
- C. Expectation-setting
- D. Enlightening
Correct Answer: A
Rationale: Informing involves providing information to the patient regarding his or her care. Suggesting is the presentation of an alternative idea for the patients consideration relative to problem solving. This action is not characterized as expectation-setting or enlightening.
The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse should describe skills in which of the following domains?
- A. Self-esteem
- B. Self-regulation
- C. Inference
- D. Autonomy
- E. Interpretation
Correct Answer: B,C,E
Rationale: Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Self-esteem and autonomy would not be on the list because they are not skills.