Nclex: ethics, delegation, prioritization, legal

Nclex: ethics, delegation, prioritization, legal

Leave the first rating Students also studied Terms in this set (36) Science MedicineNursing Save NCLEX-RN Practice Questions For 2...Teacher 33 terms TutorDkPreview NCLEX ® Delegation Questions 50 terms Daniel_Griffiths2 Preview Delegation NCLEX Questions for Nu...17 terms kfs1611Preview Leader 55 terms quiz The new graduate nurse interviews for a position in a nursing department of a large health care agency that uses the approach of shared governance. Which of these statements best illustrate the shared governance model?

• Staff groups are appointed to discuss nursing practice

and client education issues

• Non-nurse managers supervise nursing staff in groups

of units

• Nursing departments share responsibility for client

outcomes

• An appointed board oversees any administrative

decisions

• Nursing departments share responsibility for client outcomes

Shared governance or self-governance is a method of organizational design. It promotes empowerment of nurses to give them responsibility for client care issues and outcomes with other divisions in the agency.

The triage nurse identifies that a 16-year-old client is legally married and has signed the consent form for treatment. What would be an appropriate action by the nurse?

• Refer the teenager to a community pediatric hospital

emergency department

• Proceed with the triage process in the same manner as

any adult client

• Ask the teenager to wait until a parent or legal

guardian can be contacted

• Withhold treatment until telephone consent can be

obtained from their partner

• Proceed with the triage process in the same manner as any adult client

Minors may become known as an "emancipated minor" through marriage, pregnancy, high school graduation, independent living or service in the military.Therefore, this married client has the legal capacity of an adult. Otherwise, the age for legal signatures is 18 years of age.The registered nurse (RN) and the unlicensed assistive person (UAP) are caring for clients on a surgical unit.Which action(s) by the UAP warrant immediate intervention? (Select all that apply.)

• the UAP empties the indwelling catheter bag for the

client who had a transurethral resection of the prostate (TURP) yesterday

• The UAP applies moisture barrier cream to the client's

excoriated perianal area

• The UAP assists a client, who received an IV narcotic

analgesic 30 minutes ago, to ambulate in the hall

• The UAP applies a fingertip pulse oximeter on a client

whose fingernail is painted dark blue

• The UAP assists a client, who had a total knee

replacement two days ago, to shave using a straight- edge razor

• The UAP assists a client, who received an IV narcotic analgesic 30 minutes ago,

to ambulate in the hall

• The UAP applies a fingertip pulse oximeter on a client whose fingernail is

painted dark blue

• The UAP assists a client, who had a total knee replacement two days ago, to

shave using a straight-edge razor The UAP can perform a number of nursing tasks, such as emptying an indwelling urinary catheter bag and applying moisture barrier cream after peri care.However, it is unsafe for the UAP to ambulate a client who recently received an IV push narcotic. Although UAP can shave clients, it is unsafe to shave someone using a straight-edge razor because a client who had knee replacement surgery is probably taking an anticoagulant; only an electric razor should be used. Pulse oximeter readings must be done on a finger that is warm and free from dark fingernail polish.A nurse manager suspects a staff nurse of substance use disorder (SUD). Which approach would be the best initial action by the nurse manager?

• Schedule a staff conference, without the nurse

present, to collect information

• Consult with human resources about the issue and

needed actions

• Confront the nurse about the suspicions in a private

meeting

• Counsel the employee to resign to avoid investigation

and rumors

• Consult with human resources about the issue and needed actions

The nurse manager needs to consult with human resources to determine the proper procedures for documenting and reporting the nurse's behavior. The nurse manager could also consult the EAP if one is available. If the staff nurse is also suspected of diversion, and a written policy exists, the nurse manager would follow these procedures. Attempts should be made to help the nurse with SUD by providing counseling and treatment for this disease.

A client who is unconscious is brought to the emergency department by an ambulance. What document should the nurse give priority to when preparing the care for this client?

• A notarized original of the advance directive brought

in by the partner

• Orders written by the health care provider in the

emergency department

• The national statement of client rights and the client

self-determination act

• The clinical pathway protocol of the agency and the

emergency department

• A notarized original of the advance directive brought in by the partner

This document specifies the client's wishes of what actions are to be taken when the client becomes unable to make health care decisions. The advance directive often includes a living will and the power of attorney to whom will make the decisions for the client. The next document that would take precedent are the orders written by the heath care provider. The clinical pathways are used to evaluate the client's progress during therapy.The nurse, who is caring for a client with complex and unique health needs, describes the nature of the illness in an online social forum for nurses. Neither the client's real name nor any other personal identifiers are used. What, if any, consequence could result from posting this information online?

• There won't be any consequences because the

information was posted on a website for nursing professionals

• The nurse could be reprimanded for not clearing the

information first with hospital administration

• There won't be any consequences because the client's

real name was not used

• The nurse could be fired for breach of confidentiality
• The nurse could be fired for breach of confidentiality

Many health care facilities have adopted a social media policy; it is important to understand that nurses can be fired for posting personal information about clients online, because this is an invasion of privacy. In addition to being a HIPAA violation, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) gives states attorneys the right to pursue violations of patient privacy.A nurse has been assigned to four clients in the emergency department, with each client experiencing one of these conditions. Which client should the nurse check first?

• Tension pneumothorax with slight tracheal deviation to

the right

• Viral pneumonia with atelectasis
• Spontaneous pneumothorax with a respiratory rate of

38

• Acute asthma with episodes of bronchospasm
• Tension pneumothorax with slight tracheal deviation to the right

Tracheal deviation indicates a significant volume of air being trapped in the chest cavity with a mediastinal shift. In tension pneumothorax the tracheal deviation is away from the affected side. The affected side is the side where the air leak is in the lung. This situation also results in sudden air hunger, agitation, hypotension, pain in the affected side and cyanosis with a high risk of cardiac tamponade and cardiac arrest.

A client asks the nurse for information about a living will.Which statement made by the client dem onstrates an understanding of a living will? (Select all that apply.)

• "It lists all my assets and how they should be divided

among my family after I die."

• "I should sit down and discuss my wishes for end-of-life

care with my loved ones."

• A living will must be renewed by a designated family

member each time I am hospitalized."

• "A living will is a legal document that becomes a

permanent part of my health care record."

• "My wishes for end-of-life treatment are stated in

writing."

• "I will need to identify someone to be my health care

proxy."

• "It lists all my assets and how they should be divided among my family after I

die."

• "I should sit down and discuss my wishes for end-of-life care with my loved

ones."

• "A living will is a legal document that becomes a permanent part of my health

care record."

• "My wishes for end-of-life treatment are stated in writing."
• "I will need to identify someone to be my health care proxy."

An advance health care directive is also known as a living will. It is a legal document in which a person specifies his or her wishes concerning medical treatments at the end-of-life, when s/he is unable to make those decisions.Advance care planning involves sharing personal values and wishes with loved ones and selecting someone, (called a medical power of attorney or health care proxy) who will eventually make medical decisions on the client's behalf. A living will does not expire; it remains in effect unless it is changed. A living will does not include information regarding assets or a person's estate.A client's uncle calls for an update on the condition of his nephew. What should the nurse do first before providing the information to the caller?

• Call the physician to verify the client's condition before

you speak to the family member

• Ask the family member that is currently at the client's

bedside if it is okay to release the information to the client's uncle

• Consult with the client and obtain permission to

update the client's uncle of his condition

• Refuse to release any information to the family

member and remind them they must be present to obtain an update

• Consult with the client and obtain permission to update the client's uncle of his

condition You must have permission by the client to release information to the family member. If your client is unable to give permission and has a health care proxy, then information can only be given to the health care proxy and all family members can obtain updates from the proxy. Remember, it is difficult to know who is calling over the phone. Consult your organization's policy on condition requests over the phone.A nurse is named in a lawsuit. Which of these factors will offer the best protection for that nurse in a court of law?

• Clinical specialty certification by an accredited

organization

• Complete and accurate documentation of assessments

and interventions

• Above-average performance reviews prepared by

nurse manager

• Sworn statement that health care provider orders were

followed

• Complete and accurate documentation of assessments and interventions

The medical record is a legal document. Documentation should include all steps of the nursing process; it must be complete, accurate, concise and in chronological order. Inaccurate or incomplete documentation will raise red flags and may indicate the nurse failed to meet the standards of care. The attorney will review the medical record with the nurse before giving a deposition (sworn pretrial testimony). Above-average performance reviews could be considered supporting information. Certification is an "extra" based on the nurse's initiative; it is, however, unrelated to accurate charting.