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Terms in this set (30)The nurse should place the client in which position to obtain the most accurate reading of jugular vein distention? 1.Upright at 90 degrees 3.Raised to 45 degrees A nurse assesses the lungs of a client and auscultates soft, crackling, bubbling breath sounds that are more obvious on inspiration. This assessment should be documented as: 1.Vesicular 3.Crackles A nurse fails to act in a reasonable, prudent manner. Which legal principle is most likely to be applied? 1.Malice 3.Malpractice The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early Alzheimer's dementia. The client lives alone. The client's adult children live nearby. According to the prescribed medication regimen the client is to take medications six times throughout the day. What is priority nursing intervention to assist the client with compliance with medication-taking? 1.Contact
the client's children and ask them to hire a private duty aide who will provide round-the-clock care. 3.Contact the primary healthcare provider and discuss the possibility of simplifying the medication regimen. A daughter of a Chinese-speaking client approaches a nurse and asks multiple questions while maintaining direct eye contact. What culturally related concept does the daughter's behavior reflect? 1.Prejudice 3.Assimilation What should the nurse consider when obtaining an informed consent from a 17-year-old adolescent? 1.If the client is allowed to give consent. 1.If the client is allowed to give consent. A senior high school student, whose immunization status is current, asks the school nurse which immunizations will be included in the precollege physical. Which vaccine should the nurse tell the student to expect to receive? 1.Hepatitis C (HepC) 3.Measles, mumps, rubella (MMR) A nurse is reinforcing teaching to an adolescent about type 1 diabetes and self-care. Which questions from the client indicate a need for additional teaching in the cognitive domain? (Select all that apply.) 1."What is diabetes?" 1."What is diabetes?" The nurse is caring for an older adult client who is aphasic. The client's family reports to the nurse manager that the primary nurse failed to obtain a signed consent form before inserting an indwelling catheter to measure intake and output. What should the nurse manager consider before responding? 1.Procedures for a client's benefit do not require a signed consent. 3.A separate signed informed consent for routine treatments is unnecessary. While the nurse moves a client from a lying to standing position, the client experiences a rapid drop in blood pressure. The nurse would report this finding as: 1.malignant hypotension 3.orthostatic hypotension What should a nurse recommend to help a client best during the period immediately after a spouse's death? 1.Crisis counseling 4.Bereavement counseling A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching? 1.Maligning a person's character while threatening to do bodily harm. 3.The application of force to another person without lawful justification. The nurse assesses a client's pulse and documents the strength of the pulse as 3+. The nurse understands that this indicates the pulse is: 1.diminished 3.full A client who is HIV positive is admitted to a surgical unit after an orthopedic procedure. The nurse should institute appropriate precautions with the awareness that HIV is highly transmissible through: (Select all that apply.) 1 .feces 2.blood On the second day of hospitalization a client is discussing with the nurse concerns about unhealthy family relationships. During the nurse-client interaction the client begins to talk about a job problem. The nurse's response is: "Let's go back to what we were just talking about." What therapeutic communication technique did the nurse use? 1.Focusing 1.Focusing A nurse is teaching a group of parents about child abuse. What definition of assault should the nurse include in the teaching plan? 1.Assault is a threat to do bodily harm to another person. 1.Assault is a threat to do bodily harm to another person. A client has a "prayer cloth" pinned to the hospital gown. The cloth is soiled from being touched frequently. What should the nurse do when changing the client's gown? 1.Make a new prayer cloth. 3.Pin the prayer cloth to the clean gown. Which action by a home care nurse would be considered an act of euthanasia? 1.Implementing a "do not resuscitate" order in the home health setting. 4.Knowing that a dying client is overmedicating and not acting on this information
On the third postoperative day following a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. What is the best initial approach that the nurse should take when interacting with this client? 1.Explain why there is a need to increase activity. 4.Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving A terminally ill client is furious with one of the staff nurses. The client refuses the nurse's care and insists on doing self-care. A different nurse is assigned to care for the client. What should be the newly assigned nurse's initial step in revising the client's plan of care? 1.Get a full report from the first nurse and adjust the plan accordingly. 4.Assess the client's present status and include the client in a discussion of revisions to the plan of care A nurse is providing morning hygiene to a bedridden client who was admitted for exacerbation of chronic obstructive pulmonary disease (COPD). What is the priority nursing intervention when the client becomes short of breath during the care? 1.Obtain a pulse oximeter to determine the client's oxygen saturation level. 2.Put the client in a high-Fowler's position. Nurses care for clients in a variety of age groups. In which age group is the occurrence of chronic illness the greatest? 1.Older adults 1.Older adults The nurse recognizes that what is the reason the faucets on the sinks in a client's room are considered contaminated? 1.They are not in sterile areas. 2.They are touched by dirty hands when turning the water on. When changing the soiled bed linens of a client with a wound that is draining seropurulent material, what personal protective equipment (PPE) is most essential for the nurse to wear? 1.Mask 2.Clean gloves A 3-year-old child with eczema of the face and arms has disregarded the nurse's warnings to "stop scratching, or else!" The nurse finds the toddler scratching so intensely that the arms are bleeding. The nurse then ties the toddler's arms to the crib sides, saying, "I'm going to teach you one way or another." How should the nurse's behavior be interpreted? 1.These actions can be construed as assault and battery. 1.These actions can be construed as assault and battery. According to Kübler-Ross, during which stage of grieving are individuals with serious health problems most likely to seek other medical opinions? 1.Anger 2.Denial The nurse plans care for a client with a somatoform disorder based on the understanding that the disorder is: 1.A physiological response to stress. 4.An unconscious means of reducing stress A physician orders a urinalysis for a client with an indwelling catheter. To ensure that an appropriate specimen is obtained, the nurse would obtain the specimen from which site? 1.tubing injection port 1.tubing injection port A client with respiratory difficulties asks why the percussion procedure is being performed. The nurse explains that the primary purpose of percussion is to: 1.Relieve
bronchial spasm. 3.Loosen pulmonary secretions. A client is admitted to the hospital for an elective surgical procedure. The client tells a nurse about the emotional stress of recently disclosing being a homosexual to family and friends. What is the nurse's first consideration when planning care?
1.Exploring the client's emotional conflict 2.Identifying personal feelings toward this client Sets with similar termsBasics of Nursing Practice30 terms mmiiv Eaq66 terms amy_perry23 Sets found in the same folderEvolve Fundamentals - Basics101 terms tiggie86 Evolve Physiological Aspects of Care61 terms tiggie86 Basics of Nursing Practice22 terms mmiiv NCLEX Practice Tests40 terms jhicksobu89 Other sets by this creatorResp12 terms mmiiv cardio30 terms mmiiv Neuro30 terms mmiiv Resp29 terms mmiiv Other Quizlet setsWeek 4 (pectoral region, axilla, brachial plexus,…43 terms badgalbritt6PLUS Laboratory and Science Skills23 terms MrsHernandezFHS isom351 chapter 916 terms Heaf5 Related questionsQUESTION What is the 4th step in the nursing process? 15 answers QUESTION Match the template elements with the corresponding number needed for level 5 charting: PE, HPI, Hx and ROS 3 answers QUESTION What does a decreased intrinsic factor lead to? 11 answers QUESTION Examine the concept of "situational awareness" in ensuring a safe client environment. (Topic 2) 4 answers What is a reasonable prudent nurse?Reasonable and prudent nurse: A nurse that uses good judgment in providing nursing care according to accepted standards and that another nurse with similar education and experience in similar circumstances would provide.
What is tort law in nursing?Torts: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in the nurse patient relationship. Some torts specific to nursing and nursing practice include things like malpractice, negligence and violations relating to patient confidentiality. ( Berman and Synder, 2012)
What are legal standards in nursing?Standards of care or standards of practice in nursing are general guidelines that provide a foundation as to how a nurse should act and what he or she should and should not do in his or her professional capacity. Deviating from this standard can result in certain legal implications.
Which action can the nurse be legally liable for?Under the negligence legal theory, nurses may only be held liable for injuries if: The nurse owed a duty of care to the patient; The nurse breached this duty of care; and. The nurse's breach resulted in measurable damage to the patient.
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Which legal principle is applied when the nurse fails to act in a reasonable, prudent manner?
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