The charge nurse in a progressive care unit assigns the care of a patient receiving hemodialysis to a newly hired licensed practical nurse (LPN) without checking to see that the nurse has been determined competent to care for hemodialysis patients. The LPN is in orientation and fails to inform the charge nurse that she does not have experience with this type of patient. The actions of the charge nurse would be considered to be which of the following?
The department of nursing at a local hospital is considering changing to charting by exception (CBE). Which statement provides a rationale to support making this change?
Addresses the patient’s concerns holistically
Reduces the time nurses spend charting
Establishes an ongoing care plan from admission
Is most useful when constructing a timeline of events
A registered nurse administers the wrong medication to a patient. She does not notify anyone of the error and documents that the correct medication was administered. The nurse was reported to the state board of nursing. Which of the following actions can the state board of nursing take against the nurse in this situation?
Employment release from the institution
Disciplinary action against the nurse’s license to practice
Criminal misdemeanor charges against the nurse
Medical malpractice lawsuit against the nurse
The nurse notifies the primary care provider that the patient is experiencing pain. The provider gives the nurse a telephone order for morphine 4 mg intravenously every hour as needed for pain. How should the nurse document this telephone order?
09/02/13 0845 morphine 4 mg intravenously q 1 hour PRN pain T.O.: Dr. D. Kelly/Kay Andrews, RN
09/02/13 0845 morphine 4 mg intravenously q 1 hour V.O. Kay Andrews, RN
09/02/13 0845 morphine 4 mg intravenously q 1 hour PRN pain V.O.: Dr. D. Kelly/Kay Andrews, RN
09/02/13 0845 morphine 4 mg intravenously q 1 hour PRN pain. Kay Andrews, RN
For the patient with no healthcare coverage who is seeking medical care, the emergency department staff members decide whether to provide care or transport to a public facility based on which law, enacted by Congress in 1986 and updated in 2003?
Health Care Quality Improvement Act (HCQIA)
Newborns’ and Mothers’ Health Protection Act (NMHPA)
Emergency Medical Treatment and Active Labor Act (EMTALA)
Patient Self-Determination Act (PSDA)
In which of the following circumstances might the nurse defer obtaining informed consent for care and treatment of a patient?
The patient is confused and cannot understand or sign the consent form.
An unconscious patient is admitted to your unit; he is alone.
The patient is brought to the emergency department in cardiac arrest; no family is present.
The surgeon requests that the patient be sent to the surgical suite before you get the consent form signed.
You are caring for an alert, oriented 47-year-old patient who is recovering from abdominal surgery. The patient becomes angry and upset and says, “I’m leaving this hospital. Remove my IV and surgical drains or I will do it myself.” In order to keep him from removing his lines and leaving the hospital, you apply bilateral wrist restraints until you can contact the physician for an order for patient restraint. This is an example of which of the following?
Assault and battery
A client admitted to the inpatient medical-surgical unit has suffered sudden respiratory failure. The client’s condition is getting worse; he is cyanotic (turning blue) with periods of labored breathing. Of the following choices, which would be the most important thing to look up in the chart first?
Check the graphic data for vital signs and intake/output.
Examine the history and physical.
Look for an advance directive.
Study the discharge plan.
The nursing assistive personnel (NAP) informs the nurse that a patient has fallen out of bed and is in pain. The nurse assesses the patient and provides care. Identify the correct documentation of the fall.
Patient reminded to not climb OOB after falling.
Patient found on floor after falling out of bed; found by NAP Smith.
Patient fell out of bed but is currently in bed.
Patient found on floor in pain after falling out of bed.
The nursing Rand card or Kardex® is part of the patient’s permanent health record.
Which set of topics makes up a hand-off report given in a recommended format?
The nurse makes a mistake while documenting in the patient’s health record. Which action should the nurse take?
Completely cover the documentation error with black ink.
Use an opaque white fluid to cover the documentation error.
Use correction tape to make the documentation correct.
Draw a line through the error and initial the change.
The patient’s medical record contains the following documentation:
06/05/05 0200 Received patient from the E.D. BP 80/52, HR 118, RR 24, temp 104°F. Arouses to verbal stimuli but drifts off to sleep. Normal saline infusing in left arm via18 gauge IV catheter at 250 mL/hr. Urinary catheter draining scant dark amber urine. Pt receiving O2 at 6 L/min via nasal cannula. Lungs with coarse crackles at the left base. Loose cough present. Pt unable to expectorate secretions.—Ann. Davids, RN
Which type of charting has the nurse used?
The nurse takes a telephone order from a primary care provider for 40 mEq potassium chloride in 100 mL of sterile water for injection to be infused over 4 hours. Which action must the nurse take to ensure the accuracy of the order?
Ask the unit secretary to listen to the prescriber on the phone to verify the order.
Immediately notify the pharmacy of the order and verify it with a pharmacist.
Repeat the order to the prescriber even if she believes she understood the order correctly.
Transcribe the order onto note paper and verify the dosage in a drug handbook.
A client who cannot manage a patient-controlled analgesia pump is prescribed morphine 4 mg intravenously q 1 hour PRN pain. When should the nurse administer the medication?
Every hour around-the-clock
Immediately after taking off the order
As needed, but not more than once per hour
1 hour after the last administered dose
Upon initial assessment of a 75-year-old patient, you identify bruises and scratches on the patient’s arms, legs, and trunk in various stages of healing. You notify your supervisor when you suspect the patient may be a victim of physical abuse. You are complying with which of the following state laws?
Mandatory Reporting Law
Nursing Standards of Practice
Nurse Practice Act
Good Samaritan Law
The nurse administers heparin 5000 units subcutaneously at 2100 and documents in the medication administration record that the dose was administered. What other information is important for the nurse to document on the MAR?
Previous site of administration
Heart rate prior to administration
Patient response to medication
A patient refuses a dose of medication. How should the nurse document the event?
Patient is belligerent, argumentative, and refuses the 0900 dose of digoxin.
0900 dose of digoxin not given.
Patient is uncooperative and refuses the prescribed dose of digoxin.
Patient refuses the 0900 dose of digoxin.
A 4-year-old child is brought to the emergency department by his mother. He has a large bruise in his left chest and multiple contusions on his face. His mother tells you her boyfriend intentionally pushed the child down the stairs in anger. The child appears to be in a great deal of pain. Which of the following four items should the nurse do first?
Notify Child Protective Services of the suspected abuse.
Complete a physical assessment of the child.
Notify the nursing supervisor of the suspected physical abuse.
Obtain an order for pain medication.
A patient tells you that chart entries made by the nurse from the previous day indicate he was uncooperative when asked to ambulate. He says this is not true and asks his record be corrected. You understand that, if what he says is accurate, he has the right to have the documentation error corrected based on which of the following regulations?
Health Insurance Portability and Accountability Act (HIPAA)
Americans with Disabilities Act (ADA)
Health Care Quality Improvement Act (HCQIA)