Thanks for your response. For #3: Suppose you had requested supervision for the
medication administration but could not find your instructor. Who would be liable in this
case and why?
The clinical instructor can be liable if supervision was requested but not available for a
student. The student has a duty to perform correct administration of meds, same as a
registered nurse. It is the responsibility of the student to wait for the instructor or seek
out the floor nurse in this situation.
Try this practice question and include a rationale for your response:
The mental health charge nurse is reviewing the least restrictive interventions with staff.
Which of the following is considered the least restrictive intervention for a patient
exhibiting unacceptable behavior that includes pacing and yelling at other patients?
Provide a rationale for answer selected.
a. Firmly tell the patient this behavior is unacceptable
b. Remove the patient from the area and isolate
c. Restrain the patient with meds/wrist restraints
d. Seek assistance to remove other patients from the area
Answer: d. Seek assistance to remove the other patients from the area. This is the least
restrictive intervention listed. This patient needs more supervision. Clients who are
angry need a large personal space. Don’t get too close.
a is not correct. You would not speak firmly to the patient. A calm voice is indicated
when communicating with an angry patient and would be one of the first interventions
indicated.
b is not correct as trying to remove the patient from the area may increase the
aggressive behavior.
c is not correct, restraining the patient with drugs or wrist restraints is not the least
restrictive intervention.
Thanks for your response. For #3: Use the guidelines below to analyze the ethical
situation.
Determine the facts of the situation:
The patient verbalizes a request for no life-sustaining measures in front of the nurse
and family.
The physician decides to initiate a code, knowing the patient's wishes.
, No documentation exists about the patient's wishes.
The nurse is unable to contact the family to make the decision.
The patient dies.
Identify the ethical issues of the situation:
The patient has the right to autonomy and does make a decision.
The nurse is obligated to do good for the patient (beneficence) by informing the
physician of the patient's wishes and attempting to contact the family.
The nurse has the duty to be faithful to commitments (fidelity) and attempts to abide
by the patient's wishes by informing the physician prior to the code.
We may be administering KCL via IV for patients if the K levels drops too low. What are
nursing priorities when administering KCL IV?
See drug alert box page 177 in IGGY for potassium guidelines. A NPSG is to never give
K by IV push due to cardiac arrest. Iggy notes 5-10meq/hr is maximum recommended
infusion rate and to not exceed 20meq/hr. Potassium is always diluted and infused
slowly.
It’s important to make sure the patient has adequate urine output before administering
K. Also, skeletal muscle weakness is associated with hypokalemia and patients may be
too weak to stand. Provide assistance for safety as patients with hypokalemia are at risk
for falls. Cardiac monitoring is necessary, we will see PVCs and possibly other
dysrhythmias when K level is low. Also, patients with low K levels should not be taking
potassium depleting diuretics. Review the medication record to ensure medications that
are contraindicated such as K depleting diuretics are not prescribed for these patients.
Thanks for your response. For #1 Does this scenario meet the basic elements of
malpractice? No. You do not have a professional nurse-patient relationship in this case
because you were attending the event as a spectator, not in the role of the nurse. In this
scenario, there is no duty to the child. This falls under the Good Samaritan law. See
page 457 in the Nursing Today textbook. Good Samaritan statutes provide immunity
from malpractice to professionals that attempt to give assistance at the scene of an
accident. Know the laws in your state, nurses can be sued in some states if you provide
grossly negligent care.
Try this practice question and include a rationale for your response:
The nurse is assigned four patients. After receiving shift report, in which order from first
to last should the nurse assess these clients?
1. 85-year-old client with bacterial pneumonia, temp 102, and complaining of dizziness
and shortness of breath when the UAP assisted the patient up to a chair.
2. 60-year-old client with chest tubes 2 days post op following thoracotomy for lung
cancer is complaining of pain and BP changed from last reading 120/80 to 134/90
3. 35-year-old client receiving brachytherapy for cancer treatment and the 12-year-old
son has been visiting for 90 minutes and is sitting next to the bed holding the clients
hand.
, 4. 29-year-old client post abdominal surgery yesterday has an abdominal dressing over
the wound and drainage has changed from sanguineous to serosanguinous since
previous shift change.
5. Answer: 1, 3, 2, and 4.
The elderly client with pneumonia and elevated temp with dizziness and SOB is
the most acutely ill and should be the highest priority. Dizziness and SOB are
always a concern. An elevated temp and shortness of breath can lead to a
decrease in the clients oxygen levels.
The client receiving brachytherapy is the next priority. If not for patient #1 with
respiratory problems/dizzy this patient would be the top priority. Visitors for these
patients should be at least 16 years old, limited to 30 minutes at a time, and
remain at least 6 feet from the source of radiation, which is inside the patient. It’s
important you know proper precautions for patients receiving radiation treatments
including those with sealed implants.
The client with chest tubes needing pain medication is the third priority. The BP
has changed, but not enough to be the priority. A change of 20 points would be
significant.
The client with abdominal wound is not a priority. This is normal drainage.
Thanks for your response. For #2: Was the nurse correct in telling the physician about
the patient's wishes? Yes. Sometimes, doing what is correct can still lead to
unanticipated outcomes.
Nurses perform many roles in patient care including caregiver, educator, and advocate.
The Nursing Today book notes advocacy is a critical role for nurses today. This includes
advocating for patients’ rights with informed consent, advance directives, and treatment
choices as well as interpreting information. It’s important to read the pages assigned in
your textbook and know the nurse’s role regarding informed consent.
As a nurse you are expected to advocate for patients, this is especially important if the
client does not have family members to act as advocates.
You learned about safety for pediatric patients in your Maternity/Peds class. What are
important teaching points for parents regarding car seat safety for children?
Infants should remain in a rear facing car seat for as long as possible, at least until age
2. All infants and toddlers should ride in a rear-facing seat until they reach the highest
weight or height allowed by their car seat manufacturer. Most convertible seats have
limits that will allow children to ride rear facing for 2 years or more.
Children who have outgrown the rear-facing weight or height limit for their convertible
seat should use a forward-facing seat with a harness for as long as possible, up to the
highest weight or height allowed by their car seat manufacturer. Many seats can
accommodate children up to 65 pounds or more.
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