A nurse administers an incorrect medication to a client. Following an assessment of the client, the nurse determines that the client has not experienced any adverse effects as a result of the medication. The nurse does not complete an incident report because no harm came to the client. Which of the following ethical principles did the nurse violate?

Autonomy.

Veracity.

Confidentiality.

Beneficence.

Answer and Explanation

The Correct Answer is B

A. Autonomy: This principle refers to respecting a patient's right to make their own decisions about their healthcare. In this scenario, the nurse's actions did not directly impact the client's autonomy, as the client was not involved in the decision-making process regarding the incident report.

B. Veracity: This principle involves being truthful and transparent. By not completing an incident report, the nurse failed to uphold veracity, as this action concealed the truth about the medication error, potentially affecting future care and trust in the healthcare system.

C. Confidentiality: This principle is about protecting patient information. The nurse's failure to report the incident did not violate confidentiality, as it did not involve disclosing or mishandling the client's private information.

D. Beneficence: This principle focuses on doing good and acting in the best interest of the patient. While the nurse's intention might have been to avoid unnecessary alarm, failing to report the incident could prevent the healthcare team from learning from the mistake and improving patient safety, thus indirectly affecting beneficence.

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Correct Answer is D

Explanation

Choice A rationale:

Hypotension is not an expected manifestation of hypoxemia during an asthma attack. Hypotension refers to abnormally low blood pressure. During an asthma attack, the body's response to hypoxemia is more likely to involve increased heart rate (tachycardia) as the heart attempts to compensate for decreased oxygen levels.

Choice B rationale:

Dysphagia is not directly related to hypoxemia during an asthma attack. Dysphagia refers to difficulty swallowing, which is not a typical respiratory manifestation. Hypoxemia in asthma is more likely to lead to symptoms such as shortness of breath, wheezing, and increased work of breathing.

Choice C rationale:

Peripheral edema is not a typical manifestation of hypoxemia during an asthma attack. Peripheral edema, or swelling in the extremities, can occur in conditions like heart failure but is not directly related to the airway constriction and reduced oxygen exchange seen in asthma attacks.

Choice D rationale:

Agitation is the correct choice. Hypoxemia, which occurs when there is a decrease in the oxygen levels in the blood, can lead to inadequate oxygen supply to the brain. This can result in neurological symptoms such as agitation, restlessness, confusion, and even loss of consciousness. Agitation is a manifestation of the body's attempt to cope with the lack of oxygen.

A. Cyanosis. B. Petechiae. C. Dizziness. D. Blood pressure.

Correct Answer is C

Explanation

Choice A rationale:

Cyanosis - Cyanosis is a bluish discoloration of the skin and mucous membranes due to inadequate oxygenation of the blood. This is an objective sign that can be visually assessed, not based on the patient's description.

Choice B rationale:

Petechiae - Petechiae are small, pinpoint, red or purple spots on the skin caused by bleeding under the skin. Like cyanosis, this is a physical finding that can be observed directly.

Choice C rationale:

Dizziness - This is the correct choice. Dizziness is a subjective sensation that the patient experiences. It cannot be directly observed and relies on the patient's description of feeling unsteady, lightheaded, or having a spinning sensation.

Choice D rationale:

Blood pressure - Blood pressure is an objective measurement that can be taken using a blood pressure cuff and a stethoscope or automated device. It is not based on the patient's description and does not fall under subjective data.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

Correct Answer is D

Explanation

A nurse on the Cardiovascular unit is completing the patient's history and physical examination. Which of the following information provided by the patient should the nurse consider as subjective data?

Correct Answer is C

Explanation

A nurse is assessing a patient who has chronic bronchitis. The nurse should expect the patient's chest to be which of the following shapes?

A nurse is educating a newly licensed nurse about ethical principles. Which of the following situations is an example of beneficence?

A school nurse identifies that a child has pediculosis capitis (head lice) and educates the child's parents about the condition. Which of the following statements by the parents indicates an understanding of the teaching?

A nurse is admitting a client who has measles and a persistent cough. Which of the following actions is a priority for the nurse to take?

A Medical-Surgical nurse is assessing a client's heart sounds. In which of the following points of auscultation would the nurse hear the S2 sound most clearly?

A nurse on the Medical-Surgical unit is caring for a patient with a surgical incision that eviscerates. Which actions will the nurse take? (Select all that apply.).

A nurse is caring for a postoperative client who is awake, alert, and oriented. Which of the following methods should the nurse use as part of her pain management interventions to determine the intensity of the client's pain?

A nurse is providing discharge teaching for a client who requires home oxygen therapy. Which of the following statements should the nurse identify as an indication that the client needs further teaching?