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A nurse is caring for a group of clients. Which of the following actions by the nurse demonstrates client advocacy?

A.

Submitting an incident report to risk management following a client fall

B.

Documenting the effectiveness of pain medication in the client's health record

C.

Asking another nurse to check a medication calculation for a client

D.

Informing the family of a deceased client of the client's wish to be an organ donor

Answer and Explanation

The Correct Answer is D

A. "Submitting an incident report to risk management following a client fall." While this is important for safety and quality improvement, it is not a direct act of client advocacy.
B. "Documenting the effectiveness of pain medication in the client's health record." This is a critical part of nursing documentation but does not actively advocate for the client.
C. "Asking another nurse to check a medication calculation for a client." This promotes medication safety, but it is not an example of client advocacy.
D. "Informing the family of a deceased client of the client's wish to be an organ donor." Advocacy means ensuring the client’s wishes are honored, especially in sensitive situations like organ donation.
 


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Related Questions

Correct Answer is ["A","B","C","D","E","F","G","H"]

Explanation

The key pieces of information that indicate the client is at risk for falls include:

  1. Admitted following a fall down approximately five steps – Indicates a recent fall history.
  2. Client's partner reports client possibly hit their head and was a little disoriented for a minute or two – Suggests potential confusion or altered mental status.
  3. Client has a history of falls and orthostatic hypotension per client's partner – A significant risk factor for future falls.
  4. Client uses a walker – Indicates mobility impairment.
  5. Client ordered new glasses following an eye exam last week but has not received them yet – Vision impairment increases fall risk.
  6. Blood pressure: Lying: 130/90 mm Hg, Sitting: 128/88 mm Hg, Standing: 98/60 mm Hg – Orthostatic hypotension (drop in BP upon standing) can cause dizziness and falls.

Correct Answer is B

Explanation

A. "Although this is your first incident, we will have to terminate your employment." This response is punitive and does not align with a just culture, which seeks to identify the cause of errors rather than immediately disciplining staff.
B. "We will review the incident report to determine the cause of the missed medication." This aligns with just culture principles by focusing on finding the root cause (e.g., workload issues, system inefficiencies) rather than blaming the nurse.
C. "I will need to report this incident to the state board of nursing." A missed medication dose that caused no harm typically does not require reporting to the state board. Just culture focuses on improving processes rather than unnecessary punishment.
D. "The facility's legal team will be contacting you to discuss the incident." Involving legal action for a minor, non-harmful event is excessive and contradicts just culture, which emphasizes education, accountability, and system improvements over legal consequences.

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