A nurse is reviewing legal issues in health care with a group of newly licensed nurses. Which of the following recommendations should the nurse make?

Ensure that each client has a living will on file prior to treatment.

Place copies of incident reports in clients' medical records.

Obtain personal professional liability insurance coverage.

Overestimate clients' acuity to prevent short staffing.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Ensure that each client has a living will on file prior to treatment: While advance directives are encouraged, clients have the right to choose whether to have one, and care cannot be delayed or denied if they do not.

B. Place copies of incident reports in clients' medical records: Incident reports are internal risk management tools and should not be placed in the medical record, as this could increase legal liability and compromise confidentiality.

C. Obtain personal professional liability insurance coverage: Having individual liability coverage provides additional protection beyond employer coverage, ensuring legal and financial support if malpractice claims arise.

D. Overestimate clients' acuity to prevent short staffing: Falsifying acuity levels is unethical and can result in disciplinary action or loss of license; staffing concerns should be addressed through proper administrative channels.

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Correct Answer is D

Explanation

A. Vaccinate susceptible children and adults against smallpox: Vaccination is a public health intervention but is typically conducted under the direction of public health authorities and is not a routine nursing disaster preparation activity.

B. Assess types, levels, and scopes of disasters: While understanding disaster types is important, assessment of scope and level is generally part of emergency management planning at an organizational or governmental level, rather than a direct nursing responsibility.

C. Make quarantine preparations for those exposed to anthrax: Quarantine planning is a public health measure implemented by authorities during an actual event. Nurses may assist in care during quarantine, but preparing quarantines is not a primary preparation activity.

D. Participate in community drills and mock events: Engaging in drills and simulations allows nurses to practice roles, improve response times, and enhance preparedness for real disaster situations. Participation in these exercises is a key nursing activity in disaster planning.

A. Place the head of the client's bed flat with the client's legs extended. B. Apply butterfly strips to approximate the wound edges. C. Apply pressure directly to the wound for 15 min. D. Place a sterile, saline-soaked dressing on the wound.

Correct Answer is D

Explanation

Rationale:

A. Place the head of the client's bed flat with the client's legs extended: Positioning flat may increase tension on the abdominal incision, potentially worsening the dehiscence. A low Fowler’s position with knees slightly bent is preferred to reduce strain on the wound.

B. Apply butterfly strips to approximate the wound edges: Forcing the wound edges together could trap bacteria inside and increase the risk of infection. Dehiscence requires moist protection, not forced closure at the bedside.

C. Apply pressure directly to the wound for 15 min: Direct pressure is appropriate for active bleeding, not for dehiscence. Applying pressure could damage tissues further and does not address the need to protect exposed structures.

D. Place a sterile, saline-soaked dressing on the wound: A moist sterile dressing protects the wound from contamination, prevents the tissues from drying, and reduces the risk of infection while awaiting further surgical evaluation.

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Body System	Findings
Integumentary	Skin feels cool to the touch. Capillary refill 3 seconds in left foot Dressing on left hand shows small amount of moisture through gauze.
Vital Signs	Blood pressure 102/50 mm Hg Temperature 35.8° C (96.4° F) Respiratory rate 20/min
Genitourinary	Output of 25 mL dark amber urine through catheter

A nurse is reviewing legal issues in health care with a group of newly licensed nurses. Which of the following recommendations should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A newly licensed nurse is reviewing the role of a nurse in disaster planning. Which of the following is an activity a nurse should engage in disaster preparation?

Correct Answer is D

Explanation

A nurse caring for a postoperative client removes the client's dressing and notes an area of dehiscence. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse is reviewing the medical records of four clients. The nurse should identify that which of the following client findings requires follow-up care?

A nurse is caring for a client who speaks a language different from the nurse. Which of the following actions should the nurse take?

A nurse is assessing a school-age child who has moderate dehydration due to diarrhea and vomiting. Which of the following manifestations should the nurse expect?

A nurse is caring for a client who is scheduled for surgery. The client states, "I have decided not to have the surgery." Which of the following responses should the nurse make to the client?

A nurse is caring for a client who is scheduled for a surgical procedure and states, "I don't want to have this surgery anymore." Which of the following responses should the nurse make?

A nurse is assessing a client who is prescribed spironolactone. Which of the following laboratory values should the nurse monitor for this client?

A nurse is administering furosemide IV bolus to a client who has fluid volume excess. The nurse should recognize which of the following findings as an indication that the medication has been effective?