A nurse tells another nurse that she thinks that he did not provide adequate care for a client who underwent a hip arthroplasty earlier that day. Which of the following responses by the accused nurse demonstrates assertiveness?
"I feel as though I met the standard of care. Would you tell me more about your concerns?"
"You must have something against me or you wouldn't be criticizing my care."
"I am at a loss for words. I always do my best to provide good care to my clients."
"You shouldn't make accusations. Your nursing care doesn't always set a good example."
The Correct Answer is A
The response by the accused nurse that demonstrates assertiveness is "I feel as though I met the standard of care. Would you tell me more about your concerns?" This response shows that the nurse is confident in their actions and is willing to listen to the concerns of the other nurse in a respectful and professional manner.
Option B is incorrect because it is defensive and does not address the concerns of the other nurse.
Option C is incorrect because it does not demonstrate assertiveness or confidence in the nurse's actions.
Option D is incorrect because it is confrontational and does not address the concerns of the other nurse in a respectful and professional manner.
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Correct Answer is B
Explanation
A nurse's best protection against negligence or malpractice is to follow the standards of practice. These standards define the acceptable level of care that a nurse is expected to provide and are based on current evidence and professional consensus. By adhering to these standards, a nurse can demonstrate that they have provided care that meets the expected level of quality and safety.
The other options are not the best protection against negligence or malpractice. Asking permission from the managing nurse prior to performing any duties [a] may be helpful in some situations, but it is not a guarantee against negligence or malpractice. Never being alone with a patient [c] is not practical or necessary for providing safe and effective care. Recording patient interactions with your phone [d] may violate patient privacy and is not an effective way to prevent negligence or malpractice.
Correct Answer is C
Explanation
The correct answer is Choice C.
Choice A rationale: A client who had a blood transfusion and has a blood pressure of 138/76 mm Hg. This client is stable. The blood pressure is within normal range, indicating that the client is not experiencing a transfusion reaction, which could cause hypotension. Therefore, this client is not the highest priority.
Choice B rationale: A client who has skeletal traction for a femur fracture and reports incisional discomfort of 4 on a scale of 0 to 10. While pain management is an important aspect of client care, a pain level of 4 indicates that the client’s pain is manageable. Therefore, this client is not the highest priority.
Choice C rationale: A client who is 4 hours postoperative following a total hip arthroplasty and has a urinary output of 15 mL/hr. This client is showing signs of oliguria, which could indicate a serious complication such as hypovolemia or acute kidney injury. This client is the highest priority because these complications can lead to further serious issues such as shock or end-organ damage if not addressed promptly.
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