A nurse wants to follow nursing standards of care. Which document should the nurse follow?
a. World Health Organization guidelines
b. National League for Nursing brochure
c. Health care facility's written procedure manual
d. Department of Health and Human Services guidelines
C
The health care facility's written procedure manual is defined as a standard of care. Standards of care are defined by the following: (1) State Nurse Practice Acts, (2) state and federal hospital licensing laws and accreditation rules, (3) professional and specialty organizations, and (4) written policies and procedures of the nurse's health care facility. Brochures are not standards of care. World Health Organization and Department of Health and Human Services are not state or federal hospitals or professional and specialty organizations for nurses.
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An adolescent client is attempting to manipulate the nurse into giving a special privilege. The nurse recognizes the manipulation and responds by saying:
1. "All the clients must follow the rules." 2. "If I do it for you, I would have to do it for everyone." 3. "If I granted you that privilege, I'd be in trouble" 4. "That would not be fair to the others."
Because a client's mother took diethylstilbestrol (DES) during pregnancy, a nurse should advise a client to maintain screening practices for which associated health risk?
a. Decreased sperm count b. High risk of erectile dysfunction c. Increased chance of bladder cancer d. Increased risk of testicular cancer
When a nurse working in a well-child clinic asks a parent's address, the parent responds, "My children and I are homeless." The nurse can assess this response as
a. a common occurrence, because 1 out of 50 children are homeless. b. a signal to investigate the possibility that the parent has severe mental illness. c. evidence of child abuse or neglect that should be reported to social service agencies. d. unusual because most homeless individuals have severe mental illness or substance abuse problems.
The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient?
1. The patient will be at risk to experience a decreased effectiveness of the drug. 2. The patient will be at risk to experience toxic effects of the drug. 3. The patient's kidneys will excrete the drug at a faster rate. 4. The patient's serum globulin is more important than serum albumin.