The nurse obtains a prescription to apply restraints to a patient who is agitated, aggressive, and has threatened two staff members. Which action should the nurse take regarding the use of the restraints?
1. Assess the patient every 6 hours.
2. Ensure that the order is written as "PRN confusion."
3. Remind the healthcare provider to assess the patient every other day.
4. Instruct the patient on the use of the restraints.
4. Instruct the patient on the use of the restraints.
Explanation:
The patient should be educated about the restraints and the criteria for their removal. A restraint order should never be written as PRN or used for staff convenience or to punish a patient. The patient who is restrained must be assessed constantly, not every 6 hours. The healthcare provider must assess the patient daily.
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Liability insurance is an important risk-management strategy. Which of the following is true regarding liability insurance? Select all that apply
a. Nurses can have individual coverage or group coverage. b. Liability insurance provides for payment of lawyer fees only. c. Two basic types of insurance coverage are occurrence based and claim based. d. Nurses should never be without coverage e. Employer-sponsored coverage is the most limited type of insurance.
To evaluate the effectiveness of ordered interventions for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse?
a. Chest x-ray b. Oxygen saturation c. Arterial blood gas analysis d. Central venous pressure monitoring
An 18-month-old infant is brought into the emergency room with several recent cigarette burns on his chest and legs. He cannot move his left arm, which is edematous. What is the nurse's legal responsibility in this case?
a. Do nothing immediately but plan to check the child carefully if it occurs again. b. Notify the attending physician or the emergency room supervisor. c. Tell the mother that he or she suspects abuse and chastise her about her actions. d. Since the nurse only has suspicions, re-member that an individual is innocent until proven guilty.
The nurse is assessing clients after delivery. For which client is early discharge at 24 hours after delivery appropriate?
1. Woman and baby who have had two successful breastfeedings 2. Woman who is bottle-feeding her infant and has not voided since delivery 3. Twins delivered at 35 weeks, bottle-feeding 4. Cesarean birth performed for fetal distress