All of the following statements about protocols are true EXCEPT
a. protocols are often used for immediate life-threatening situations
b. protocols are individualized for each patient
c. protocols define what interventions are permissible
d. protocols are used to save time
B
A protocol is a series of standing orders or procedures that should be followed under certain specific conditions. Health care organizations frequently have standing orders or protocols for patient preparation for diagnostic tests or for immediate interventions in life-threatening circumstances.
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A resident in a nursing home insists that a priest hear his confession. The resident is very anxious, and the nursing home does not have a Roman Catholic chaplain. Which intervention should the nurse implement?
a. An Episcopal priest is coming to visit the home this evening. Arrange an appoint-ment with her for the resident. b. Report the resident's change in behavior in detail so that the attending physician can appropriately prescribe medication. c. Refer the resident to the staff psychologist to address the underlying cause of the pa-tient's anxiety. d. Look in the local telephone book for a Roman Catholic Church, and ask the priest to visit the resident.
The nurse is reviewing the health history of a newly admitted patient and reads that the patient has been previously diagnosed with exostoses. How should the nurse accommodate this fact into the patient's plan of care?
A) The nurse should perform the Rinne and Weber tests. B) The nurse should arrange for audiometry testing as soon as possible. C) The nurse should collaborate with the pharmacist to assess for potential ototoxic medications. D) No specific assessments or interventions are necessary to addressing exostoses.
The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient?
a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis
One of the nurses on your unit tells you that his grandmother, who speaks no English, was recently admitted to the hospital with a heart condition. The nurses caring for the grandmother have labeled her a difficult patient
The nurse further explains that the grandmother immigrated from China just 6 months ago and generally only interacts with family members and close family friends. You hypothesize that the grandmother is most likely experiencing which of the following? a. Cultural intensity c. Cultural stereotyping b. Culture shock d. Cultural incompetence