A charge nurse in a long-term care facility notices the smell of alcohol on a nurse's breath. Which of the following actions should the nurse take first?
Assign clients to the remaining staff.
Call the supervisor to ask for another nurse.
Remove the nurse from the client care area.
Document objective findings about the situation.
The Correct Answer is C
A. Assign clients to the remaining staff is not the first action. The nurse should address the suspected impairment of the staff member before assigning clients to others.
B. Call the supervisor to ask for another nurse is not the first action. While notifying the supervisor is important, the nurse should first ensure that the impaired nurse is removed from direct client care to prevent any potential harm to clients.
C. Remove the nurse from the client care area is correct. The first priority is to ensure that the nurse who may be impaired is not caring for clients to ensure client safety.
D. Document objective findings about the situation is important but not the first step. The immediate priority is ensuring the safety of clients by removing the nurse from the care area. Documentation can follow after ensuring client safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The client's potassium level is 2.7 mEq/L is incorrect. A potassium level of 2.7 mEq/L is low and indicates hypokalemia, which is a life-threatening condition that can occur in anorexia nervosa, particularly if the client is engaging in behaviors like purging. This level should be addressed immediately, not considered a positive outcome.
B. The client resumes menstruation is correct. The resumption of menstruation is a positive outcome of treatment for anorexia nervosa. It indicates that the client's nutritional status has improved and that the body is starting to regain normal function after addressing issues like malnutrition and hormonal imbalances.
C. The client's pulse rate is 44/min is incorrect. A pulse rate of 44/min is bradycardia, which is a common sign of anorexia nervosa due to malnutrition and the body's attempt to conserve energy. While it may improve with treatment, this finding would not be considered a positive outcome.
D. The client develops lanugo is incorrect. Lanugo (fine, soft hair) typically develops in severe anorexia nervosa due to malnutrition and is a sign of starvation. The appearance of lanugo is not a positive outcome but rather a compensatory mechanism to retain heat, indicating that the client is still in a malnourished state.
Correct Answer is A
Explanation
A. “I will consider what is going to benefit the most people when making decisions.”: This is correct. Utilitarianism is an ethical theory that focuses on the greatest good for the greatest number of people. Decisions are made based on the outcomes that benefit the most individuals, even if they might not always align with individual preferences.
B. "I will respect the decision of a client who has a chronic illness to stop treatment.": This reflects the principle of autonomy, not utilitarianism. Autonomy focuses on respecting an individual's right to make their own decisions, rather than the greater good.
C. "I will place a higher emphasis on human dignity than on the needs of a group.": This statement leans more toward a deontological perspective, which prioritizes individual rights and dignity over collective benefits.
D. "I will withhold a terminal diagnosis from a client who has cancer.": This reflects a paternalistic approach, where decisions are made by healthcare providers for the patient, which is not a principle of utilitarianism. Utilitarianism would consider the benefits and harms of full disclosure to the patient, rather than withholding information.
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