A charge nurse is providing an in-service about client advocacy to a group of newly licensed nurses. Which of the following examples should the nurse include?

Witnessing a client's signature for informed consent

Instructing a client about how to apply antiembolic stockings

Ensuring that all clients receive equal treatment

Requesting a social services consultation for a client who states they cannot afford their medications

Answer and Explanation

The Correct Answer is D

A. Witnessing a client's signature for informed consent: Witnessing consent is a legal responsibility, not an advocacy role. The nurse verifies the client’s signature but does not address the client’s needs or ensure their voice is represented in care decisions.

B. Instructing a client about how to apply antiembolic stockings: Teaching a client is part of health promotion and nursing education. While important, it does not represent advocacy since it does not involve speaking up or acting on behalf of the client’s expressed needs.

C. Ensuring that all clients receive equal treatment: Providing equitable care is an ethical obligation for all nurses but does not fully represent advocacy. Advocacy specifically involves acting on a client’s behalf when barriers or unmet needs are identified.

D. Requesting a social services consultation for a client who states they cannot afford their medications: This is advocacy because the nurse is acting on the client’s expressed concern and connecting them to resources that address barriers to care. It ensures the client’s health needs are supported beyond routine clinical interventions.

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Correct Answer is C

Explanation

A. Change the secondary IV infusion set twice weekly: Secondary IV sets, such as piggyback infusions, should generally be changed every 24 hours to reduce the risk of contamination and infection. Changing them twice weekly would not maintain proper asepsis.

B. Change a continuously infusing IV bag after 48 hr: Continuous IV bags should be replaced at least every 24 hours to prevent bacterial growth. Waiting 48 hours increases the risk of microbial contamination and bloodstream infections.

C. Change the primary IV infusion set every 96 hr: Changing the primary IV infusion set every 96 hours (4 days) aligns with standard infection-control guidelines. This interval helps maintain asepsis while minimizing the risk of IV-related infections.

D. Change the extension tubing once per week: Extension tubing connected to the IV line should be changed more frequently, typically every 72 to 96 hours, to prevent contamination. Once per week is too infrequent and increases infection risk.

A. Dispose of the wasted portion of the opioid medication in the sharps box. B. Count the total amount of opioid medication remaining after removing the needed amount. C. Ask a second nurse to witness the discarding of unused opioid medication. D. Report opioid medication count discrepancies to the provider.

Correct Answer is C

Explanation

A. Dispose of the wasted portion of the opioid medication in the sharps box: Opioid medications should never be discarded in the sharps box because it does not ensure proper tracking or accountability. Controlled substances require a witnessed disposal process.

B. Count the total amount of opioid medication remaining after removing the needed amount: While tracking inventory is important, this step alone does not ensure compliance with controlled substance regulations or safe disposal practices.

C. Ask a second nurse to witness the discarding of unused opioid medication: Having a second nurse witness the disposal of any unused portion ensures accountability, prevents diversion, and complies with legal and institutional controlled substance policies.

D. Report opioid medication count discrepancies to the provider: Discrepancies should be reported to the charge nurse or pharmacy according to policy, not directly to the provider. Reporting is part of accountability but not the immediate action during administration and disposal.

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A charge nurse is providing an in-service about client advocacy to a group of newly licensed nurses. Which of the following examples should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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