A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway?

An allergy to penicillin required an alternative antibiotic to be prescribed.

Antibiotic therapy was initiated 2 hr after implementation of the care pathway.

The route of antibiotic therapy on the care pathway was changed from IV to PO.

A blood culture was obtained after antibiotic therapy had been initiated.

Answer and Explanation

The Correct Answer is D

The correct answer is: d.

Choice A reason: An allergy to penicillin requiring an alternative antibiotic to be prescribed is a common and expected variation in care. Allergies are patient-specific factors that must be accommodated within the care pathway. The need for an alternative antibiotic does not typically constitute a variance that requires reporting, as adjustments for allergies are part of personalized care planning.

Choice B reason: Initiating antibiotic therapy 2 hours after implementation of the care pathway may not require a variance report if it falls within the acceptable time frame for antibiotic administration. The timing of antibiotic therapy can be critical, but slight deviations are often accounted for within the care pathway guidelines. However, if the care pathway specifies a narrower time frame for initiation, then this could be a reportable variance.

Choice C reason: Changing the route of antibiotic therapy from IV to PO (oral) is a clinical decision that may be based on the patient's condition, progress, and ability to tolerate oral medications. This switch is a part of antimicrobial stewardship and is often encouraged when clinically appropriate to reduce IV line use and potential complications. It is a standard practice and does not typically require a variance report unless the change contradicts a specific protocol in the care pathway.

Choice D reason: Obtaining a blood culture after the initiation of antibiotic therapy is a significant variance from the standard care pathway. Blood cultures should be obtained before starting antibiotics to accurately identify the causative organisms and their antibiotic sensitivities. Starting antibiotics before obtaining blood cultures can reduce the likelihood of growing the bacteria in the culture, potentially leading to misdiagnosis and inappropriate treatment. This is a deviation from the standard of care that requires a variance report.

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Correct Answer is B

Explanation

Choice A reason: This is not the correct choice because the Good Samaritan Act is a law that protects health care providers and other individuals from legal liability when they provide emergency care to someone who is injured or ill outside of a health care facility. The act does not apply to the staff in the emergency department, who are expected to follow the standards of care and obtain consent for treatment.

Choice B reason: This is the correct choice because implied consent is a type of consent that is assumed when a client is unable to give verbal or written consent due to their condition, and the treatment is necessary to save their life or prevent further harm. The staff can proceed with emergency surgery based on implied consent, as the client is unconscious and has extensive internal injuries that require immediate intervention.

Choice C reason: This is not the correct choice because a living will is a document that expresses a client's wishes regarding their end-of-life care, such as whether they want to receive life-sustaining treatments or not. A living will does not apply to the client in this scenario, who is not terminally ill or in a persistent vegetative state, and who may recover from their injuries with surgery.

Choice D reason: This is not the correct choice because nonmaleficence is an ethical principle that means to do no harm or prevent harm to the client. Nonmaleficence does not permit the staff to proceed with emergency surgery, as it does not override the need for consent. The staff should also consider the principle of beneficence, which means to do good or promote the well-being of the client.

A. Notify staff of the increased fall rate. B. Identify clients who are at risk for falls. C. Review current literature regarding client falls. D. Implement a fall prevention plan.

Correct Answer is B

Explanation

Choice A reason: Notifying staff of the increased fall rate is not the first action that the nurse should take, as it does not address the root cause of the problem or the possible solutions. The nurse should inform the staff of the fall rate after conducting a thorough analysis and developing a plan of action.

Choice B reason: Identifying clients who are at risk for falls is the first action that the nurse should take, as it helps to determine the scope and severity of the problem and the factors that contribute to it. The nurse should use a valid and reliable tool to assess the fall risk of each client and document the findings.

Choice C reason: Reviewing current literature regarding client falls is not the first action that the nurse should take, as it does not provide specific information about the facility's situation or the client's needs. The nurse should review the literature after identifying the clients who are at risk for falls and before implementing a fall prevention plan.

Choice D reason: Implementing a fall prevention plan is not the first action that the nurse should take, as it requires evidence-based interventions and evaluation methods that are tailored to the facility's context and the client's characteristics. The nurse should implement a fall prevention plan after reviewing the current literature and obtaining approval from the stakeholders.

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A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway?

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Explanation

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Explanation

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