A nurse enters a client's room and finds the client lying on the floor. All four side rails of the client's bed are raised. The nurse should identify that this situation is an example of which of the following components of nursing malpractice?

Unreasonable intrusion

Libel

Negligence

Assault

Answer and Explanation

The Correct Answer is C

Rationale:

A. Unreasonable intrusion: This term refers to a violation of a client's right to privacy, such as entering a room without consent or exposing private health information. It does not apply to patient injury or safety issues resulting from care decisions.

B. Libel: Libel involves written defamation that harms a person’s reputation. It is not relevant to a situation involving physical injury or improper use of restraints like raised bedrails.

C. Negligence: Negligence occurs when a nurse fails to provide the standard of care, leading to client harm. Raising all four side rails can be considered a form of restraint and increases the risk of injury from falls, especially if the client attempts to climb over them, making this a clear example of negligence.

D. Assault: Assault in nursing involves threatening or attempting to touch a client without consent. It does not apply to passive actions that result in harm, such as improper restraint or fall risk management.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is C

Explanation

Rationale:

A. Position the client to maintain hip flexion: Hip flexion greater than 90 degrees increases intra-abdominal and intrathoracic pressure, which can impair venous return from the brain and raise intracranial pressure. The hips should be kept in a neutral, extended position.

B. Administer an enema if the client develops constipation: While managing constipation is important, enemas can stimulate the vagus nerve and raise ICP due to straining. Stool softeners or gentle interventions are preferred to avoid abrupt increases in intracranial pressure.

C. Provide 100% oxygen to the client prior to suctioning: Preoxygenation prevents hypoxia, which can increase cerebral blood flow and elevate ICP. Suctioning should always be preceded by hyperoxygenation to reduce this risk in patients with brain injuries.

D. Ensure that the PEEP level is set at 20 cm of H2O: High PEEP levels like 20 cm H₂O can impede cerebral venous outflow and raise ICP. PEEP should be used cautiously in clients with brain injuries and adjusted to the lowest effective setting to maintain oxygenation.

A. Health Insurance Portability and Accountability Act of 1996 B. Occupational Safety and Health Administration C. Professional standards review organization D. Emergency Medical Treatment and Active Labor

Correct Answer is B

Explanation

Rationale:

A. Health Insurance Portability and Accountability Act of 1996: HIPAA regulates the protection and confidentiality of patient health information. It does not address employee vaccination requirements or workplace safety related to infectious disease exposure.

B. Occupational Safety and Health Administration: OSHA requires employers to offer the hepatitis B vaccine to all employees who may be exposed to blood or other infectious materials. This is part of its Bloodborne Pathogens Standard to reduce occupational risk.

C. Professional standards review organization: These groups evaluate the quality and efficiency of care provided by healthcare institutions but are not regulatory bodies for workplace safety or immunization protocols.

D. Emergency Medical Treatment and Active Labor: EMTALA ensures public access to emergency services regardless of ability to pay. It is not related to employee vaccination or workplace infection control policies.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse enters a client's room and finds the client lying on the floor. All four side rails of the client's bed are raised. The nurse should identify that this situation is an example of which of the following components of nursing malpractice?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is developing a plan of care for a client who has increased intracranial pressure from a traumatic brain injury and is receiving mechanical ventilation. Which of the following interventions should the nurse include in the plan?

Correct Answer is C

Explanation

An employee health nurse is teaching a newly hired nurse about the protocol for having hepatitis B vaccine available for administration to employees. Which of the following requires the availability of this vaccine for employees?

Correct Answer is B

Explanation

A public health nurse is preparing an awareness program to decrease health care disparities by introducing the goals for Healthy People 2020. The nurse should include which of the following goals in the program?

A nurse is developing a plan of care for a client who has a head injury. Which of the following interventions should the nurse include in the plan to prevent the client from experiencing an increase in intracranial pressure? (Select all that apply.)

A nurse is assessing a client who has meningitis. The nurse should identify which of the following findings as a manifestation of hydrocephalus?

A nurse is caring for a client who has Parkinson's disease and is taking carbidopa/levodopa. The nurse should identify that which of the following types of medications is contraindicated with the use of this medication?

A nurse is developing a plan of care for a client who has cirrhosis. Which of the following interventions should the nurse include in the client's plan?

A nurse is teaching an educational session about risk management. Which of the following actions should the nurse include as the first step of the risk management process?

A nurse manager witnesses a nurse having a conflict with an assistive personal (AP). Which of the following actions should the nurse manager take first?

A charge nurse is assigning care for four clients. Which of the following tasks should the nurse identify as within the nursing role of the licensed practical nurse?