A nurse has been found guilty of medication mismanagement at the community clinic. The nurse was fired and the nurse manager was obligated to report the event.
Which organization has the legal obligation to enforce the laws and rules found in a Nurse Practice Act?

Choice A rationale

Atraumatic care focuses on minimizing physical and psychological distress for both the client and their caregivers. By employing strategies such as therapeutic play, age-appropriate explanations, and parental involvement, it reduces fear, anxiety, and stress responses, which can negatively impact physiological outcomes and coping mechanisms. This approach promotes a sense of security and control.

Choice B rationale

Atraumatic care aims to *enhance* client and caregiver control, not remove it. Empowering clients and families by providing information, involving them in decision-making, and respecting their preferences is a core principle. This approach fosters a sense of partnership and autonomy, which inherently reduces feelings of helplessness and stress, improving overall well-being.

Choice C rationale

By minimizing emotional and physical distress, atraumatic care helps to reduce the physiological stress response, including the release of cortisol and catecholamines. This reduction in stress mediators can improve immune function and reduce inflammation, thereby promoting a more conducive environment for healing and recovery, leading to potentially faster resolution of illness or injury.

Choice D rationale

Atraumatic care often requires *more* time initially from nurses to establish rapport, provide thorough explanations, engage in therapeutic play, and involve families in care. While it can lead to improved long-term outcomes and potentially fewer complications, its immediate implementation involves an investment of time to ensure comfort and understanding, not a reduction.

Choice A rationale

While clients with Cushing's syndrome may experience fatigue due to elevated cortisol levels affecting sleep patterns and muscle catabolism, clustering activities only in the morning may not adequately address the fluctuating energy levels or provide sufficient rest periods throughout the day. A more balanced approach involving rest periods and activity modification throughout the day is generally more beneficial.

Choice B rationale

Clients with Cushing's syndrome often experience fluid retention and edema due to the mineralocorticoid effects of excess cortisol. Therefore, increasing fluid intake would exacerbate fluid overload rather than alleviate symptoms. Fluid restriction and diuretic therapy may be necessary to manage fluid balance and prevent complications like hypertension and heart failure.

Choice C rationale

Cushing's syndrome is characterized by endogenous overproduction of cortisol, meaning the body already produces too much. Requesting a medical prescription for cortisol would further elevate cortisol levels, worsening the client's symptoms and potentially leading to adrenal crisis if exogenous cortisol is administered in addition to already elevated endogenous levels. Management focuses on reducing cortisol.

Choice D rationale

Assessing daily weights is crucial for clients with Cushing's syndrome due to the propensity for fluid retention and weight gain caused by increased mineralocorticoid activity of cortisol. Daily weights provide an objective measure of fluid balance and can indicate exacerbation or improvement of edema, helping guide interventions and monitor treatment effectiveness. Normal weight fluctuation should be within 1-2 kg in 24 hours.