A nurse is teaching a class on torts.
The nurse should include which of the following situations as an example of negligence?
A client who is competent refuses an antidepressant medication. The nurse dissolves the medication in food and administers it to her without her knowledge.
A client who is alert and oriented makes an informed decision to leave the hospital against medical advice. The nurse applies restraints to the client to prevent him from leaving.
A nurse finds a client who is on a low-sodium diet eating salted potato chips. The nurse tells the client that she will apply wrist restraints if he does not stop eating the salted potato chips.
A nurse identifies the absence of peripheral pulsation in a casted extremity in the early morning and reports it to the provider in the early afternoon.
The Correct Answer is D
Choice A rationale
Administering medication without a competent client's knowledge or consent constitutes battery, an intentional tort. Battery involves an unconsented touching of another person, even if the intent is benevolent. This action violates the client's autonomy and right to self-determination regarding their medical treatment, which is a fundamental ethical and legal principle in healthcare.
Choice B rationale
Applying restraints to a competent, alert, and oriented client who wishes to leave against medical advice is false imprisonment, an intentional tort. False imprisonment involves the unlawful restraint of a person against their will. Competent adults have the right to refuse treatment and discharge themselves, and their freedom of movement cannot be unduly restricted.
Choice C rationale
Threatening to apply restraints to a client for not adhering to a dietary restriction constitutes assault, an intentional tort. Assault involves placing another person in reasonable apprehension of an immediate harmful or offensive contact. While dietary adherence is important, threatening physical restraint for non-compliance is an inappropriate and unlawful response.
Choice D rationale
This scenario exemplifies negligence, which is unintentional tort. Negligence occurs when a healthcare professional fails to act as a reasonably prudent nurse would under similar circumstances, resulting in harm to the patient. The delay in reporting a critical change in a client's condition, such as absent peripheral pulsation, falls below the standard of care and can lead to severe and irreversible tissue damage or limb loss.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
A normal serum sodium level ranges from 135 to 145 mEq/L. A value of 120 mEq/L is significantly below the normal range, indicating hyponatremia, not an elevated level. Therefore, reporting it as elevated would be incorrect.
Choice B rationale
While laboratory errors can occur, a serum sodium level of 120 mEq/L in a client with chronic renal failure is a plausible finding due to impaired fluid and electrolyte balance, making a repeat analysis not the immediate primary interpretation without further clinical context.
Choice C rationale
While electrolyte abnormalities are common in chronic renal failure, a serum sodium of 120 mEq/L is a low sodium level (hyponatremia), not necessarily an "expected" abnormality in the sense of being benign or typical without specific context. It reflects a significant imbalance.
Choice D rationale
Chronic renal failure often leads to fluid retention due to impaired kidney excretion. This excessive water retention dilutes the body's sodium concentration, leading to a condition known as dilutional hyponatremia, where the total body sodium may be normal or even elevated, but its concentration is lowered by the excess fluid.
Correct Answer is A
Explanation
Choice A rationale
Confronting bullying behavior directly establishes clear professional boundaries and expectations within the unit. This approach fosters a psychologically safe environment, which is crucial for team cohesion and optimal patient care. Addressing the issue promptly prevents escalation and demonstrates leadership commitment to a respectful workplace, promoting accountability and encouraging healthier communication patterns among staff.
Choice B rationale
Modeling bullying behavior is counterproductive and unethical, as it normalizes and perpetuates harmful actions within the workplace. Such actions undermine trust, decrease morale, and can lead to increased stress, burnout, and higher staff turnover rates. A nurse manager's role is to promote a positive and supportive work environment, not to emulate detrimental behaviors.
Choice C rationale
Ignoring horizontal violence, even if not physical, can have significant negative psychological and professional consequences for staff members and the unit. Verbal abuse and gossip erode trust, create a toxic work environment, and can lead to increased anxiety, depression, and decreased job satisfaction, ultimately impacting patient care quality.
Choice D rationale
While logging observed behavior is a useful documentation tool, waiting for an annual evaluation to address horizontal violence delays necessary intervention. Prompt and direct confrontation is essential to mitigate immediate harm and prevent further escalation. Addressing the issue in a timely manner demonstrates a commitment to a safe workplace and supports a healthy team dynamic.
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