After bilateral knee replacement surgery, an elderly client wants to go to a rehabilitation facility for additional physical therapy. That facility refuses to admit this client for insurance reasons. The nurse then calls the insurance company and strongly explains why this client needs to go to a rehabilitation facility. This is an example of:

responsibility.

confidentiality.

social justice.

advocacy

Answer and Explanation

The Correct Answer is D

A. Responsibility: Responsibility refers to the duty or obligation to fulfill one's role or tasks appropriately. While advocating for the client may be considered a responsibility of the nurse, the specific action described in the scenario—calling the insurance company to strongly explain the client's need for rehabilitation—is more accurately categorized as advocacy.

B. Confidentiality: Confidentiality pertains to protecting the privacy and confidentiality of patient information. The scenario does not involve the disclosure of confidential information but rather advocating for the client's needs regarding their rehabilitation placement.

C. Social justice: Social justice involves promoting fairness, equality, and equitable access to resources and opportunities for all members of society. While advocating for the client may align with principles of social justice, the specific action described in the scenario—calling the insurance company to argue for the client's rehabilitation placement—is more directly related to individual advocacy rather than addressing broader societal inequalities.

D. Advocacy: Advocacy refers to actively supporting and speaking up for the rights, needs, and interests of others. In this scenario, the nurse advocates for the elderly client by calling the insurance company to strongly explain why the client needs to go to a rehabilitation facility despite the facility's refusal. This action demonstrates the nurse's commitment to ensuring the client receives appropriate care and support.

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Free Nursing Study Resources

Correct Answer is ["A","E"]

Explanation

When administering an enema to an adult patient with constipation, the nurse must insert the tubing into the patient's rectum to deliver the enema solution effectively. However, it's crucial to avoid inserting the tubing too far to prevent injury or discomfort to the patient. The recommended insertion distance varies depending on the individual patient's anatomy and the type of enema being administered.

A. 4 in. (10.2 cm):

Inserting the enema tubing approximately 4 inches (10.2 cm) into the patient's rectum is considered a safe and effective distance for most adult patients. This depth allows the enema solution to reach the sigmoid colon, facilitating the evacuation of stool and relieving constipation without risking insertion too deeply into the rectum.

B. 5 in (12.7 cm): Inserting the tubing 5 inches into the rectum is generally deeper than necessary and may increase the risk of injury or discomfort. This distance is not typically recommended for safe and effective administration of an enema.

C. 6 in. (15.25 cm): Inserting the tubing 6 inches into the rectum is deeper than necessary and may increase the risk of injury or discomfort. This distance is generally not recommended for safe and effective administration of an enema.

D. 2 in. (5.1 cm): Inserting the tubing 2 inches into the rectum is not considered a safe and effective distance for many adult patients. This distance does not allow for the effective delivery of the enema solution into the lower rectum and sigmoid colon without inserting the tubing too far.

E. 3 in. (7.6 cm): Inserting the tubing 3 inches into the rectum is also considered a safe and effective distance for many adult patients. This distance allows for the delivery of the enema solution into the lower rectum and sigmoid colon without inserting the tubing too far.

A. Multiple lesions on dorsal aspect of feet probably due to elder abuse B. Four burned areas noted on plantar area of each foot C. Several partially healed lesions on bottom of left foot, looks like cigarette burns D. Four round, 2 cm in diameter lesions on plantar aspect of right foot

Correct Answer is D

Explanation

A. Multiple lesions on the dorsal aspect of feet probably due to elder abuse: This option includes a speculative interpretation of the lesions and implies a potential cause (elder abuse) without clear evidence. Speculating about the cause of lesions without proper assessment or confirmation is inappropriate for documentation.

B. Four burned areas noted on the plantar area of each foot: This option describes the finding of burned areas on the plantar area of each foot, but it lacks specificity regarding the size or characteristics of the burns. Additionally, it does not differentiate between the left and right foot. Clarity and precision are important in documentation to ensure accurate communication of findings.

C. Several partially healed lesions on the bottom of the left foot, looks like cigarette burns: While this option provides some details about the location and appearance of the lesions, it lacks specificity regarding the number and size of the lesions. Additionally, it focuses only on the left foot, omitting any findings from the right foot.

D. Four round, 2 cm in diameter lesions on the plantar aspect of the right foot: This is the correct answer. It provides clear and specific details about the findings, including the number, size, and location of the lesions. Using objective descriptors such as "round" and "2 cm in diameter" enhances the clarity of the documentation. Additionally, specifying the location as "plantar aspect of the right foot" ensures accurate communication of the assessment findings.

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Naxlex Comprehensive Predictor Exams

The nurse must administer an enema to an adult patient with constipation. Which is a safe and effective distance for the nurse to insert the tubing into the patient's rectum? (SELECT ALL THAT APPLY)

Correct Answer is ["A","E"]

Explanation

What is the best way for the nurse to document the assessment of a client's foot on the Admission Database?

Correct Answer is D

Explanation

What is the best description for the professional value of social justice? The nurse…

A client who is under extreme stress will have an increased production of antidiuretic hormone (ADH) and aldosterone. The nurse should expect a decrease in which clinical finding?

The nurse is caring for a client who presents with a sudden 5 lb. (2.3 kg) weight gain, bounding pulses, and a blood pressure of 174/94. These clinical findings are indicative of:

The nurse teaches the client that fiber provides the bulk in the stools to allow for easier defecation. The nurse recognizes that teaching is effective when the client's menu choices include more:

Nurse Z is extremely attentive to their client's emotional & spiritual needs. The nurse spends up to 45 minutes each day providing the psychosocial support. As a result, the nurse does not plan enough time to perform assessments or give medications on time. This nurse is liable for:

A client is prescribed isotonic IV hydration for their current fluid balance problem. Which property of isotonic fluid replacement is essential for the nurse to understand?

A nurse verbally contracts with a client to reassess their pain level after repositioning and an analgesic is given. The nurse returns within 60 minutes to evaluate effectiveness of the interventions. What ethical principle does this represent?

At change of shift, the off going nurse notices a distinct odor of alcohol on the breath of the nurse who is receiving report. Which action is most appropriate?