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:

poor time management

neglect

fraud

an intentional tort

Answer and Explanation

The Correct Answer is A

A. Poor time management: This option is the correct answer. Poor time management occurs when a nurse fails to allocate sufficient time to complete essential nursing tasks, such as assessments and medication administration, due to excessive focus on non-priority activities, such as providing emotional and spiritual support. In this scenario, Nurse Z's inability to plan and allocate adequate time for essential nursing duties indicates poor time management skills.

B. Neglect: Neglect involves the failure to provide necessary care or attention to a client's needs, resulting in harm or potential harm. While Nurse Z's excessive focus on emotional and spiritual support may lead to neglect of other essential nursing responsibilities, the primary issue in this scenario is poor time management rather than deliberate neglect.

C. Fraud: Fraud involves intentional deception or misrepresentation for personal gain. There is no indication in the scenario that Nurse Z's actions involve deceit or manipulation for personal benefit, so fraud is not applicable in this context.

D. Intentional tort: Intentional torts involve deliberate actions that result in harm to another person. Nurse Z's failure to plan enough time for assessments and medication administration appears to stem from poor time management rather than intentional harm, so an intentional tort is not applicable in this scenario.

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Correct Answer is A

Explanation

This statement raises concern because it suggests that the client is experiencing thoughts of hopelessness and suicidal ideation. Expressions of feeling overwhelmed by pain to the extent of questioning the desire to continue living indicate a need for immediate attention and intervention to address the client's emotional distress and ensure their safety.

B. This statement indicates the client's proactive approach to pain management by taking medication preemptively before pain becomes severe. It reflects an understanding of pain management strategies and a willingness to address pain effectively.

C. Although this statement acknowledges the challenge of coping with pain, it also suggests the client's attempts to cope by mentally dissociating from the pain. While coping mechanisms vary among individuals, this response does not raise immediate concern unless accompanied by more severe signs of distress.

D. This statement acknowledges the chronic nature of the client's pain and its impact on daily activities but does not indicate thoughts of self-harm or severe emotional distress. It reflects the client's adaptation to living with pain and a willingness to engage in activities despite its presence.

A. Offer toileting reminders every 2 hours B. Provide clothing that is easy to manipulate C. Explain the need to call for the nurse to help with toileting D. Encourage avoidance of fluids between meals

Correct Answer is A

Explanation

A. Offer toileting reminders every 2 hours: This is the best nursing action because it helps prevent urinary incontinence by prompting the client to use the bathroom regularly. Clients with cognitive impairment may have difficulty recognizing the need to void or remembering when to do so. Providing frequent reminders helps maintain bladder continence and reduces the risk of accidents.

B. Provide clothing that is easy to manipulate: While providing clothing that is easy to manipulate can be helpful for clients with cognitive impairment to independently manage toileting, it does not directly address the issue of facilitating bladder continence. Easy-to-manipulate clothing may assist with toileting independence but does not address the need for regular voiding to prevent urinary incontinence.

C. Explain the need to call for the nurse to help with toileting: While educating the client about when to seek assistance for toileting needs is important, it may not be sufficient for facilitating bladder continence in a client with cognitive impairment. Clients may still have difficulty recognizing the need to void or remembering to call for assistance, making frequent reminders more effective in promoting continence.

D. Encourage avoidance of fluids between meals: Encouraging avoidance of fluids between meals is not an appropriate strategy for promoting bladder continence. Restricting fluids can lead to dehydration and other health complications. Maintaining adequate hydration is essential for overall health, and clients should be encouraged to drink fluids regularly throughout the day. Additionally, restricting fluids does not address the underlying issue of cognitive impairment affecting toileting behaviors.

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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:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is performing an admission assessment on a client who has chronic pain. Which statement made by the client causes the most concern?

Correct Answer is A

Explanation

What would be the best nursing action to facilitate bladder continence for the client who is cognitively impaired?

Correct Answer is A

Explanation

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