The nurse is obliged to follow a physician's order unless which condition is present?
The order violates hospital policy.
The order is a verbal order.
The order is transcribed into the computer.
The order is handwritten.
The Correct Answer is A
Choice A rationale
Nurses have a legal and ethical obligation to protect client safety by ensuring all actions align with established hospital policies and evidence-based standards. If a physician's order contradicts these protocols, it may be unsafe or outside the nurse's scope of practice. Policy serves as a protective framework for both the patient and the healthcare provider. Following an order that violates policy could result in disciplinary action or harm, so the nurse must clarify or challenge the order.
Choice B rationale
While verbal orders are less ideal than written ones, they are not inherently invalid, especially in emergency situations. Most facilities have specific protocols for verbal orders, such as a "read-back" requirement to ensure accuracy. A nurse is still obliged to follow a verbal order provided it is clear, appropriate for the client, and eventually signed by the prescriber. Refusing an order solely because it is verbal could delay critical care in urgent clinical scenarios.
Choice C rationale
Computerized physician order entry is the modern standard for reducing transcription errors and improving patient safety. An order being in the computer actually makes it more formal and easier to track. Nurses are expected to follow these orders as they are considered the primary record of the intended treatment plan. Unless the order is clinically contraindicated or appears to contain a gross error, the fact that it is in the computer system reinforces the obligation to follow it.
Choice D rationale
Handwritten orders are a traditional form of medical instruction and remain valid in many healthcare settings. While they carry a higher risk of being misread due to poor legibility, they are legally binding once written in the client's chart. If a nurse can clearly read and understand a handwritten order that is clinically appropriate, they are required to carry it out. Legibility issues should be addressed by seeking clarification rather than by simply ignoring the physician's directive. .
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Muscular dystrophy is a genetic disorder characterized by progressive muscle weakness and degeneration. While it can affect the smooth muscles of the gastrointestinal tract, it typically leads to functional issues like paralytic ileus or decreased motility rather than a mechanical obstruction. Mechanical obstructions are physical barriers that block the flow of contents through the lumen. In muscular dystrophy, the problem is usually a lack of effective peristalsis (functional) rather than a physical mass or structural blockage within the intestinal pipe.
Choice B rationale
Parkinson's disease is a neurodegenerative disorder that primarily affects movement and coordination. It often leads to significant constipation and slow colonic transit due to autonomic nervous system dysfunction and the effects of medications. This results in a functional obstruction where the muscles do not move waste efficiently. It is not considered a mechanical obstruction unless the chronic constipation leads to a severe fecal impaction that physically blocks the lumen, but the primary pathology itself is neurological and functional.
Choice C rationale
Colon cancer is a leading cause of mechanical intestinal obstruction. As a tumor grows within the lumen of the large intestine, it physically narrows the passage, eventually preventing the movement of stool and gas. This is a structural or anatomical barrier that requires medical or surgical intervention to clear. Other examples of mechanical obstructions include adhesions, hernias, and volvulus. Cancer cells infiltrate the bowel wall and create a fixed mass, which is a classic example of a mechanical blockage.
Choice D rationale
Diabetes mellitus can lead to gastrointestinal complications such as gastroparesis or diabetic enteropathy due to autonomic neuropathy. These conditions result from nerve damage that impairs the normal rhythmic contractions of the intestines, leading to slow emptying and functional stasis. While this can cause symptoms similar to an obstruction, it is not a mechanical or structural blockage. The underlying issue is the failure of the nerves to signal the muscles to move, rather than a physical object blocking the path.
Correct Answer is B
Explanation
Choice B rationale
Aspirating urine from the catheter port is the only method to ensure the specimen is sterile and fresh. The port is specifically designed for needleless access after being cleansed with an antiseptic. This prevents the introduction of external bacteria into the bladder. Because the urine is pulled directly from the tubing before reaching the bag, it has not been subject to bacterial overgrowth or chemical degradation, providing an accurate representation of the client's current urinary status.
Choice A rationale
Collecting urine from the bag is inappropriate for a sterile specimen because the bag is a reservoir where bacteria can rapidly multiply. Urine in the bag may have been sitting at room temperature for hours, leading to inaccurate colony counts and false-positive results for infection. Normal urine is typically sterile in the bladder, but bag specimens are contaminated by the plastic and previous output. This method would lead to improper diagnosis and potentially unnecessary antibiotic treatment for the client.
Choice C rationale
Pouring urine from the collection bag involves the same contamination risks as aspiration from the bag. Additionally, opening the drainage spout increases the risk of introducing pathogens into the closed drainage system, which can cause an ascending urinary tract infection. For a culture and sensitivity test, the sample must be obtained using aseptic technique from the proximal port. Pouring is only acceptable for non-sterile tests like a routine urinalysis where bacterial presence is not being quantified.
Choice D rationale
Removing an indwelling catheter simply to obtain a urine specimen is invasive, unnecessary, and increases the risk of urethral trauma and infection. It also creates a need for reinsertion if the catheter was clinically indicated for monitoring output or managing retention. The catheter is designed with a sampling port to avoid such disruptive actions. Standard nursing practice dictates using the least invasive and most efficient method available to maintain the integrity of the closed urinary drainage system.
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