What consideration should the nurse-manager prioritize when creating a program to deal with the issue of substance abuse by employees?

The program is unnecessary because state boards of nursing have authority over this issue.

The program should emphasize punishment due to the safety risk posed by impaired employees.

For confidentiality reasons, the program should be planned and executed by the personnel department.

The program should emphasize screening, prevention and early intervention.

Answer and Explanation

The Correct Answer is D

A.   While state boards of nursing do have regulatory authority over nursing practice and can take action against nurses who abuse substances, this does not negate the need for an internal program. Organizations should proactively address substance abuse to support employee health and safety, rather than relying solely on external authorities.
B.   While safety is a critical concern, emphasizing punishment can create a culture of fear and may discourage employees from seeking help. A punitive approach may lead to further issues, such as hiding problems rather than addressing them.
C.   While confidentiality is important, the involvement of the personnel department alone may not be sufficient to address the complexities of substance abuse. A comprehensive program should include input from healthcare professionals, mental health experts, and employee assistance programs to effectively manage and support affected employees.
D.   This is the most appropriate consideration. A program focusing on screening, prevention, and early intervention can help identify issues before they escalate, support employees in getting the help they need, and create a healthier workplace culture.

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Correct Answer is C

Explanation

A. While monitoring temperature is important in assessing for infection, it is not the priority assessment before administering morphine. Temperature does not directly relate to the immediate effects or risks associated with opioid administration.
B. Blood pressure monitoring is essential, especially in a postoperative patient. However, opioids primarily impact the respiratory system rather than directly causing significant changes in blood pressure. While hypotension can occur with opioids, it is not the most immediate concern when administering morphine.
C. This is the priority assessment. Opioids, including morphine, can cause respiratory depression, which is a serious and potentially life-threatening side effect. Before administering morphine, it is crucial to assess the respiratory rate to ensure the patient is not at risk for respiratory distress. If the respiratory rate is low (typically less than 12 breaths per minute), the nurse may need to hold the medication and notify the healthcare provider.
D. While it is important to monitor heart rate, especially in postoperative patients, the primary concern with morphine administration is its effect on respiration. The heart rate may not be as critical to assess immediately before administering morphine as the respiratory rate is.

A. A teenage client asks the nurse not to tell her parents that she is pregnant. B. A client does not want her husband to know that she is a client on the unit. C. An older adult client discloses to the nurse that her son occasionally hits her. D. A client states that he does not want to know the results of his recent diagnostic test.

Correct Answer is C

Explanation

A. While this situation raises ethical considerations, particularly regarding adolescent confidentiality, the nurse is not justified in overriding the client's right to confidentiality solely based on the request. In many jurisdictions, minors may have the right to confidentiality about reproductive health issues, though this can vary.
B. The nurse is generally required to respect this client's confidentiality. Unless there is a specific safety concern (e.g., domestic violence), the nurse should honor the client's request to keep this information private. Confidentiality should be upheld unless there is a clear and immediate risk of harm.
C. In this situation, the nurse may be justified in overriding the client’s confidentiality due to the disclosure of potential abuse. Healthcare professionals are often mandated reporters in cases of suspected abuse or neglect, particularly involving vulnerable populations such as older adults. The nurse has a duty to report this situation to ensure the safety of the client.
D. A client's wish not to know their diagnostic results does not justify overriding their confidentiality. The nurse must respect the client’s autonomy and decision-making regarding their own health information. The nurse should provide support and discuss the implications of this decision but should not disclose the results without the client’s consent.

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What consideration should the nurse-manager prioritize when creating a program to deal with the issue of substance abuse by employees?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is postoperative following abdominal surgery and reports incisional pain. The surgeon has prescribed morphine 4 mg IV bolus every 6 hr as needed. Before administering this medication, the nurse should complete which priority assessment?

Correct Answer is C

Explanation

In which situation would the nurse be justified in overriding a client's right to confidentiality?

Correct Answer is C

Explanation

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