Which situation requires a nurse to complete an incident report? The nurse:.
Does not complete the care plan for a newly admitted client before leaving the unit.
Records a client’s refusal to take a prescribed medication on the chart.
Contaminates and discards two indwelling catheters during the insertion procedure.
Experiences back pain after moving a client up in the bed.
The Correct Answer is C
The nurse should complete an incident report when he or she contaminates and discards two indwelling catheters during the insertion procedure. This is because an incident report is a tool for documenting any event that is not consistent with the routine operation of a health care unit or the routine care of a client. An incident report helps to identify potential risks and improve quality and safety.
Choice A is wrong because not completing the care plan for a newly admitted client before leaving the unit is not an incident that requires reporting.
It is a matter of time management and prioritization.
Choice B is wrong because recording a client’s refusal to take prescribed medication on the chart is not an incident that requires reporting.
It is a part of the nursing documentation and communication.
Choice D is wrong because experiencing back pain after moving a client up in the bed is not an incident that requires reporting.
It is a personal injury that may be related to improper body mechanics or ergonomics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
temperature 101.8° F(38.8° C), BP 100/60 mm Hg, pulse 98/min, RR 28/min. This set of vital signs indicates that the client may have an infection or sepsis, which are potential complications of an open cholecystectomy. The client has a fever, tachycardia, tachypnea, and hypotension, which are signs of systemic inflammatory response syndrome (SIRS).
Choice A is wrong because it shows mild hypothermia, hypotension, and tachycardia, which could be due to dehydration or blood loss, but not necessarily infection.
Choice B is wrong because it shows a slight fever, normal blood pressure, and bradycardia, which could be due to pain or medication, but not infection.
Choice C is wrong because it shows a low-grade fever, normal blood pressure and pulse, and mild tachypnea, which could be due to inflammation or dehydration, but not infection.
Correct Answer is D
Explanation
This is because assault is the threat of harm or unwanted contact, and battery is the actual physical contact without consent.
If the nurse administers the injection despite the client’s refusal, the nurse is violating the client’s autonomy and right to refuse treatment, and is committing both assault and battery.
Choice A is wrong because malice means having a deliberate intention to harm someone. The nurse may not have malice but may be acting out of ignorance or negligence.
Choice B is wrong because malpractice means a failure to meet a standard of care or conduct that causes injury or damage to a patient.
The nurse may be guilty of malpractice, but this is not the best term to describe the nurse’s action.
Choice C is wrong because negligence means a lack of care or skill that results in harm or injury.
The nurse may be negligent, but this is not the best term to describe the nurse’s action.
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