The pt is ordered IV heparin and the RN questions if the dose is safe according to the pt's age and weight. What actions should the RN implement? (SATA)

a) Administer half the medication & document concerns.

b) Call the HCP & discuss concerns.

c) Withhold the dose at this time.

d) Administer the IV heparin as ordered.

e) Administer the IV as ordered, but document concerns.

b) Call the HCP & discuss concerns. 

c) Withhold the dose at this time. 

Rationale:

Remember that it's your license, so if you have any concerns, especially about an improper dose of a heavy-hitter med such as heparin, you should always withhold the drug until you can contact the HCP and get some clarity. 

An older adult pt who lives alone is admitted to the hospital for debility & weakness. What's the most important intervention to ensuring cost-effective care is provided for this pt?

a) Request the HCP write an order for nursing home placement.

b) Listen compassionately to the pt's concerns about being unable to live independently.

c) Ensure case mgmt is actively involved in the pt's care to facilitate care coordination.

d) Administer the pt's regular home meds as ordered.

c) Ensure case mgmt is actively involved in the pt's care to facilitate care coordination. 

Rationale:

The RN should ensure that case mgmt is actively involved in the pt's care, because they are essential for coordinating care for pt's, including social work, PT, home health, etc. Pt's are d/c'd from the hospital sooner & managing more complex health concerns at home in the current healthcare environment, and social work is instrumental in ensuring pt's have access to all the services they need. Giving home meds is important, but not the most important action for cost-effective care. This pt may be able to return to their previous independent living arrangements, especially with social work & additional home health services, so requesting a nursing home placement is inappropriate. The RN should always listen to the pt's concerns with compassion, but this pt may still be able to live independently, so we want to ensure that that happens if at all possible. 

A RN working in the ED receives an order from an ortho surgeon to obtain written consent from a pt for an ORIF of a forearm fx. The surgeon hasn't seen the pt but has reviewed the XRs in the OR between cases. Which would be the most appropriate response by the RN to the surgeon?

a) "I will get the consent signed right away and attach it to the pt's chart."

b) "It's your responsibility to obtain informed consent from the pt."

c) "I'll have the pt sign, but you must explain the procedure before surgery."

d) "I will explain the procedure and call you back if the pt won't sign the consent."

b) "It's your responsibility to obtain informed consent from the pt."

Rationale:

It's the surgeon's responsibility to carry out procedural teaching and obtain informed consent before a procedure. This should include risks, benefits, and alternatives. The RN can then collect the pt's signature on an informed consent form, but they aren't doing the teaching themselves. Additionally, if the pt has a question when you are collecting their signature, then you must contact the HCP to come answer questions that have not already been touched on my the HCP. 

The RN is working in a hospital. Which examples of a RN executing a HCP's orders are correct? (SATA)

a) The RN repeats back the HCP's phone order.

b) The RN calls the HCP for routine admission orders.

c) The RN accepts a fax order for bisacodyl 10 mg suppository now.

d) The RN clarifies a med dose of IV metoprolol 200 mg as needed for SBP > 160 mmHg.

e) The RN accepts a phone order for a NRB O2 mask for a pt with a pulse ox of 98%.

a) The RN repeats back the HCP's phone order. 

c) The RN accepts a fax order for bisacodyl 10 mg suppository now. 

d) The RN clarifies a med dose of IV metoprolol 200 mg as needed for SBP > 160 mmHg. 

Rationale:

A faxed order is written by the HCP, so this is acceptable. If an order is given over the phone by the HCP, you should always be repeating it back to ensure you have written it down correctly. If a dose is in question because it's too large or isn't safe for the pt's condition, then you should clarify that with the HCP. Also, why would you put a NRB O2 mask on a pt when their O2 sat is 98%? 

According to hospital policy, a RN in charge of a neuro floor must facilitate discharges during a disaster event so pt's involved in the disaster can be admitted promptly. After quickly reviewing the pt census, the RN identifies 5 post-op pt's who may be ready for d/c. Which should the RN do next?

a) Notify the HCP of the disaster event & ask them to come immediately to d/c pt's.

b) Wait for the HCP to make rounds & then ask the HCP to d/c the pt's.

c) Assess each pt, call the HCP, and ask for d/c orders if appropriate.

d) Call the HCP to ask for d/c orders for the pt's.

c) Assess each pt, call the HCP, and ask for d/c orders if appropriate. 

Rationale:

Before you call an HCP about a pt or multiple pt's, you should always assess them first, because you have to have justification, rationale, and any information the HCP may require when you make your request or ask your question. Plus, you should never ask for d/c orders from the HCP if you haven't assessed the pt first. Also, this is an emergent situation, so you wouldn't stand around waiting for the HCP to grace you with their presence before asking for d/c orders. 

The RN manager is holding a meeting with the RN team to discuss mgmt's decision to reduce staffing on the unit. During the discussion, one of the RNs stands up and yells at the RN manager, using profanity, and threatening "to take this decision further." To defuse the situation, which would be the best step for the RN manager to take?

a) Call a break in the meeting & talk to the RN in a private place.

b) Ask the rest of the staff if they also feel the same way.

c) Tell the RN who is acting out to settle down and act professionally.

d) Suspend the RN who is acting out for the inappropriate behavior.

a) Call a break in the meeting & talk to the RN in a private place. 

Rationale:

Remember crisis mgmt from mental health. When someone is acting out, has an outburst, or are ramping up, you should be removing them from the situation and speaking to them privately and calmly. In a way, this is similar to redirecting a pt. You are removing them from the heated environment and giving them a chance to regain their control of rational thinking without embarrassing them in front of their colleagues. Taking them aside also prevents others from encouraging their behavior, which could further escalate the situation. 

While the RN is caring for a primiparous pt on postpartum day 1, the pt asks, "How is that person doing who lost their baby from prematurity? We were in labor together." Which response by the RN would be most appropriate?

a) Tell the pt, "I need to ask their permission before discussing their well-being."

b) Ignore the pt's question & continue with AM cares.

c) Tell the pt, "I'm not sure how the other person is doing today."

d) "Explain to the pt that "RNs aren't allowed to discuss other pt's on the unit."

d) "Explain to the pt that "RNs aren't allowed to discuss other pt's on the unit."

Rationale:

HIPAA prevents you from sharing pt information with others who aren't authorized to receive the information. Ignoring the question isn't going to help and could interfere with the pt-RN relationship. Telling the pt you aren't sure how they are today implies that you'll find out and tell the pt. Asking the other pt for permission to discuss their health with another pt is inappropriate because confidentiality must be maintained at all times. Educating the pt on the fact that RNs aren't allowed to discuss other pt's on the unit nips it in the bud. 

The RN is tracking data on a group of pt's with HF who have been d/c'd from the hospital & are being followed by the clinic. Which data are the best indicators that RN interventions of monitoring & teaching have been effective?

a) 5% of the pt's required hospitalization in the last 90 days.

b) 75% of pt's viewed the educational DVD.

c) 80% of the pt's reported that they are taking their meds.

d) 90% of the pt's have not gained weight.

a) 5% of the pt's required hospitalization in the last 90 days. 

Rationale:

The goals of managing pt's outside the hospital are for the pt's to maintain health & prevent readmission; thus, interventions like monitoring & teaching appear to have contributed to low readmission rate in this group of pt's. Although it's important that the pt's view their educational material, continue to take their meds as directed, and avoid gaining weight, the primary indicator of effectiveness of the program is a lack of rehospitalization. 

The RN is admitting a primigravid pt at 37 wks gestation who has been dx'd with pre-eclampsia to L&D. Which pt care room is most appropriate for the pt?

a) A darkened private room as close to the RN station as possible

b) A semi-private room midway down the hall from the RN station

c) A brightly lit private room at the end of the hall from the RN station

d) A private room with many windows that is near the OR

a) A darkened private room as close to the RN station as possible