NNN

04-28-2024 PALMER

Oct 03, 20249 min read

(c) The Royal Pentagon Review Specialists Dean Dr./Atty. Glenn Reyes Luansing RN, LLB - JD, LLM, DCL, PD, DSM

Professional Adjustments & Nursing Judiprudence

AAACCESS

Nursing as a profession entails Accountability, Autonomy, Altruism, Caring, Competency, Ethics, Service-Oriented, Specialized Knowledge and Skills

  • Continuing Professional Training (15 units required), In-service Training
  1. Patient Autonomy: there are three decisions in autonomy;
    • Informed Consent: treatment plan, alternatives, risks, side effects. There are five characteristics of a valid consent:
      • Voluntary
      • Opportunity to ask questions
      • Treatment or surgery must be explained
      • Understood by patients
      • Matured both Physically (18+) and Mentally (Unaltered LOC)
    • Right to Refuse
      • If refused, and there are no risks: respect the decision.
      • If refused, and there are risks: explain the risk to patients or relatives.
      • If the patient still refuses life-saving treatment or devices, sign a Waiver.
    • Withdrawal
  2. Substitute/Proxy Consent:
    • Parents
    • Relatives/Guardians/Next of Kin
    • Paternalism is the act of deciding for others.

Drugs and Prescription

  1. Only licensed doctors of medicine are allowed to prescribe drugs. Recommendation of drugs to the patient as a nurse is malpractice.
  2. Check the basic three informations for drug orders:
    • Prescribing Physician: name, location, and PRC license number
    • Patient: name, age, sex
    • Drug: generic or generic (brand) + duration and frequency/interval.
  3. 10 Rs of Medication:
    • Right Patient: a universally acceptable method to determine the patient’s identity is to check the patient’s identification band. In an outpatient basis, ask the patient of their name.
    • Right Drug
    • Right Site
    • Right Frequency
    • Right Timing
    • Right Client Education
    • Right to Refuse
    • Right Assessment
    • Right Documentation
    • Right Evaluation
  4. Verbal or Telephone Medication Orders: write the date, time, and name of the physician, along with the complete order in the doctor’s order sheet in the patient chart.
    • Repeat the order back to the physician (clarify) before ending the call.
    • Sign the paper. By the next round or the next 24 hours, have the doctor countersign the order.
  5. Doubts or Errors: in case of doubt, call the attention of the prescribing physician for any corrections.

Documentation

Medical records are legally owned and safekept by the hospital. These records are kept within 5 years of the discharge or death of the patient. Its purposes are (mn. CLEARS):

  1. Communication for patient’s care
  2. Legal document
  3. Evidencea
  4. Assurance of Continuous Care
  5. Research
  6. Statistics

Good charting requires (mn. FLIP):

  1. Full, Factual, and Accurate
  2. Legible
  3. Immediately after procedure. If late, the entry should be specified as an addendum.
  4. Personal/Confidential; documentation cannot be delegated.

Bad charting involves (mn. LISA):

  1. Language, Jargons, or Words that are unacceptable
  2. Improper Corrections: crossing out, liquid taper, etc. are not allowed. Strikethrough: draw one or two straight lines across the mistake and write it as an error or mistake, date the correction, and sign.
  3. Spaces and skips: do not leave spaces to avoid tampering. Obstruct empty spaces with lines.
  4. Abbreviations are only used when medically recognized.

Example Questions

  1. Which of the following is the most distinguishing characteristic of a professional nurse?
  2. Who formulated the definition of nursing as a profession? American Nurses Association (ANA)
  3. What is the first name of the Philippine Nurses Association (PNA)? Filipino Nurse Association
  4. When was the PNA founded? September 2, 1922
  5. Who was the founder of the PNA? Anastasia Tupas
  6. Is having a license a right or a privilege? Privilege; a license is renewed every three years.
  7. Nursing is best defined as a profession that is?
    • Concerned with nursing diagnosis and treatment
    • Help people to do activities that contribute to health recovery and peaceful death only
    • Care for people sick or well in all health care setting
    • Assist people to self care
  8. What is the liability of the nurse if consent is wrongfully secured through mental fears or threats? Assault. With introduction of physical force, it becomes Assault with Battery.
  9. What is the maximum number of hours a patient can be restrained for? 2 hours
  10. Legally, the surgical procedure should be explained by who? Surgeon; whoever shall be the one to perform the procedure.
  11. In a surgical consent form, what is the role of the nurse? Witness
  12. The doctor and patient are having difficulty communicating for an ICF. What is the nurse’s action?
    • Social worker
    • Translator
    • Telecare
    • Any member of the healthcare team who knows how to translate
  13. When is a patient able to sign a consent form? (1) physically; legal age of 18, and (2) mentally; unaffected LOC
  14. Petra is 16 years old and about to deliver. Who should sign?
    • Petra
    • Boyfriend
    • Parents
    • Any healthcare team member or relatives
  15. Who can give consent?
    • Patient under Rehab
    • Dialysis Patient
    • Early-onset Alzheimers
    • Post-operative Patient
  16. The patient has been given pre-operative medications, but have not signed the consent.
    • Have the doctor sign.
    • Relatives and others.
    • Call the attention of the doctor.
    • Proceed with the surgery.
  17. A patient was in a car crash. A stat craniotomy is required. No relatives or next of kin is available. The doctor is the one to sign the consent.
  18. The patient is unable to give consent, but another person decides for them. Paternalism
  19. For involuntary clients, informed consent is usually provided by?
    • Parents
    • Relatives
    • Nurse
    • Chief Nurse
  20. A thumb mark from an unconscious patient is?
    • Invalid
    • Inappropriate
    • Legal
    • Valid
  21. What is the correct format for a prescription under the R.A. 16675 (Generics Act): Generic, Generic (Brand), but never just Brand. This is so that the patient can choose the brand of their medicine.
  22. In an emergency, a telephone order should be countersigned within:
    • 48 hours
    • 36 hours
    • 12 hours; 24 hours is acceptable, but it should be as soon as possible/by the next round.
    • 24 hours
  23. Two patients are receiving Lanoxin. One patient does not have a readable identification band. Ask the patient their name.
  24. One way of verifying the right message or order from the doctor was communication effectively through telephone is by?
    • Phrasing intelligently
    • Repeating the order/message
    • Documenting immediately even with doubts
    • Speaking distinctly using enough volume.
  25. If you are an outsider nursing researcher, who is the legal owner of the chart to sign for a consent form?
    • Patient
    • Doctor
    • Hospital
    • All members of the healthcare team
  26. What is the proper way to sign the nurse’s notes?
    • A.J. Santos, Staff Nurse
    • A.J. Santos, Registered Nurse
    • A.J. Santos, RN
    • (Nickname), RN
  27. A consideration when giving medication to elderly clients:
    • Multiple simultaneous drugs.
    • Elderly clients metabolizes and excretes drugs differently.
    • Medication affects the elderly client during the hours of the morning and evening.
    • Medication has an effect on the respiratory system of the elderly client because of slow metabolism.
  28. The nurse is verifying whether to give a medication to a client. What should she check first?
    • The client’s name and identity
    • Expiration date of the drug
    • Route of delivery
    • Chart to see whether the drug was ordered.
  29. Which of the following illustrates gross negligence?
    • The patient has a mosquito forceps in the abdomen after surgery.
    • The nurse failed to ask for consent yet proceeded with surgery.
    • The nurse forgot to give an 8 AM dose of digitalis.
    • The nurse did not check the DTR of a patient in severe preeclampsia before a repeat dose of MgSO4.
  30. If the attending doctor gives a telephone order for a new medication and the staff is busy, the nurse’s best action is to:
    • Request a supervisor to take the order.
    • Refuse to take the order because they are not legal.
    • Request the medical intern to write down the order and sign it because it will be countersigned.
    • Request the resident on duty to receive the call and write the order as well as sign it.
  31. Which of the following actions would be considered negligence?
    • Inserting a 16 Fr NGT tube and aspirating 15cc of gastric contents.
    • Administering Demerol IM to a patient prior to using the incentive spirometer.
    • Administering ferrous sulfate (Feosol) 325 mg with coffee.
    • Initially administering blood at 5 cc per minute.
  32. A patient who is to undergo surgery will be signing a consent form. The nurse’s main responsibility for informed consent is to?
    • Ensure that the patient has not received any sedation two to three hours prior to signing the consent form.
    • Validate that the patient understands the procedure
    • Complete all blank spaces in front of the patient before witnessing.
    • Explain the procedure and any risk factors to the patient thoroughly.
  33. A coworker comes in looking unkempt and uncoordinated. Their breath reeks of alcohol. What is the best course of action?
    • Call the supervisor and report the coworker.
    • Confront the coworker, tell them they are intoxicated, and relieve them of their nursing duties immediately.
    • Ignore the situation.
    • Give sandra a lecture about substance abuse and do nothing else.
  34. A urologist who is visiting a relative for a kidney condition wants to see the chart. What is the best action to take?
    • Refuse and send a complaint to the medical department.
    • Refuse and refer them to the attending physician for the information he needs.
    • Show the urologist the chart.
    • Ask your immediate supervisor to deal with the problem for you.
  35. You are making an entry in the nurse’s notes. You discover that you forgot something half an hour ago. You would best correct this by:
    • Crossing through the current entry, writing “error”, initiating it, and then making the entry you forgot to enter earlier.
    • Making the entry now with the time since that is when you documenting it.
    • Making the entry with the time the event happened and labeling it as a late entry.
    • Doing nothing as it’s too late.
  36. An OR nurse notices consent for an emergency craniotomy was not taken, after the procedure.
    • Valid
    • Legal
    • Inappropriate
    • Invalid
  • In situational questions, keywords are always related to the correct answer. Conjunctive words e.g. except, always, in the moment, etc. should also be considered.
  • Two options are often obviously wrong. Eliminate

Backlinks

  • No backlinks found

Graph View