Page 184 - Saunders Comprehensive Review For NCLEX-RN

treatment and supervision of the impaired nurse. This occurrence needs to be
reported to the nursing supervisor, who will then report to the board of nursing and
other authorities, such as the police, as required. The nurse may call security if a
disturbance occurs, but no information in the question supports this need, and so
this is not the appropriate action. Option 4 is an inappropriate and unsafe action.
Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate option
4 first, because this is an inappropriate and unsafe action. Recall the lines of
organizational structure to assist in directing you to the correct option.
Level of Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—Implementation
Content Area: Leadership/Management: Ethical/Legal
Health Problem: Mental Health: Addictions
Priority Concepts: Ethics; Professionalism
References: Lewis et al. (2017), p. 125; www.americannursetoday.com/the-
impaired-nurse-would-you-know-what-to-do-if-you-suspected-substance-abuse.

21. Answer: 4

Rationale: Instructional directives (living wills) are required to be in writing and
signed by the client. The client’s signature must be witnessed by specified
individuals or notarized. Laws and guidelines regarding instructional directives
vary from state to state, and it is the responsibility of the nurse to know the laws.
Many states prohibit any employee, including the nurse of a facility where the client
is receiving care, from being a witness. Option 2 is nontherapeutic and not a helpful
response. The nurse should seek the assistance of the nursing supervisor.
Test-Taking Strategy: Note the strategic words, most appropriate. Options 1 and 3
are comparable or alike and should be eliminated first. Option 2 is eliminated
because it is a nontherapeutic response.
Level of Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—Implementation
Content Area: Leadership/Management: Ethical/Legal
Health Problem: N/A
Priority Concepts: Health Care Law; Professionalism
Reference: Ignatavicius, Workman, Rebar (2018), pp. 104, 106.

22. Answer: 2, 3, 4, 5

Rationale: Electronic health records (EHR) will have a time date stamp that
indicates an amendment has been entered. If the nurse makes an error in the MAR,
the nurse should follow agency policies to correct the error. In the MAR, the nurse
can click on the entry (usually right-click) and modify it to reflect the corrected
information. Since this is an opioid medication, the nurse should obtain a
cosignature from the RN who witnessed the wasting of the excess medication, to
validate that 1 mg, rather than 2 mg, was given. A nurse’s note should be used to
detail the event and the corrections made, and the nurse’s name and title will be

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