A home care nurse receives a physician order for a medication ...

[Davideckstein7]

A home care nurse receives a physician order for a medication that the patient does not want to take because the patient has a history of side effects from this medication.
 
  The nurse carefully listens to the patient, considers it in light of the patient's condition, questions its appropriateness, and examines alternative treatments. What is the nurse's best action?
  a. Call the physician, explain rationale, and suggest a different medication.
  b. Consult an experienced nurse on whether there are other similar treatments.
  c. Hold the drug until the physician returns to the unit and can be questioned.
  d. Question other staff as to the physician's acceptance of nursing input.

Question 2

A new graduate nurse is working with an experienced nurse to chart assessment findings. The new nurse notes that the physical therapist wrote on the chart that the patient is lazy and did not want to participate in assigned therapies this AM.
 
  The experienced nurse asks the new nurse what may be going on here. What is the best explanation for this statement?
  a. Data on the chart can sometimes be documented in a biased manner.
  b. Data on the chart changes as the patient's condition changes.
  c. Data on the chart is usually accurate and can be verified from the patient.
  d. Reading the chart is not a wise use of time as this can be time consuming and tedious.

[lorealeza]

Answer to Question 1

ANS: A
Determining how best to proceed on behalf of a patient's best health care outcomes may require clinical judgment. At the committed level of critical thinking, the nurse chooses an action after all possibilities have been examined. A home care nurse who is using good clinical judgment techniques should have confidence in their decision and may not have another nurse available as this is an autonomous setting. Holding the drug might jeopardize the patient's health, so this is not the best solution. The nurse working at this level of critical thinking makes choices based on careful examination of situations and alternatives; whether or not the physician is open to nursing input is not relevant.

Answer to Question 2

ANS: A
It is important that the nurse records only what is assessed, without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patient's condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is clearly a different activity from charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.