A client is receiving pain medication through a PCA pump. Which of the following actions should the nurse take?

Correct Answer: D

Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.

Correct Answer: A

Rationale: The correct answer is option A: 'Confirming that a client's pain has decreased after receiving an analgesic.' This task involves assessing the effectiveness of the medication, which can be delegated to the assistive personnel. Options B, C, and D involve skills that should be performed by licensed healthcare professionals due to their complexity and potential risks if not done correctly. Ambulating a postoperative client requires monitoring for signs of distress or complications, inserting a urinary catheter involves an invasive procedure with infection risks, and demonstrating the use of medical devices like an incentive spirometer requires specialized knowledge to ensure correct usage.

Correct Answer: C

Rationale: The correct answer is C. Nurses are healthcare professionals who can independently make decisions within their defined scope of practice, providing care to patients. This autonomy allows nurses to assess, diagnose, plan, intervene, and evaluate patient care without direct supervision from physicians. Choice A is incorrect because while nurses do need to graduate from nursing school, it's to earn a degree, not necessarily to obtain a license. Choice B is incorrect as while continuous education is important in nursing, it is not a defining characteristic of the profession. Choice D is incorrect because while nurses are expected to adhere to professional behaviors, it is not limited to their professional lives but extends to their personal lives as well.

Correct Answer: A

Rationale: The correct answer is A because the 2010 Institute of Medicine report recommended that nurses practice to the full extent of their education, which includes utilizing advanced practice nurses. This supports the efficient delivery of healthcare services. Choice B is incorrect as it focuses on the relationship between advanced practice nurses and physicians rather than a reason for increasing their use. Choice C is not a direct reason for increasing the use of advanced practice nurses but rather a statement about the terminal degree for nurse practitioners. Choice D is incorrect as advanced practice nurses do possess the skills necessary to diagnose and provide advanced care.

Correct Answer: B

Rationale: The correct answer is **B: Assessment** because it is the foundational step in any nursing process, especially when addressing ethical dilemmas. Ethical dilemmas in nursing often involve complex, nuanced situations where multiple perspectives, values, and potential outcomes must be carefully considered. Assessment involves gathering all relevant information—medical, psychosocial, cultural, and ethical—to fully understand the context of the dilemma. This includes reviewing the patient’s medical history, their expressed wishes (if possible), the family’s concerns, legal considerations, and institutional policies. Without a thorough assessment, any subsequent actions could be misguided, ineffective, or even harmful. Ethical decision-making frameworks, such as the Four-Box Model (medical indications, patient preferences, quality of life, and contextual features), rely on comprehensive data collection first. Only after this can the nurse proceed to analyze, plan, and implement a solution. **A: Planning** is incorrect because it is a premature step if the nurse has not yet assessed the full scope of the dilemma. Planning involves developing a strategy to address the problem, but without a clear understanding of the patient’s condition, values, and the ethical conflict at hand, any plan would lack a solid foundation. For example, if the dilemma involves end-of-life care, the nurse cannot plan whether to advocate for palliative measures or continued treatment without first assessing the patient’s prognosis, advance directives, and family dynamics. Planning without assessment risks imposing solutions that do not align with the patient’s best interests or legal/ethical standards. **C: Evaluation** is incorrect because it occurs after actions have been taken, not at the outset of addressing an ethical dilemma. Evaluation involves reviewing the outcomes of implemented interventions to determine their effectiveness. In this scenario, no interventions or decisions have yet been made, so evaluating at this stage would be illogical. For instance, if the dilemma involves a family’s disagreement over a patient’s treatment, evaluating outcomes before even understanding the conflict would skip critical steps like clarifying misunderstandings or consulting ethics committees. Evaluation is essential but belongs at the end of the process, not the beginning. **D: Implementation** is incorrect because it assumes the nurse already has a clear course of action, which is impossible without first assessing the situation. Implementation involves executing a plan, but in an ethical dilemma, the plan itself must be carefully constructed based on gathered data. Jumping to implementation could lead to actions that violate patient autonomy, professional ethics, or legal standards. For example, if a family insists on a treatment the patient previously refused, implementing their demands without assessing the patient’s documented wishes or capacity would be unethical. Implementation relies on prior steps—assessment, analysis, and planning—to ensure the action is justified and appropriate. In summary, assessment is the critical first step because it ensures the nurse has all necessary information to navigate the ethical dilemma thoughtfully and systematically. Skipping this step undermines the integrity of the entire decision-making process, potentially leading to poor outcomes for the patient and family. The other choices—planning, evaluation, and implementation—are vital components of the nursing process but are only effective when built upon a thorough assessment.