An obstetric nurse comes across an automobile accident. The driver seems to have a crushed upper airway, and while waiting for emergency medical services to arrive, the nurse makes a cut in the trachea and inserts a straw from a purse to provide an airway. The patient survives and has a permanent problem with vocal cords, making it difficult to talk. Which statement is true regarding the nurse's performance?
The nurse stayed within the guidelines of the Good Samaritan Law.
The nurse acted appropriately and saved the patient's life.
The nurse should have just stayed with the patient and waited for help.
The nurse took actions beyond those that are standard and appropriate.
The Correct Answer is D
A. The Good Samaritan Law typically protects individuals who provide care in emergency situations but may not apply if the actions taken are beyond the standard of care or are not in the nurse's training.
B. While the nurse's intention was to save the patient's life, the method employed was not a recognized standard procedure for airway management and may have caused harm.
C. Waiting for help may not have been an appropriate option if the patient's airway was compromised, but the method employed by the nurse was not advisable.
D. Cutting into the trachea and using a straw as a makeshift airway are actions that exceed the typical scope of nursing practice and could be deemed inappropriate, regardless of the outcome for the patient.
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Correct Answer is B
Explanation
A. A Yankauer suction tip catheter is used for suctioning secretions and does not assess cardiac function or afterload.
B. A blood pressure cuff is essential for measuring blood pressure, which can indicate increased afterload through elevated systemic vascular resistance.
C. An oxygen cannula is used for delivering supplemental oxygen and does not provide information about cardiac afterload.
D. A pulse oximeter measures oxygen saturation, which is not directly related to assessing cardiac afterload.
Correct Answer is B
Explanation
A. The pharmacist is responsible for filling prescriptions accurately but does not have control over how the nurse interprets the prescription once received.
B. The nurse has the ultimate responsibility for verifying and administering medications safely, including clarifying unclear prescriptions before administration.
C. The hospital has policies and systems in place to reduce errors, but accountability for individual actions lies with the nurse administering the medication.
D. The health care provider is responsible for prescribing medications accurately; however, the nurse must confirm and clarify any unclear prescriptions before administration.