Discipline of Nursing and Nursing Knowledge

While small, nutritionally dense meals and snacks are necessary for clients with HIV and/or TB, another action is of greater priority. B) Obtain the first of 3 sputum specimens for laboratory testing. CORRECT Because secretions collect during the night, Jeff should take the opportunity to cough and expectorate upon awakening before performing other morning activities. C) Take a shower and get ready to go to radiology for a chest X-ray. INCORRECT Another action is of greater priority. D) Weigh to determine if weight loss from the disease is continuing. INCORRECT Although daily weight monitoring may be done, another action is of greater priority. Legal/Ethical Concepts A female staff nurse tells the nursing supervisor that she does not want to be assigned to care for Jeff. She states, "I have never cared for a client with HIV and do not want to start now. I have babies at home that need me." 7. The nursing supervisor should base her response on what information about the right of a nurse to refuse to care for clients with HIV? A) The registered nurse has the right and responsibility to protect the health of self and family and may therefore refuse to care for clients with contagious diseases. INCORRECT This answer does not meet the professional guidelines set forth by the ANA Code for Nurses that guide ethical nursing practice. B) The registered nurse may refuse to care for a client in circumstances where risk to the nurse outweighs the nurse's responsibility to care for a client or if the assignment conflicts with the nurse's ethical standards. CORRECT According to the ANA Code for Nurses, a nurse may morally refuse to participate in care, but only on the grounds of either client advocacy or moral objection to a specific type of intervention. Exceptions may be made when risk of harm outweighs the nurse's responsibility to care for a given client. For example, an immunosuppressed nurse may refuse to care for clients with certain infectious processes. The pregnant nurse may refuse to care for the client with HIV who has secondary infections such as toxoplasmosis or cytomegalovirus, both of which can cause severe damage or death to the fetus. C) Refusal to treat or care for a person based on race, gender, or age is discrimination, which the federal government prohibits. INCORRECT The nurse in this case is not refusing to care for the client based on these parameters. If the nurse did refuse, it would be illegal. D) The required staffing ratio of licensed personnel to client population does not allow for professional nurses to refuse to care for a client. INCORRECT Staffing ratio is a budgeting issue. Nurses in many states may claim "safe harbor" if they feel staffing is unsafe, but this is not the reason given for refusal in this case. 8. How should the nursing supervisor respond to the staff nurse who does not want to care for Jeff? A) "I understand. I will assign you to a different client and give Jeff to one of the other nurses." INCORRECT This response does not provide an opportunity to assess if something else is needed. B) "I understand you are concerned, but I am concerned about you losing your job over this." INCORRECT Not only is addressing possible dismissal of the nurse premature, this response does not provide an opportunity to assess whether something else is needed. C) "I understand your fears, but do you realize this will cause a hardship on your fellow staff members?" INCORRECT This response does not help develop the nurse as a team member, nor does it provide an opportunity to assess if something else is needed. D) "I understand you want to protect your children. Please tell me your concerns regarding caring for a client with HIV." CORRECT This response by the nurse supervisor demonstrates compassion and provides an opportunity to discover if education of the staff nurse is needed. Client Education The nurse checks on Jeff and finds him reading a brochure about TB. 9. Which statement by Jeff indicates that he understands why he is at risk for TB?

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