Professional Issues practice questions

Answer: B) An 81-year-old with a urinary tract infection and new confusion who was given IV lorazepam for agitation and keeps trying to get up to urinate

Fall risk is highest when several factors combine, such as older age, acute confusion, sedating medications like benzodiazepines and urgent unassisted toileting. Patients who are oriented and follow safety instructions are at lower risk even if they have one risk factor.

• AIncorrect. Older age and a mobility aid both add risk. But this patient is oriented, has had no sedating medications and can follow instructions to call for help, so the combined risk is lower.
• BCorrect. Several major risk factors act together here: advanced age, acute confusion, a benzodiazepine that causes drowsiness and poor balance, and repeated unassisted attempts to get up to toilet. The confusion means the patient cannot reliably remember to call for help.
• CIncorrect. The sedating antihistamine raises this patient's risk. But the patient is younger, oriented and following safety instructions, so the risk is lower than for a confused older adult who has been given a benzodiazepine.
• DIncorrect. The recent syncope was a risk, but it has been treated and the orthostatic vital signs are now normal. This young, oriented patient has no ongoing confusion or sedation.

Answer: B) The PAINAD scale

• AIncorrect. They may not be able to use it.
• BCorrect. It uses breathing, vocalization, face, body language and consolability.
• CIncorrect. That measures consciousness.
• DIncorrect. That predicts pressure injury.

Answer: B) Air-dry damp items, then place each item in its own sealed, labeled paper bag

Forensic clothing evidence is air-dried if damp and then packaged one item per paper bag, never in plastic. Each bag is sealed, labeled and kept attended to preserve the chain of custody.

• AIncorrect. Plastic traps moisture, which encourages bacterial and fungal growth that can break down biological evidence.
• BCorrect. Paper lets any remaining moisture evaporate, and packaging each item separately prevents cross-transfer of evidence. Each bag is sealed, labeled and kept attended to maintain the chain of custody.
• CIncorrect. Putting items in the same bag allows trace and biological evidence to transfer between them. Each item should be packaged separately.
• DIncorrect. Rinsing destroys biological evidence, and plastic biohazard bags hold in moisture that degrades whatever evidence is left.

Answer: B) Start emergency treatment under implied consent while staff keep trying to reach the parents

Under EMTALA and the emergency exception (implied consent) doctrine, an unaccompanied minor with an emergency medical condition gets life- or limb-saving treatment without waiting for parental consent. Efforts to reach the parents can continue but must not delay care.

• AIncorrect. When an emergency medical condition is identified in an unaccompanied minor, life- or limb-saving treatment must not be delayed to seek parental consent.
• BCorrect. The emergency exception rule (doctrine of implied consent) assumes any reasonable parent would consent to emergency treatment, and EMTALA requires stabilizing care. Staff can keep trying to reach the family and document those attempts, but care must not wait for them.
• CIncorrect. A court order is not needed for emergency care of a minor, and seeking one would cause a dangerous delay. Implied consent covers this situation.
• DIncorrect. Being alone does not make a minor emancipated; emancipation depends on legal status. Here care goes ahead under the emergency exception, not on the minor's signature.

Answer: A) Arrange a voluntary facilitated team debrief in the coming days and offer peer support and employee assistance referral

After a traumatic pediatric death, staff are best helped by voluntary team debriefing, peer support, and referral to professional resources, as in critical incident stress management and second-victim programs. Mandatory single-session debriefing is not supported by the evidence.

• ACorrect. Critical incident stress management and second-victim support models stress early, voluntary peer support, a structured team discussion, and access to professional help (such as an employee assistance program) for staff who need more.
• BIncorrect. Systematic reviews have not shown that compulsory single-session psychological debriefing that forces individuals to relive the event prevents PTSD. Some evidence suggests it may be harmful. Support should be voluntary and ongoing.
• CIncorrect. A morbidity and mortality review looks at clinical quality, not staff wellbeing. Putting off emotional support for weeks leaves acute stress reactions unaddressed. Staff want early contact from colleagues.
• DIncorrect. Sending a visibly distressed nurse straight into another similar high-stress event without support can make her stress reaction worse and may affect patient safety. Check in with her first and offer support.

Answer: A) 3

• ACorrect. Vital signs may move them to level 2.
• BIncorrect. That needs no resources.
• CIncorrect. That needs one resource.
• DIncorrect. That needs immediate lifesaving intervention.

Answer: B) Talk through the experiences with trusted colleagues and contact the employee assistance program

Compassion fatigue is best managed by addressing it actively: talking with supportive colleagues, using employer resources such as an EAP, and getting rest and self-care. Emotional distance, extra work and waiting it out let it continue.

• AIncorrect. Pulling away emotionally is a symptom of compassion fatigue, not a way to treat it. It does nothing about the underlying distress and can make care for families worse.
• BCorrect. CDC guidance encourages health workers to talk openly with supportive colleagues about how work stress affects them and to use workplace mental health resources such as employee assistance programs.
• CIncorrect. Extra hours cut into rest and recovery, which CDC lists as part of coping with work stress. Staying busy only avoids the distress and is likely to make exhaustion worse.
• DIncorrect. The nurse already has symptoms that affect their work and interactions with families. Delaying support is a form of avoidance and lets the distress continue instead of addressing it early.

Answer: A) Promptly report the observations to the charge nurse or supervisor following facility policy

A nurse who suspects a coworker is impaired should promptly report it to a supervisor through facility channels. Reporting protects patients and starts evaluation and assistance; covering up, confronting the coworker alone, or waiting for proof does not.

• ACorrect. Suspected impairment puts patients at immediate risk. Reporting to a supervisor promptly allows the coworker to be removed from patient care and evaluated through the facility's reporting process.
• BIncorrect. Handling it alone without reporting is a form of covering up. It skips the facility's process and does not reliably protect patients. Guidance says to report rather than make excuses for an impaired colleague.
• CIncorrect. Waiting leaves patients exposed to an impaired provider. When there is reasonable suspicion, the nurse should err on the side of patient safety and report right away.
• DIncorrect. State authorities may need to be notified, but a board complaint doesn't remove the coworker from patient care during this shift. The immediate safety concern has to go to the supervisor first.

Answer: C) Letting triage nurses start approved protocol orders, such as labs, ECG, or imaging, before provider evaluation

Advanced triage protocols (nurse-initiated orders at triage) start diagnostics early and are associated with shorter ED length of stay. Boarding and delayed inpatient discharges are output factors that worsen crowding.

• AIncorrect. Triage is meant to be a brief, focused acuity assessment. Adding a full assessment at triage lengthens the front-end process and delays rooming and treatment, so it does not improve flow.
• BIncorrect. Holding admitted patients in the ED is boarding, a leading output-side cause of crowding. It ties up ED beds and staff and increases length of stay.
• CCorrect. With advanced triage protocols, nurse-initiated orders start diagnostics before the provider sees the patient. Evidence reviews link them to shorter ED length of stay (about 36 minutes in the AHRQ review).
• DIncorrect. Late-day discharges delay the release of inpatient beds. That increases ED boarding and worsens crowding instead of relieving it.

Answer: C) Finding stable inpatients who can safely go home

• AIncorrect. Only safe discharges.
• BIncorrect. That isn't reverse triage.
• CCorrect. It creates surge capacity.
• DIncorrect. It's about creating capacity.