Nursing 203- Intro to Clinical: Ch. 6-7 – Flashcards
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In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? (p. 99, p. 100, p. 108. Taylor Fundamental)
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The nurse is demonstrating integrity, which is defined as acting in accordance with an appropriate code of ethics and accepted standards of practice. Seeking to remedy errors made by self or others is an example of integrity. Altruism is a concern for the welfare and being of others. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the inherent worth and uniqueness of individuals and populations.
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A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which of the following statements demonstrates the principle of accountability? (p. 96-97 Taylor's Fundamentals)
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Filling out an occurrence report and notifying the health care provider When an untoward occurrence occurs, the nurse will be considered to be accountable when the proper actions are taken. In this instance, an occurrence form is filled out for follow-up, and the provider is notified. The other choices are incorrect actions
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A nursing student learns to model behavior exemplified by the instructor. This is an example of? (pp. 99-100)
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Ethical conduct Modeling professional behavior of the instructor will teach the student and result in appropriate ethical conduct. The other choices are not reflective of ethical conduct learned by modeled behavior.
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Students nurses need to know about the Code of Ethics for Nurses. The Code of Ethics includes a set of principles to follow. Identify the tenets of the Code of Ethics for Nurses. Select all that apply. (pp. 98-100)
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The nurse maintains standards of personal conduct. • The nurse is active in developing a core of research based principles. • The nurse holds personal information as confidential. Standards of personal conduct, developing research, and confidentiality are all tenets of the Code of Ethics for Nurses. The other choices are not included in the Code of Ethics for Nurses.
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Which of the following nursing situations is an example of an ethical dilemma? (p. 98)
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Performing cardiac compressions when a signed Do Not Resuscitate order (DNR) is not available An ethical dilemma occurs when it is difficult for a decision to be made. If there is no signed DNR, then legally cardiac compressions must be started. Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope. (
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Which of the following is a characteristic of the care-based approach to bioethics? (p. 96)
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The promotion of the dignity and respect of clients as people The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of patients and people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences.
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A nurse obtains an order for a bed alarm for a confused client. This is an example of which of the following ethical principles? (p. 104)
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Paternalism Making a decision for a client who is confused to prevent an injury is an example of paternalism. Deception and conflict would not promote the safety of a client who is unable to make safe decisions and confidentiality does not apply in this instance.
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What is the term for the beliefs held by the individual about what matters? (p. 92)
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Values Values are ideals and beliefs held by an individual or group; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people. A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death and questions and concerns regarding quality of life as it relates to advanced technology.
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Which of the following ethical principles is related to the idea of self-determination? (p.97)
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Autonomy Autonomy refers to self-rule, or self-determination; it respects the rights of patients or their surrogates to make health care decisions. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm.
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Which of the following theories of ethics most highly prioritizes the nurse's relationship with patients and the nurse's character in the practice of ethical nursing?
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Care-based ethics Central to the care-based approach to ethics is the nurse's relationships with patients and the nurse's "being," or character and identity. Deontology, utilitarianism, and principle-based ethics each prioritize goals and principles that exist beyond the particularities of the nursepatient relationship.
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A nurse knows the ethical term "Do not cause harm" is an example of (p.106):
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Nonmaleficence Nonmalefiecence is the conduction of procedures and interventions in a safe manner so that no harm is caused to the client. The other choices do not reflect the definition of this ethical term.
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A client rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? (p. 109)
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Fidelity Fidelity is keeping one's promises and never abandoning a client entrusted to your care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make health care decisions. Nonmaleficence is preventing harm from being done to a client. Justice involves giving each client his due and acting fairly.
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The nurse is managing the care of a terminally ill client whose spouse insists that all measures be continued. The nurse speaks to the spouse about obtaining a hospice consult. This is an example of "ethical" what? (p. 95-96)
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Valuing Ethical valuing is the belief about worth, as in speaking to the spouse and placing value on the life and wishes of the client. The other choices do not define valuing.
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A client age 46 years has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This patient is utilizing which ethical principle in making his decision? (p. 97)
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Autonomy Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that like cases should be treated alike.
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What would be an example of the nurse practicing fidelity? The nurse :
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Stays with the patient during his or her death as promised Fidelity requires the nurse to keep promises made and to be faithful to one's commitments.
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A nursing student reports to the instructor that a medication due at 9 a.m. was omitted. Which of the following principles is the student demonstrating? (p. 94)
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Integrity The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the student reported the occurrence of the missed medication. The definition of altruism is concern for others, social justice is upholding of principles, and autonomy is the right to self-determination, so those choices are not correct.
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A nurse shows client advocacy by doing which of the following examples? (p. 104)
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Offering a hospice consultation to a client who is terminally ill The definition of advocacy is to ensure that the best interests are being met. A hospice consult is an appropriate example. The other choices do not reflect advocacy for the client.
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A nursing faculty is presenting a lecture on ethics. The correct definition of ethical distress is (p. 101):
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Knowing the correct action, but unable to perform due to constraints. Knowing the correct action but being unable to perform the action due to constraints is the definition of ethical distress. The other choices are incorrect.
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A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing her judgments based on her expertise. Which of the following types of health care decision making does this represent? (p. 103)
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Shared decision making Shared decision making is recommended by most Ethicists and involves the client's preferences and the nurse's expertise to make the best decision. The Paternalistic model involves the clinician making the decisions and the Patient Sovereignty model involves the patient making all the decisions without input from the clinician.
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A nurse volunteers to serve on the hospital ethics committee. Which of the following indicates that the nurse knows what the purpose of an ethics committee is? (p.102)
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Assist in decision-making based on the client's best interests An ethics committee will meet when a client is unable to make an end-of-life decision and the family cannot come to a consensus. The committee members are there to advocate for the best interest of the client. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.
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A nurse demonstrates the professional value known as altruism when caring for patients in a long-term care facility. What is an example of a nursing action based on this value? (p. 94)
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A nurse researches the culture of a Muslim patient when planning nursing care. The professional value of altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse's concern for the welfare of clients, other nurses, and other health care providers. An example of altruism from the question would be the action of a nurse researching the culture of a Muslim client when planning nursing care. The other options are not examples of altruism.
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A nurse has completed four hours of his eight-hour shift on a medical-surgical unit when he receives a phone call from the nursing supervisor. The nursing supervisor informs him that he needs to give a report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that he has been busy with his client assignment and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem? (p. 104)
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Allocation of scarce nursing resources This is a clear example of ethical issues surrounding the allocation of scarce nursing resources and involves distributing nursing care.
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Which of the following words is best described by the following: the protection and support of another's rights? (p. 106)
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Advocacy Advocacy is the protection and support of another's rights. Nurses who value patient advocacy make sure their loyalty to an employing institution or colleague does not compromise their primary commitment to the patient; give priority to the good of the individual patient rather than to the good of society in general; and carefully evaluate the competing claims of the patient's autonomy and patient well-being. Paternalism is acting for patients without their consent to secure good or prevent harm. Autonomy is respecting the rights of patients or their surrogates to make healthcare decisions; it is also known as self-determination. Ethics is the formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing.
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Which of the following best describes feminist ethics?
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An approach critiquing existing patterns of oppression and domination in society. Feminist ethics offers an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guides for practice. The care-based approach directs attention to the specific situation of individual patients viewed within the context of their life narratives. And the formal study of ethical issues that arise in the practice of nursing describes nursing ethics.
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Which of the following are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. (p. 97)
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• Compassion • Trustworthiness • Humility Trustworthiness, humility, and compassion are all examples of professional virtues and cultivated dispositions of character and conduct that motivate and enable us to be good human beings. Deception and conflict are not positive examples so are not correct choices.
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What would be an example of the nurse practicing fidelity? The nurse (p. 97):
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Stays with the patient during his or her death as promised Fidelity requires the nurse to keep promises made and to be faithful to one's commitments.
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A nursing student is studying the principle of autonomy. Which of the following examples most accurately depicts this principle (p.97)?
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Describing surgery to a client before the consent is signed Describing surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision, thus an autonomous one. The other choices are not reflective a client decision making.
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A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for patients in a long-term care facility. Which nursing actions best exemplify this principle? (p.97)
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• The nurse performs regular patient assessments for pressure ulcers. • The nurse follows "medication rights" when administering medicine to patients. The concept of nonmaleficence refers to avoiding causing harm. Examples of nonmaleficence include the nurse performing regular patient assessments for pressure ulcers. Nonmaleficence would also include the nurse following "medication rights" when administering medicine to clients. The other options listed are not true examples of the nurse incorporating the principle of nonmaleficence.
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A nurse who provides the information and support that patients and their families need to make the decision that is right for them is practicing what principle of bioethics?
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Autonomy Autonomy, also known as self-determination, is respecting the rights of clients or their surrogates to make health care decisions. The nurse would provide the information and support the client and family need to make the decision that is right for them, including collaborating with other members of the health care team to advocate for the client. Nonmaleficence is avoiding causing harm. Justice is giving each individual their due and acting fairly. Fidelity is the keeping of promises.
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Which ethical principle refers to the obligation to do good? (p. 97)
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Beneficence Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; it is more binding than beneficence.
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The International Council of Nurses (ICN) Code of Ethics for Nurses (2005) has which of the following elements? Select all that apply. (p.99)
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• People • Practice • Profession • Co-workers The International Code of Ethics is based on the tenets of people, practice, profession, and co-workers and the relationship among them. Family, although important, is not included in those elements. (
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A nursing faculty is discussing laissez-faire values with students. Which of the following is an example of those values? (p. 93-94)
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Parents allowing a child to decide not to have an intravenous line inserted A laissez-faire environment is one that allows others, especially children, to make decisions without guidance, resulting in a decision that may not be a sound one. The other choices are not reflective of the definition of a laissez-faire environment.
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A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which of the following statements demonstrates the principle of accountability?
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Filling out an occurrence report and notifying the health care provider When an untoward occurrence occurs, the nurse will be considered to be accountable when the proper actions are taken. In this instance, an occurrence form is filled out for follow-up, and the provider is notified. The other choices are incorrect actions.
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A nursing student is studying the principle of autonomy. Which of the following examples most accurately depicts this principle? (p. 97)
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Describing surgery to a client before the consent is signed Describing surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision, thus an autonomous one. The other choices are not reflective a client decision making.
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Which of the following theories of ethics most highly prioritizes the nurse's relationship with patients and the nurse's character in the practice of ethical nursing? (p. 103)
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Care-based ethics Central to the care-based approach to ethics is the nurse's relationships with patients and the nurse's "being," or character and identity. Deontology, utilitarianism, and principle-based ethics each prioritize goals and principles that exist beyond the particularities of the nursepatient relationship.
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A nurse who provides the information and support that patients and their families need to make the decision that is right for them is practicing what principle of bioethics? (p. 94)
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Autonomy Autonomy, also known as self-determination, is respecting the rights of clients or their surrogates to make health care decisions. The nurse would provide the information and support the client and family need to make the decision that is right for them, including collaborating with other members of the health care team to advocate for the client. Nonmaleficence is avoiding causing harm. Justice is giving each individual their due and acting fairly. Fidelity is the keeping of promises.
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Which of the following nursing situations is an example of the care-based approach to ethics? Select all that apply. (p. 97)
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• Holding the hand of a dying client • Providing a back rub to a client on bed rest • Involving the parent in the bed bath of a child Holding the hand of a dying client, providing a back rub and involving the parents are all examples of a care-based approach. The other choices are not reflective of this.
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Nurses who value patient advocacy follow what guideline? (p. 105)
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They give priority to the good of the individual patient rather than to the good of society in general. Advocacy is the protection and support of another's rights. If the nurse values patient advocacy, the nurse would give priority to the good of the individual client rather than to the good of society in general. The nurse would not be demonstrating advocacy if the nurse values the loyalty to an employing institution or to a colleague over their commitment to their client. The nurse demonstrating patient advocacy would not choose the claims of the client's well-being over the claims of the client's autonomy. The nurse would not make decisions for clients who are uninformed concerning the client's rights and opportunities.
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The foundation for decisions about resource allocation throughout a society or group is based on the ethical principle of:
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Justice Justice is the foundation for decisions about resource allocation throughout a society or group.
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A female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, "this happens to many women." Which type of ethical approach is the nurse exhibiting? (p. 97-98)
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Feminist A feminist approach is one where the focus is on specific female problems and concerns, and the statement "this happens to many women" is an example of this. The other choices are not correct as they are not reflective of this ethical approach.
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Nurses must maintain the privacy of clients. Which example is a breach in privacy and would pose an ethical problem? (p. 96-99)
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taking a picture of a client with the nurse's cell phone. Taking a picture of a hospitalized client is a direct breach of privacy. The other choices are appropriate actions and do not reflect a breach in privacy.
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A client is brought to the emergency department (ED) by the son who states, "I am unable to care for my mother anymore." The nurses identifies this son's ethical problem as being which of the following? (p. 101)
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Distress Ethical distress is when someone wants to do the right thing but is not able to. The son brings the mother to the ED to maintain her safety, although he needs to take care of her. The other choices may be part of the son's decision, however the immediate problem is one of distress.
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A nurse volunteers to serve on the hospital ethics committee. Which of the following indicates that the nurse knows what the purpose of an ethics committee is? (p. 102)
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Assist in decision-making based on the client's best interests An ethics committee will meet when a client is unable to make an end-of-life decision and the family cannot come to a consensus. The committee members are there to advocate for the best interest of the client. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.
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A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing her judgments based on her expertise. Which of the following types of health care decision making does this represent?
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Shared decision making Shared decision making is recommended by most Ethicists and involves the client's preferences and the nurse's expertise to make the best decision. The Paternalistic model involves the clinician making the decisions and the Patient Sovereignty model involves the patient making all the decisions without input from the clinician.
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A client is brought to the emergency department (ED) by the son who states, "I am unable to care for my mother anymore." The nurses identifies this son's ethical problem as being which of the following? (p.101)
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Distress Ethical distress is when someone wants to do the right thing but is not able to. The son brings the mother to the ED to maintain her safety, although he needs to take care of her. The other choices may be part of the son's decision, however the immediate problem is one of distress.
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A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing her judgments based on her expertise. Which of the following types of health care decision making does this represent?
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Shared decision making Shared decision making is recommended by most Ethicists and involves the client's preferences and the nurse's expertise to make the best decision. The Paternalistic model involves the clinician making the decisions and the Patient Sovereignty model involves the patient making all the decisions without input from the clinician.
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Injuries related to lifting or transferring patients occur in the health care setting and may be considered a work-related injury. Which law was intended to reduce work-related injuries and illnesses? (p. 133)
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The Occupational Safety and Health Act of 1970 set legal standards in the United States in an effort to ensure safe and healthful working conditions for men and women. The Health Care Quality Improvement Act of 1986 was enacted to encourage health care practitioners to identify and discipline practitioners who engage in unprofessional conduct, and to restrict the ability of incompetent practitioners to move from state to state without disclosure of the practitioner's previous performance. Title VII of the Civil Rights Act of 1964 protects employees from discrimination. The Americans with Disabilities Act of 1990 prohibits discrimination against disabled people and requires covered entities to reasonably accommodate individuals who are protected by the Act.
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In comparison with licensure, which measures entry-level competence, what does certification validate? (p. 117)
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specialty knowledge and clinical judgment Whereas licensure measures entry-level competence, certification validates specialty knowledge, experience, and clinical judgment. Certification does not validate innocence, years of practice, or ability in multiple practice areas.
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The health care facility is involved in litigation by four clients. When reviewing the cases, which legal case would the nurse attorney identify to best describe malpractice? (p. 120)
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The nurse administers amoxicillin (Amicar) to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. All elements of liability are in place for administering amoxicillin to a client with documented allergies to penicillin: the nurse had a duty, but breached it when giving the medication. There also was causation (amoxicillin) and harm (seizures and respiratory arrest). The nurse is negligent when applying an ice pack without an order. The nurse used proper mechanics, so the client fall is an accident even though harm occurred. Giving the wrong medication could be cause for malpractice, but there was no harm.
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Which of the following is an example of certification? (p. 117)
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A nurse who demonstrates advanced expertise in a content area of nursing through special testing. Certification is a voluntary process where a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the National League for Nursing Accrediting Commission and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit healthcare agencies.
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A client admitted with Hodgkin disease has a handwritten prescription for vinblastine 3.7 mg intravenously (IV) weekly. The nurse interprets the prescription as vincristine 3.7 mg and administers the wrong medication. The client becomes neurovascularly compromised and has a fatal reaction to the medication. The client's family begins a litigious suit against the facility and the nurse's license is suspended by the board of nursing. In preparation for the lawsuit, the nurse meets with the nurse attorney to review the events. Which appropriate statement, if given by the nurse, indicates he has an understanding of the lawsuit? (p. 127)
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"I had a duty and it was my responsibility to get clarification before administering the medication, which I did not." The nurse has a legal obligation to carry out health care provider's prescriptions unless the order is ambiguous (the nurse could not read provider's handwriting), contraindicated (vincristine dosage was too high), and contraindicated (wrong medication). The nurse had a duty and needed to get clarification, which he did not. The nurse is liable because there was a duty, which was breached, causation (wrong medication), and harm (client's death). Checking the medication is the correct thing to do, but the priority was assuring the medication was the correct one as prescribed.
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A nurse is caring for a client who has undergone coronary angioplasty. The cardiac monitor is showing abnormal ECG waves, indicating arterial fibrillation. The nurse does not recognize the importance of the sign; as a result, the client's condition deteriorates and the client has to be taken up for an emergency procedure. Which of the following describes the nurse's legal liability? (p. 118)
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Tort A tort is a cause of action in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. A tort implies that a person breached his or her duty to another person. In this case, the nurse had a duty that was breached. A felony is a serious criminal offense, such as murder. Defamation is an act in which untrue information harms a person's reputation. Slander is a character attack uttered orally in the presence of others. (less)
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A nurse is overheard in the hospital cafeteria making false comments about a client. The nurse is guilty of (p. 120):
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Slander Slander is oral defamation of character. Libel is written defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent. Invasion of privacy involves a breach of keeping client information confidential.
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A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which of the following legal terms describes the case? (p. 118)
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Tort A tort is a litigation in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. The lack of action on the nurse's part truly indicates unintentional tort. A misdemeanor or felony would be an offense under criminal law, and neither is applicable in this case. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.
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A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license? (p. 117)
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The State Board of Nurse Examiners The State Board of Nurse Examiners in the United States may revoke or suspend a nurse's license or registration for drug or alcohol abuse.
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Which process evaluates and recognizes educational programs as having met certain standards? (p. 117)
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Accreditation Accreditation is the process by which an educational program is evaluated and recognized as having met certain standards. Credentialing refers to ways in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants the license to do so. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area.
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A medical surgical client is in the radiology department. The client's cousin arrives on the medical surgical unit and asks to speak with the nurse caring for his cousin. The visitor asks the nurse to provide a brief outline of the client's illness. Which response, if given by the nurse, would demonstrate application of legal safeguard in her practice? (p. 118-119)
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"I cannot give you that information due to client confidentiality." Sharing a client's information without his or her consent is an invasion of privacy. The nurse cannot give out the information even if the client proves a relationship or at a later time without the client's consent. It is inappropriate to call the client to ask for permission.
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A nurse enters the client's room and finds the client lying on the floor experiencing a seizure activity. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report? (p. 129)
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To evaluate quality care and potential risks for injury to the client An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. Incident reports determine how to prevent hazardous situations and serve as a reference in case of future litigation. Accurate and detailed documentation often helps to prove that the nurse acted reasonably or appropriately in the circumstances. It may not always serve as a method of determining the nurse's fault in the incident. The document does not evaluate the immediate care provided to the client but states the actions taken.
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The nurse educator is presenting a lecture on the Occupational Safety and Health Act. Which situations, if identified by the nursing staff, would indicate to the educator that the staff understands which actions about the Occupational Safety and Health Act? (p. 133)
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Helps reduce workforce injuries and illness in the workplace The Occupational Safety and Health Act helps to reduce injuries and illness in the workplace. The National Practitioner Data Bank is a clearinghouse for health care practitioners who engage in unprofessional conduct and restrict them from moving from state to state. Nurses are obligated to report abuse because of the nurse-patient relationship; it is not a requirement of the Occupational Safety and Health Act. The American with Disabilities Act protects people with communicable diseases and those recovering from drug or alcohol addiction.
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A nurse assesses a client with psychotic symptoms and determines that the client needs vest restraints. However, the client asks the nurse not to put on vest restraints. What would be the best nursing action? (p. 133)
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Contact the physician and obtain necessary orders. If a nurse feels that a client needs to be restrained, the nurse should inform the physician and obtain necessary orders. The nurse should also discuss this with the client's family members and ask their opinion. The nurse should not sedate the client and then restrain him, as the nurse could be charged with battery if there is restraint without orders. Applying a wrist restraint instead of a vest restraint is like compromising with the client, which is unethical.
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A client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure? (p. 125)
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The nurse ensures that the client's family signs the consent form. The nurse should ensure that the client's family signs the consent form. However, in some states and heath care facilities, it is the physician who ensures that the client's family signs the consent form. The client cannot sign the consent if he is not in an alert state or is unable to communicate. If the client is not in a condition to the sign the consent, a family member can sign the consent on his behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery.
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A nurse comes across a screaming child in the park. The child was hit by a baseball bat, resulting in a swollen and reddened left arm. Any attempt to move the child's left arm results in the child screaming intensely. The nurse used two baseball bats to make a split, which she applied to the child's left arm. The child is transported to the hospital and later develops compartmental syndrome of the left arm. The nurse requests a meeting with the nurse attorney to discuss the possibility of being involved in a litigious suit by the child's family. After a review of the events, which important information will the attorney share with the nurse concerning the case? (p. 131)
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The nurse is protected by the Good Samaritan Act, which states the nurse may give emergency care using good judgment. The nurse is protected by the Good Samaritan Act, which states the health practitioner may give emergency care in a prudent manner using good judgment. The nurse used two sturdy objects to immobile the child's arm; therefore, she was not grossly negligent. A prudent nurse would have done the same. The Good Samaritan Act states the health care practitioner is not obligated to assist; however, it protects the practitioner if she decides to render emergency care.
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A nurse who comments to her coworkers at lunch that her patient with a sexually transmitted disease has been sexually active in the community may be guilty of what tort? (p. 118)
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Slander Defamation of character is an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. Slander is spoken defamation of character; libel is written defamation. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.
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The nurse attempts to notify a health care provider about a client's elevated temperature, but does not get a response. Which statement, if documented by the nurse, would indicate that the nurse is following proper protocol for nursing documentation? (p. 128)
answer
1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified. Documentation must have the correct, factual, and timely information. The nurse must document when the health provider was called and response or lack of response; what nursing action was done, if any, and notification of appropriate personnel. The nurse cannot administer medication without an order. The nurse should be careful and not make incriminating statements, such as, "as usual health care provider did not respond." The nurse should not wait until rounds are made to inform the supervisor.
question
Nurses practicing in a critical care unit must acquire specialized skills and knowledge to provide care to the critically ill patient. These nurses can validate this specialty competence through what process? (p. 117)
answer
Certification Certification validates specialty knowledge, experience, and clinical judgment. The example in the question of the nurse in a critical care unit having specialized skills and knowledge to provide care would be an example of certification. Licensure is a specialized form of credentialing based on laws passed by a state legislature. Licensure endorses entry level competence. Legal accreditation is granted to educational programs by state agencies endorsing the approval of the programs design and mission to meet the needs of state requirements. Litigation is not a method for validation.
question
Professional regulations and laws that govern nursing practice are primarily in place for which of the following reasons?
answer
To protect the safety of the public Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.
question
A client has a prescription for amoxicillin (Amoxil) 500 mg P.O. (by mouth) every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops a pulmonary embolus, experiences respiratory distress, and is transferred to the intensive care unit. The client's family files a lawsuit against the facility and the nurse. While reviewing the case, which legal action has the nurse attorney identified that meets the criteria for the client's lawsuit? (p. 120)
answer
Malpractice The facility and nurse could be charged with malpractice, which is failing to perform or performing an act that causes harm to a client. Administering the medication intravenously instead of orally as prescribed has caused harm to a client. Negligence is failing to perform care for a client. When a person threatens to touch a client without consent, it is assault, whereas battery is carrying out the implied threat (assault).
question
A nurse hired to work in an ambulatory setting attends new employee orientation. The nurse never worked in ambulatory before and is concerned about the Scope and Standards of Practice for Professional Ambulatory Care Nursing. Which response, given by the nurse educator, would further explain the Scope and Standards of Practice for Professional Care Nursing to the new nurse? (p. 124)
answer
"The Scope and Standards of Practice for Professional Ambulatory Care Nursing deal with the professional obligations of a nurse working in the ambulatory setting." The Scope and Standards of Practice for Professional Ambulatory Care Nursing are the standards of care for nurses working in the ambulatory arena. It does not take precedent over the facility's policies and procedures, but must be worked in conjunction with the policies and procedures. It is not used for assessing nurses. NCLEX determines if a nurse is minimally competent to practice as a nurse.
question
A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged? (p.118)
answer
Slander The nurse can be charged with slander, which is a verbal attack on a person's character. Libel pertains to damaging written statements read by others. Both libel and slander are considered defamation of character - an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. Negligence and malpractice pertain to actions which are committed or omitted, thereby causing physical harm to a client.
question
The nurse attorney provides an educational session to the nursing staff on acts of negligence. Which responses by the staff would indicate to the attorney that the staff can accurately identify acts of negligence? Select all that apply. (p. 120-122)
answer
• "I can be charged with negligence if I notify the heath care practitioner about a change in a client's status, but am unable to reach him and do not follow up or document." • "I can be charged with negligence if I apply a heating pad to the client's skin and the client suffers a first-degree burn." Negligence occurs when a nurse fails to provide care that another nurse with the same educational background would perform. Applying heat and burning the client's skin is not an act another prudent nurse would do. The nurse must act as the client's advocate by following up and documenting when a health care provider does not respond to a change in the client's condition. When a nurse follows correct policies for administering medications, following the standards of care and using equipment in the correct manner eliminates the risk of practicing in a negligent manner.
question
The nursing faculty is lecturing on unintentional and intentional torts. The faculty asks a nursing student to provide an example of an unintentional tort. Which example, if provided by the student, would indicate the student has a clear understanding of torts? (p. 118)
answer
A nurse gives a medication and client has an adverse reaction. Unintentional tort occurs when the nurse did not intend harm, but harm occurred (administration of medication and client has an adverse reaction). The other three responses are intentional torts.
question
Having recently completed a specialty nursing program in neonatal care, a nurse is now preparing to leave her current position on a medical unit and begin providing care in the hospital's neonatal intensive care unit (NICU). The nurse has completed which of the following processes of credentialing? (p. 116-117)
answer
Certification The process of certification involves the attainment and validation of specialized nursing knowledge and skills. Certification is often necessary in order to ensure that the nursing care that is provided in specialized and high-acuity settings is safe and appropriate. Accreditation is the process by which an educational program, rather than an individual nurse, identifies that standards are being met. The process of licensure involves the determination that a nurse meets minimum requirements to practice, but not necessarily the specialized knowledge that is necessary for some care settings. Validation is not a specific aspect of the process of credentialing.
question
The nurse educator is presenting an in-service on nursing and malpractice. Which statements, made by the nursing staff, would indicate to the educator that further teaching is required? Select all that apply. (p. 129)
answer
• "If I make a mistake, I will not tell anyone" • "I will have the supervisor fill out the incident report when I make an error." Errors and mistakes should be reported and incident reports filled out. The incident report should be filled out by the person responsible for the error. Documentation should be accurate, factual, complete, and timely. Nurses are accountable for any designated task. The nursing plan is part of the client's permanent record.
question
During the admission assessment of a female client age 40 years with a suspected mandibular fracture, the client discloses to the nurse that her injury came as a result of her husband hitting her. Which of the following actions should the nurse prioritize when responding to this disclosure? (p. 133)
answer
Reporting the abuse to the appropriate authorities Nurses have a legal and ethical obligation to report cases of abuse. It would be inappropriate and likely unethical to require a third party witness to the statement or to withhold action pending assessment results. The nurse's obligation to report abuse legally supersedes the client's right to privacy.
question
The evening nurse received a change-of-shift report from the day nurse. The day nurses' report states, "The client required intubation for respiratory distress this morning, but has been stable all day." The evening nurse collects the following information during the first assessment: Skin flushed. Client lethargic. Temperature 103.0°F. A review of the client's chart reveals that the client's last assessment was done 7 hours earlier. A review of the findings by the nurse attorney determines which facts might be in place regarding liability? Select all that apply.
answer
• Breach of duty has occurred. The nurses had a duty to care for the client and breached duty by not assessing the client in 7 hours. No determination of the nurse or facility's response is made until a complete investigation is done.
question
A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the atenolol to 12.5 mg. However, since the physician is late for another visit, she requests that the nurse write down the order for her. What should be the appropriate nursing action in this situation? (p. 127)
answer
The nurse should ask the physician to come back and write the order. The nurse should ask the physician to come back later and write down the order. However, nurses are discouraged from following any verbal orders, except in emergency. The nurse should never write an order on a physician's behalf because this is a wrong practice. The client should be informed about the change of medications, but this is not an appropriate action. The nurse should not leave the work for a later time, because the nurse may forget it.
question
A client with end-stage renal disease decides against further treatment and requests a "Do Not Resuscitate" (DNR) order. The DNR status is part of the change-of-shift report. The client stops breathing and a nurse begins cardiopulmonary resuscitation. The family is upset and makes a complaint to the charge nurse. When discussing the nurse's action, the charge nurse appropriately identifies which wrongdoing the nurse has violated? (p. 118)
answer
Battery The nurse has committed battery by performing CPR against the client's wishes. Assault occurs when a person threatens to touch a client without consent. Fraud is a willful and purposeful misrepresentation, whereas defamation occurs when a derogatory remark is made about another person.
question
A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which of the following statements is true regarding the Good Samaritan law? (p. 131)
answer
The Good Samaritan law will provide legal immunity to the nurse. The Good Samaritan laws provide legal immunity to passersby who provide emergency first aid to victims of accidents. Therefore, the law is applicable to the nurse as well; moreover, the nurse did not accept any compensation for the service provided. The law is equally applicable to everyone, but does not provide absolute exemption from prosecution in cases of negligence. Paramedics, ambulance personnel, physicians, and nurses who stop to provide assistance are still held to a higher standard of care because they have training above and beyond that of average laypeople. In cases of gross negligence, health care workers may be charged with a criminal offense.
question
Which of the following nursing students would most likely be held liable for negligence?
answer
A nursing student administers medication to a resident, while working as a nursing assistant at a local nursing home. The nursing student who administers medication to a resident, while working as a nursing assistant at a local nursing home is performing a task outside the scope of the job responsibilities of a nursing assistant. The other options demonstrate legally defensible actions by the nursing student. (less)
