NU142- Chapter 3: Critical Thinking, Ethical Decision Making, and the Nursing Process

Patient health education provided by the nurse

is an independent function of nursing practice.

A nurse in a hospice facility cares for clients with terminal illnesses and witnesses a great deal of pain and emotional distress. Which factor that affects healthcare ethics determines how the nurse must respond when a client asks for help in ending his or her suffering?

legislative and judicial decisions

Which type of nursing diagnosis identifies potential problems that may arise due to the client's disease, condition, or situation?

risk

morals

specific beliefs or actions whose outcomes are often examined through a systematic ethical analysis

morality

the adherence to informal personal values

ethics

the formal, systematic approach used to understand, analyze, and evaluate matters of right and wrong as they relate to well-being

A nurse using critical thinking interprets data and determines appropriate interventions. What factor will affect the nurse's ability to employ critical thinking with data interpretation?

the nurse's personal biases

collaborative problems

the physiologic manifestations, which are monitored to detect a new onset of changes in patient status and are managed by nursing, medicine, and allied health professionals

assessment

the systematic collection of data, through interview, observation, and examination, to determine the patient's health status and any actual or potential problems

teleologic theory or consequentialism

the theoretical basis of ethics, which focuses on the ends or consequences of actions, such as utilitarianism

A nurse saw a coworker steal drugs from a locked cabinet. The supervisor notices the missing drugs and has a good idea who is responsible for the theft. The supervisor asks if the nurse saw anything out of the ordinary. Which professional value reflects a nurse's duty to tell the truth?

veracity

moral integrity

virtue composed of honesty, truthfulness, benevolence, wisdom, and moral courage

Which ethical principle refers to the duty to do good?

Beneficence

Which component of the nursing process deals with the identification of client problems?

Diagnosis

Which of the following is a true statement about critical thinking according to Alfaro-LeFevre (2010)?

It is guided by professional standards and codes of ethics.

The nurse is to administer a potassium supplement to the client. The nurse does not check the potassium level prior to administering the medication and later finds that the potassium level was at a critical high. What principle has this nurse violated?

Nonmaleficence

The physician asks the nurse not to disclose a client's diagnosis of end-stage cancer with the client until the client's family can be available to provide support. During the nurse's shift, the client asks the nurse, "What is wrong with me? Everyone is treating me like I am dying." Which of the following replies by the nurse allows the nurse to maintain integrity while providing care for the patient?

"You feel like people are treating you like you are dying?"

The nurse working in the operating room is scheduled to circulate for an elective abortion. The nurse tells the supervisor that it will not be possible to assist with this case due to religious beliefs. What problem is the nurse experiencing with this surgical case?

An ethical dilemma

A nurse is beginning a health history with a client and states, "Which part of your health history would you like to start with?" This type of communication technique is called

Broad opening

Analyzing information for patterns, maintaining a flexible attitude, and making decisions reflecting creativity are all what type of components necessary for nurses?

Critical thinking

Which element is at the center of the processes of clinical reasoning and clinical judgment?

Critical thinking

The LPN is collaborating with the RN in developing a plan of care for a new client. Which description of nursing roles best describes the LPN's contribution to the plan?

Data gathering, identification of client strengths, and assurance of client safety during the assessment phase

The nurse obtains a client's oral temperature reading of 36.8°C. How should the nurse proceed?

Document the client's temperature result as obtained.

A client has designated her daughter as a person to make healthcare decisions for the client if he is not able to do so. What type of advance directive is this considered?

Durable power of attorney (DPOA) for healthcare

Which source of information helps the nurse formulate nursing diagnoses for a specific client?

Essential assessment data

Which term is defined as a formal systematic study of moral beliefs?

Ethics

What statement does the nurse determine is a medical diagnosis rather than a nursing diagnosis?

Fever of unknown origin

Which element is involved in the planning phase of the nursing process?

Identify measurable outcomes

Which of the following is a true statement about a living will?

It states the client's wishes regarding healthcare if terminally ill.

A client had a total hip replacement earlier in the day. The nurse sits with the client to establish some goals. One goal they agree on is to ambulate 1 to 2 miles each day. This is an example of which type of goal?

Long-term

The nurse understands that one of the characteristics of critical thinking is flexibility. What can the nurse do to achieve this characteristic?

Modify priorities and adapt to change.

Based on the nurse's knowledge of the increased risk for bleeding in a client undergoing chemotherapy or radiation, which of the following interventions does the nurse need to include in the client's plan of care? Select all that apply.

Monitoring the platelet count Monitoring for signs of abnormal bleeding Instructing the client to use a soft toothbrush Instructing the client to use an electric razor

Several times, family members have asked a nurse to share personal prescriptions when they were in need of pain medication or antibiotics. Which type of rules or standards should govern the nurse's moral decision?

ethics

A client has just emerged from hip surgery. The nurse enters the client's room and finds the client trying to get out of bed. The client is combative and confused. What actions are appropriate for the nurse to take? Select all that apply.

Notify and obtain a health care provider's order to restrain the client. Ask an employee to sit with the client. Complete a physical assessment

The registered nurse (RN) is responsible for delegating patient care responsibilities to licensed practical nurses (LPNs) as well as ancillary personnel. What would be the most appropriate task to delegate to a nursing assistant?

Obtaining vital signs for a patient that has been hospitalized for 3 days

The RN develops an outcome standard of "client will ambulate with an assistive device 60 feet with assistance twice a day" for a client who had a hip replacement. What part of the nursing process is involved with this outcome statement?

Planning

Which is an important function of accurate and thorough documentation?

Providing a foundation for evaluation and quality improvement

Which situation would require the nurse to use critical thinking and decision-making skills in providing genetics-related nursing care?

Providing fertility counseling to a young family with a 2-year-old child with cystic fibrosis

What therapeutic communication technique validates what the nurse believes to be the main idea of an interaction?

Restating

Which of the following is the highest level of human need according to Maslow (1968)?

Self-actualization

Which therapeutic communication technique may occur during the planning stage, when the client is presented with alternative ideas for consideration relative to problem solving?

Suggesting

A client has a nursing diagnosis of "Feeding self-care deficit related to right-sided weakness. Which of the following would be the most appropriate expected outcome for this client?

The client will demonstrate an ability to feed himself with a spoon at the morning meal.

A nurse chooses a quiet, private area to conduct an end-of-shift report to the oncoming nurse. Following this procedure is necessary because of what ethical problem in nursing?

The right of confidentiality is essential to protect each client's private information.

A client has been admitted to the hospital with a large sacral pressure ulcer. The physician orders the wound care protocol to be performed twice a day. What would be a statement on the plan of care that would address the implementation phase of the nursing process for this client?

Turn the client every 2 hours.

While in the grocery store, a nurse is confronted by a neighbor who asks how the neighbor's hospitalized aunt is doing. The nurse decides that because she knows the neighbor well and the neighbor is related to the client, it is acceptable to tell the neighbor about the client's progress. This scenario can be seen as

Unethical and illegal

While collecting assessment information for a client in labor, the nurse learns that the client's surgical history includes an elective abortion. The client asks the nurse not to tell her spouse about the previous abortion. Faced with moral uncertainty, how should the nurse proceed?

Uphold the client's wishes, ensuring patient confidentiality

A hospital board of directors decides to close a pediatric burn treatment center (BTC) that annually admits 50 patients and to open a treatment center for terminally ill AIDS patients (with an expected annual admission of 200). This decision means that the nearest BTC for children is now 300 miles away. What example of ethical reasoning is this decision consistent with?

Utilitarianism

A client has just been told she has cancer. The client tells the nurse that she is not sure if she wants her family to know. The nurse encourages the client to consider sharing this information with her family members so they can support her through future treatment-related decisions. What ethical principle is the nurse demonstrating?

Veracity

A client is admitted to the hospital for control of diabetes mellitus. When does the nurse understand the nursing process begins?

When the client enters the healthcare system

nursing diagnoses

a clinical judgment concerning an individual's, family's, group's, or community's actual or potential health problems, state of health promotion, or potential risk that can be managed by independent nursing interventions

critical thinking

a cognitive process that utilizes thinking that is purposeful, insightful, reflective, and goal directed to develop conclusions, solutions, and alternatives that are appropriate for the given situation

An advanced directive in which one person identifies another person to make health care decisions on his or her behalf is known as

a durable power of attorney for health care.

nursing process

a systematic, problem-solving approach for meeting people's health care and nursing needs; components include assessment, diagnosis, planning, implementation, and evaluation

utilitarianism

a teleologic theory of ethics based on the concept of promotion of the greatest good for the greatest number of people who may be affected by an action

implementation

actualization or carrying out of the plan of care through nursing interventions

planning

development of measurable goals and outcomes, as well as a plan of care designed to assist the patient in resolving the diagnosed problems and achieving the identified goals and desired outcomes

The physician has ordered cimetidine for a client with gastric ulcers, and the nurse administers the first dose. The nurse's actions are noted in the medical record. This notation is an example of which aspect of implementing the plan of care?

documentation

deontological or formalist theory

an ethical theory that states rational beings are ethically bound to act from a "sense of duty" independent of the ends or consequences

moral dilemma

circumstances in which a clear conflict exists between two or more moral principles or competing moral claims that are incompatible

moral problem

competing moral claim or principle; one claim or principle is clearly dominant

moral uncertainty

conflict that arises within a person when the individual cannot accurately define what the moral situation is or what moral principles apply but has a strong feeling that something is not right

moral distress

conflict that arises within oneself when a person is aware of the correct course of action but institutional constraints stand in the way of pursuing the correct action

evaluation

determination of the patient's responses to the nursing interventions and the extent to which the outcomes have been achieved

The nurse is developing a client's care plan. What activity best exemplifies the assessment phase of the nursing process?

determines the client has a pulse rate of 88 bpm