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

Which type of nursing diagnosis is a clinical judgment of a client's motivation and behavior to increase his or her well-being?

health promotion

Patient health education provided by the nurse

is an independent function of nursing practice.

Which type of nursing diagnosis identifies an existing condition that the client is experiencing?

problem-focused

The purpose of a concept care map is to:

show the whole picture of the client..

A longterm care facility's newest client refuses to attend group activities or social events offered by the facility. Which level of Maslow's hierarchy do social events address?

third: love and belonging needs

A client presents to the acute care facility with several signs and symptoms. How will the nurse determine and prioritize the client's healthcare needs?

using a systematic method to plan and implement care to reach desired outcomes

The nurse prepares to administer medication to the patient. The patient states, "I would prefer not to take that medication until I speak with my physician." The nurse honors the patient's desire to make decisions, following which common ethical principle?

Autonomy

The use of patient restraints limits which ethical principle?

Autonomy

Which ethical principle refers to the duty to do good?

Beneficence

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

Planning

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

The nurse moves a confused, disruptive patient to a private room at the end of the hall so that other patients can rest, even though the confused patient becomes more agitated. The nurse's intervention is consistent with what moral theory?

"Consequentialism," by which good consequences for the greatest number are maximized

A client, 50 years old, is admitted for treatment of a gastric tumor. The client asks the nurse, "Do you think I have cancer?" Which response by the nurse would be most therapeutic?

"You sound concerned about what the physicians will tell you."

Which situation would be appropriate for ethics committee review? Select all that apply.

- Client refusal of a lifesaving blood transfusion because of religious preference - Placing a 21-year-old client with cystic fibrosis on the double-lung transplant list - Institutional participation in gene chip technology directed at disease prevention

Assessment, the first of five steps in the nursing process, begins with initial patient contact. What activities by the nurse are included in this component of the nursing process? (Select all that apply.)

- Interviewing and obtaining a nursing history - Observing for altered symptomatology - Collecting and analyzing data

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

Telling the truth (veracity) is one of the basic principles of North American culture. Three ethical dilemmas in clinical practice can directly conflict with this principle. Choose the three from the list below.

- Revealing a diagnosis to people other than the client with the diagnosis - Using placebos - Not revealing a diagnosis to a client

A nurse walks into a client's room to find the client trying to get out of bed. The client is confused and combative and states she needs to get up to check on the cat. What action is appropriate for the nurse to take? Choose all that apply.

- Use the services of a trained sitter. - Ask a family member to sit with the client. - Be compliant with annual education regarding appropriate use of restraints.

The following nursing diagnoses are formulated with a client: constipation, acute pain, and caregiver role strain. During the planning phase of the nursing process, the nurse will prioritize the diagnoses in what order?

Acute pain, constipation, caregiver role strain

When prioritizing a client's care plan based on Maslow's hierarchy of needs, the nurse's first priority would be:

Administering pain medication

A client has been diagnosed with cardiac dysfunction and admitted to a health care center. The nurse notices that the client's ankles and feet are swollen. Using critical thinking skills, which nursing intervention does the nurse know to perform next?

Assess client for dependent edema

The RN is obtaining a health history and performing a physical assessment for a client who is admitted to the hospital with complaints of chest pain. What part of the nursing process does the LPN understand the RN is performing?

Assessment

The nurse is administering a medication to a client for the treatment of his constipation. The client states that he prefers not to take the medication today. The nurse respects the client's right and informs him if he needs it later, just let the nurse know. What professional value is the nurse displaying?

Autonomy

The nurse is caring for a client in the intensive care unit that is on life support measures. The family members are opposed in their decision to take the client off of life support. What option does the nurse discuss with the nurse manager?

Contact the ethics committee for their input.

The nurse is attending a client with chronic renal failure. The client says that of late he has lost his appetite and feels like everyday situations have become more stressful. The client reports feeling disappointed and frustrated with his condition, and says that he has not been of any help to his family. What is the most important nursing intervention that the nurse needs to carry out at this point?

Coordinate with resources for client support

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 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.

Which of the following is an important element of implementation?

Documentation

Which of the following is involved in the implementation step of the nursing process?

Documenting nursing care and client responses

Which of the following is a cognitive or mental activity that nurses use in critical thinking?

Drawing on past clinical experiences and knowledge to explain what is happening

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

Ethics

Healthcare providers use a problem-solving approach for ethical dilemmas. Which is the last step of the ethical decision-making model?

Evaluate the decision in terms of effects and results.

A client is to be discharged from an acute care facility after treatment for pneumonia. The nurse notes that the client's lungs are clear and denies shortness of breath. The nurse's actions reflect which step of the nursing process?

Evaluation

A client reports postoperative pain near the incision site on his abdomen. He describes the pain as constantly burning and rates it at an 8/10 using the pain scale. The nurse administers morphine sulfate 2 mg IVP as ordered. Ten minutes later the nurse documents that the client now rates his pain at a 3/10 using the pain scale. The nurse's documentation is an example of which part of the nursing process?

Evaluation

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

Fever of unknown origin

Which type of nursing diagnosis has a goal to increase well-being and enhance specific health behaviors?

Health promotion

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

Identify measurable outcomes

Which communication technique is helpful in health teaching about relevant aspects of a client's well-being and self-care?

Informing

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.

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

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

Nurses are aware that clients must give consent before surgery, but sometimes a question arises as to whether a client is truly informed. This is an example of

Meta-ethics

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.

The nurse needs to perform an admission assessment for a client who does not speak the same language as the nurse. The client's wife is fluent in both the nurse's and the client's languages. When completing the physical assessment is critical in planning patient care, how should the nurse proceed?

Obtain a translator to assist with interpretation during admission assessment.

Developing a written plan of nursing care takes place during which step of the nursing process?

Planning

The nurse is prioritizing the care of a client who has diagnoses of uncontrolled diabetes and may have the left foot amputated related to a nonhealing ulcer. What need would the nurse place at the lowest level while prioritizing this client's care?

Self-actualization needs

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.

The nurse has developed a plan of care for a client who is having a surgical procedure and is at risk for the development of pneumonia. The nurse devises the outcome statement to read: "The client will have clear lungs by the third postoperative day. " On the third postoperative day, the patient has left lower lobe crackles and infiltrates on the chest x-ray. What conclusion does the nurse reach for this client?

The outcome is not achieved, and the plan requires critical reevaluation and revision.

The nurse is preparing a client for a colonoscopy at the hospital. Who does the nurse understand is responsible for obtaining the informed consent from this client?

The physician

While working in an institution that uses computer documentation, the nurse understands the need to log out of the computer if it is not in use. 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 patient?

Turn the client every 2 hours.

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

Which ethics theory focuses on ends or consequences of actions?

Utilitarian theory

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

When the client enters the healthcare system

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

A client has just returned to the unit following abdominal surgery and is in significant pain. According to the nursing process, how frequently will the nurse perform assessments on this client?

as often as needed

Several days this week, a nurse takes time after work to read to a visually impaired client who has no family close by. This behavior demonstrates that ethical values:

concern the treatment of others.