Fundamentals of Nursing

1. According to Berman, what are the two key words for a healthy lifestyle? A. Eat and Exercise B. Diet and Diligence C. Balance and Moderation D. Mind and Body

Answer: C. Key words for a healthy lifestyle are balance and moderation. Berman text p. 456

1. A nurse discovers a client lying on the floor. He/she helps him back to bed. What should the nurse do FIRST? 1. File an incident report 2. Restrain the client 3. Notify another nurse 4. Ask a CNA to check on the client 5. Put a bed alarm on the client

1. Correct answer is E. Putting a bed alarm on the client promotes immediate safety of the client. An incident report should be filed second. Berman & Snyder page 75

3. Which of the following is an example of a nurses obligation in ethical decision making? (select all) A. Using judgment regarding individual competency when accepting and delegating responsibility B. Following what you believe is ethical rather than carrying out hospital policies C. Participating in the advancement of the profession through individual contributions D. Ensure that the individual receives sufficient information on which to base consent for care

A, C, and D are correct. Information regarding the ANA's Code of Ethics for Nurses and the International Council of Nurses Code of Ethics can be found on page 86 and 87. Box 5-6 on p. 88 states a couple examples of nurses' obligations in ethical decisions. This box states that "carrying out hospital policies" is an obligation in ethical decisions, which is why B would be an incorrect answer. Berman, 8th ed. (86-88)

Which of the following exemplify goals of being a client advocate? Select all that apply. 1) Be subjective 2) Protect client's rights 3) Decide for the client 4) Disregard the family's decision 5) Intervene on client's behalf

ANSWER: 2,5 Rationale 1) The nurse must remain objective 2) CORRECT: This is the overall goal of an advocate 3) This disregards client's autonomy 4) Family, which could be primary decision-makers in some cultures. This is culturally insensitive. 5) CORRECT: The nurse intervenes on the client's behalf, often by influencing others. Advocate's Role: Berman text Chapter 5 pg. 93-94

Which of the following behaviors indicate unclear values? 1) A client with an endomorph build, diagnosed with diabetes is admitted to the hospital 2) A client decides to live a "simpler life" and retires early to avoid stress and live longer. 3) A client with COPD refuses to stop smoking even after doctor's advice 4) A client says that she breast feeds to ensure her baby's health.

ANSWER: 3 Rationale 1) Not enough information is provided to determine values. No behavior was stated in example. 2) No confusion or uncertainty about which course of action to take. Actions in sync with values. 3) CORRECT: Ignoring a health professionals advice 4) No inconsistencies in communication or behavior. Words in sync with values. Behaviors That May Indicate Unclear Values: Berman text Chapter 5 pg. 83 Box 5-3

Which of the follow best defines prejudice? 1. A preconceived notion that is not based on adequate knowledge; it can be beneficial or unbeneficial. 2. Assumptions about a racial group. 3. The differential and negative treatment of individuals on the basis or their race, ethnicity, gender, or other group membership. 4. Making the assumption that an individual reflects all characteristics associated with being a member of a group.

Answer: 1. "Prejudice is a preconceived notion or judgment that is not based on sufficient knowledge. It may be favorable or unfavorable" (Berman, 317).

A nurse did not look up the patient's drug allergies in the chart and ignored the red band on the patient's wrist. The nurse administered a contraindicated medication, which resulted in urticaria and angioedema in the patient. The nurse noticed later and administered a shot of epinephrine, symptoms went away; the patient got better. The nurse felt no need to report the incident. Which of the following moral principles did the nurse violate? Select all that apply. 1) Veracity 2) Fidelity 3) Beneficence 4) Non maleficence 5) Justice

ANSWERS: 1,3,4 Rationale 1) CORRECT: Veracity- omission of the truth is not telling the whole truth. 2) Fidelity-the nurse did not express a promise in this scenario. 3) CORRECT: Beneficence- it was not "good" to try and cover it up. 4) CORRECT: Non maleficence- the patient was in harm's way when administered the wrong medication, when it could have been avoided with a simple check of allergies. 5) Justice- the nurse was not faced with a trial of justice in this scenario. Moral Principles: Berman text Chapter 5 pg. 85-86

Question 1: An ER nurse is caring for a Southeast Asian female patient who has been diagnosed with appendicitis but refused surgery. Which of the following responses by the nurse would be considered most appropriate? 1. wait for the patient's husband to arrive to assist with decision making 2. do nothing because the patient has autonomy to refuse treatment 3. advocate for the patient and her decision of not getting the surgery 4. prepare the patient's discharge paperwork along with pain medication

Answer: 1 is correct because of the Asian culture, most often, the head of household or family members ultimately make health decision. In contrast, patients with Western views want control over their health rather than allowing a family member to contribute in their decision. The nurse with this understanding should wait for the husband to arrive and with his presence the patient may be more comfortable with the idea of having surgery. 2. incorrect because the nurse is giving in rather than to think holistically in regards to patient's cultural background. 3. incorrect because the nurse is lacking in the knowledge and the differences of cultures when making health decisions. 4. incorrect because the nurse is not advocating for the patient in respect to her cultural background. Berman text, pg 93

A student nurse in their clinical makes a mistake and it was later found that the act was negligent. Who may be held responsible? Select all that apply. 1. The student 2. The hospital or agency 3. The educational institution 4. The nurse that the student was following

Answer 1, 2, 3. The nursing student is responsible for their actions and is not practicing under another nurse's license. The hospital or agency and the educational institution will also be held potentially responsible. Berman pg. 75

1. A patient diagnosed with late-stage lung cancer is experiencing breakthrough pain and is asking for more pain medication. He was given morphine, an opioid-based drug, less than 3 hours ago. What should a nurse do, following Provision 1.3 of the ANA Code of Ethics? 1) give enough morphine to the patient to alleviate his pain 2) wait for further directives from the patient's oncologist 3) refuse to give more morphine due to risk of respiratory arrest 4) offer to give the patient a non-opioid pain medication instead

Answer: 1 Rationale: According to Provision 1.3 of the ANA Code of Ethics (the nature of health problems), the nurse should respect the rights, dignity, and worth of all those who require nursing services for health promotion, illness prevention, health restoration, comfort, and supportive care to those who are dying. As such, the nurse should provide necessary pain management to the patient even though this may hasten death. The emphasis is on avoiding needless pain and suffering by the dying patient. However, the nurse should not do so with the intent of ending the patient's life, regardless of the benevolence of intentions. Choices 2, 3 and 4 are not correct because delaying or holding back on pain relief to the extent that pain is not controlled is not acting in patient's best interests. (source: ANA Code of Ethics pdf handout)

A patient is deciding if she should move forward with an invasive cosmetic surgery, how should her nurse help her come to the best decision? 1. Ask, "Have you considered any other options?" 2. Provide a story about a patient who did this surgery and was happy. 3. Ask, "How will you discuss the surgery your family or friends?" 4. Ask, "Why are you second guessing yourself now that you're so close to what you want?"

Answer: 1 and 3 are examples of ways a nurse could clarify patient values. 1 is an example of "listing alternatives" and 3 is an example of "choose freely" (Berman, 82). The other choices are too opinionated or coercive. I got 1 point off because I need to "make alternatives about the same length, sentence structure; be sure you include 'select all that apply' when there is more than one correct answer." She did use one of my questions on the last exam but changed it.

Which of the following are examples of a health disparity? 1. Blacks have a 10 times higher rate of new AIDS (acquired immune deficiency syndrome) cases than whites. 2. Women get breast cancer more frequently then men. 3. More black women dye more from breast cancer than white women, despite the fact that more white women get breast cancer than black women. 4. People living in rural areas that live closer to a hospital than people in the city.

Answer: 1 and 3. A health disparity is when one population experiences different care when compared to a different population (Berman, 317-318). Answer 1 comes from textbook, answer 2 is made up, answer 3 is from our group presentations, and answer 4 is made up.

A nurse is asked to obtain a consent form from a patient. After the patient signs the form it asks the nurse to sign as well. By signing these forms the nurse is confirming which of the following? Select all that apply. 1. The signature is authentic. 2. The nurse explained the procedure to the client. 3. The client gave consent voluntarily. 4. The client appears competent to give consent.

Answer: 1,3,4. The nurse's signature on the form of does not require the nurse to explain the procedure, but it does indicate the nurse saw the client sign it and it was given voluntarily and the person was competent enough to give consent. Berman pg. 62

A 70 year old man had a heart attack and was resuscitated. After waking with several broken ribs and in severe pain the man decided that he does not want to go through this situation again. The patient decides he wants to sign a DNR, but the family of the patient thinks that the patient is making a rash decision. What should the nurse do? 1. Order the necessary forms for the patient. 2. Talk to the patient from the family's perspective. 3. Wait until the family is gone and talk to the patient about different options. 4. Ask a doctor to talk to the patient.

Answer: 1. It is the nurse's moral responsibility to honor the patient's right to autonomy and allow the patient to sign a DNR. Berman pg. 85

A nurse suspects that a treatment ordered by a physician will harm her patient; what would be the proper action for the nurse to take? 1. Refuse to carry out orders and report the situation to her nurse supervisor 2. Carry out the orders, then immediately report to her nurse supervisor 3. Inform the patient and allow her to choose whether or not to accept treatment 4. Report the physician to hospital's human resources department

Answer: 1. rationale: Even though it is the physician's orders that the nurse is following, the responsibility of any nursing actions will be the responsibility of the nurse. The proper action would be to avoid doing anything that would harm a patient and report to the nurse supervisor. (Berman, p. 58)

(1) A registered nurse wishing to practice in a state other than where they are licensed should: 1) Rent a house there to establish residency 2) Contract the other state's Board of Nursing 3) Retake the N-CLEX exam in that other state 4) Open a bank account to establish residency

Answer: 2 - If the states have an interstate compact the nurse will be able to practice in both states. Berman p 56

Question 2: A patient who is diagnosed with a terminal cancer and was instructed by a physician to start chemotherapy. What is the most appropriate question that the nurse should ask the patient? 1. Are you aware of the side effects of chemotherapy? 2. Can I share my story as a breast cancer survivor? 3. How do you feel about your decision? 4. Do you want to know your prognosis?

Answer: 3 is the correct answer because the nurse is asking the patient to clarify his/her perspectives and values. Asking about the patient's feeling will initiate a dialogue and the nurse will truly find out what's most important value in the patient's care plan. 1. incorrect because asking about awareness of side effects will not clarify client's value in order for the nurse to plan effective care. 2. Sharing a positive story will not help in identifying client's value towards the newly diagnosed cancer. 3. raising the question of prognosis will help with clarifying the client's value. Instead the question will even stop the dialogue. Berman text pg. 82

2. Which of the following does not reflect a violation of the conflicts of interest provision in the ANA Code of Ethics? 1. a nurse who cares for the football coach of his/her son who promised more playing time for the son 2. a nurse who hands out free samples from the pharmaceutical company where his/her spouse works 3. a nurse who refers elderly disabled clients to a family member who runs a private home care agency 4. a nurse who requests to be removed from the care of a patient who had assaulted his/her daughter

Answer: 4 Rationale: According to the ANA Code of Ethics (provision 4.4), a conflict of interest occurs when a nurse's personal interests interfere with the patient's best interests or the nurse's professional responsibilities. The nurse should never exploit the patient for any type of personal gain. When the nurse perceives a potential conflict of interest, he/she should reveal the potential conflict to parties involved, and in some instances, remove himself/herself from the situation. Choices 1, 2 and 3 are all violations of the conflicts of interest provision. (source: ANA Code of Ethics pdf handout)

Who does the BRN (Board of Registered Nursing) represent? Select all that apply A. The public B. Certified Nursing Assistants C. Registered nurses D. Healthcare professionals

Answer: A (Source: BRN website: http://www.rn.ca.gov/about_us/whatisbrn.shtml) The BRN represents the public and regulates registered nurses in the state of California.

Which of the following is ethical. Select all that apply A. Respect a patient's advanced directive of DNR even though the family disagrees. B. Helping a terminal patient administer lethal medication in Oregon. C. Refusing to assist in an abortion due to religious or moral principles. D. Suggest a new medicine to a patient because your friend told you it was effective.

Answer: A, B, C are correct. For A, since the patient completed an advanced directive, the nurse is ethically responsible for voicing that decision. B is correct because euthanasia is legal in certain states, including Oregon. C is correct because conscience clauses allow nurses to refuse assisting with an abortion if it violates moral principles. D could be true if the 'friend' was someone credible, but more research should be done before suggesting a medicine to a patient since nurses are supposed to maximize the client's well-being. Berman, page 89-93

1) Which of the following statements illustrate behaviors of unclear values? Select all that apply. a) Patient with diabetes who will not stop consuming sodas and processed foods b) Obese patient expresses she wants to lose weight but do not want to exercise. c) A patient who continually seeks helps to stop smoking but cannot cut down. d) Patient with high blood pressure who is thinking about cutting down salt intake. e) Patient who is anorexic ignores doctor's recommendation on healthy lifestyle.

Answer: A, B, C, E Rationale: Answers A & E ignore health professional's advice. Answer B demonstrates inconsistent behavior/communication. Answer C exhibits patient's numerous admissions to a health agency for the same problem. Answers A, B, C, and E exemplify behaviors that may indicate unclear values. Answer D demonstrates that patient is in the precontemplation stage. Berman, pg. 83, 285

2. A nurse who is completely against homosexuality is refusing to provide care for a 45 year old gay patient with AIDS. Which of the essential nursing values is this nurse lacking? Select all that apply. A. Human dignity B. Altruism C. Utility D. Social justice

Answer: A, B, D. This nurse does not show concern for the welfare of her patient (altruism); this nurse does not show respect for the inherent worth and uniqueness of individuals (human dignity); this nurse does not provide fair treatment regardless of sexual orientation (social injustice). Utility is not an essential nursing value. Berman text, p 81

2) A nurse who is aware of one's relationship to others, fosters trusting relationships, and presents oneself as someone who respects others and demands respect demonstrate which 6 Cs of caring in nursing? Select all that apply a) Compassion b) Capability c) Confidence d) Conscience e) Comportment

Answer: A, C, E Rationale: Answer B is not part of the 6 C's of caring in nursing. Answer A: A nurse exemplifies compassion when one is aware of one's relationship to others and participates in the experience of another. Answer C: A nurse who has the quality that foster trusting relationships and comfort with self, client, and family shows confidence. Answer E: A nurse that is in harmony with a caring presence and present oneself as someone who respects others and demands respect illustrates comportment. Berman, pg. 451

1. Which of the following could be considered a social determinant of health? A. Living in an area where there are plenty of social meeting spots, i.e. cafes, parks B. Attending a quality school C. Frequenting a restaurant that does not have a wheelchair accessible ramp D. Not having access to the internet

Answer: A,B and D Rationale: A, B, and D are all social determinants of health but C is an example of a physical determinant of health. The lack of a ramp can be a physical determinant of health. (Healthy People 2020)

1. Occasionally, the client's best interest is contrary to the nurse's personal belief system. What is this contradiction referred as? A) Moral Distress B) Moral Conflict C) Moral Disagreement D) Moral Discrepancy

Answer: A. Moral distress causes serious issues in the workplace and nurses might need assistance with coping. The four A's to help nurses cope with moral distress are: ask, affirm, assess, and act. (Berman, pg 89).

3. If an institution denies medical care to a group of people based on their sexual identity, what cultural concept are they exemplifying? A. Discrimination B. Stereotyping C. Racism D. Generalization

Answer: A. The institution is giving negative or differential treatment to a specific group of people. This is absolutely wrong, as all people deserve the same quality of care regardless of their gender, sexual identity, race, or ethnicity. (Berman, p. 317)

3. Which of the following choices best defines the idea of personal standards of what is right and wrong? A. ethics B. morality C. fidelity D. veracity

Answer: B Rationale: According to Berman and Snyder, morality is defined as "private and personal standards of what is right and wrong in conduct, character, and attitude." They define ethics as "the rules or principles that govern right conduct", fidelity as being "faithful to agreements and promises" and veracity as telling the truth. (source: textbook, pages 82-86).

2. Upon request, a medical professional gives a terminally ill patient a lethal dosage of medication that the patient can administer at home. This can best be described as: A. active euthanasia B. assisted suicide C. passive euthanasia D. voluntary manslaughter

Answer: B Rationale: Assisted suicide occurs when a patient is given the means to end his life himself, upon request. Active euthanasia involves actions that bring about a patient's death directly (e.g. a medical professional administering a lethal dose of medication). Passive euthanasia occurs when life support is removed. Manslaughter may or may not be a punishment for euthanasia and assisted suicide, depending on the circumstances. (source: textbook, page 92)

What is a term used to describe an area with little access to large grocery stores with fresh and affordable foods needed to maintain a healthy diet? A. Rural B. Food desert C. Wasteland D. Urban

Answer: B (Source: Group 4's Health of the Community presentation "West Oakland: Food Desert")

Which form of euthanasia also known as "mercy killing" is in violation of the Code for Nurses? Select all that apply. A. Passive euthanasia B. Assisted suicide C. WWLST D. Active euthanasia

Answer: B, D. ANA's position statement state that both active euthanasia and assisted suicide are in violation of the Code for Nurses. Passive euthanasia is commonly referred to (WWLST) may be both legally and ethically more acceptable to most persons than assisted suicide. Berman text, p 92

• 1. Which of the following scenarios best reflects the concept of nonmaleficence, rather than beneficence? A. Administering painkillers to a post-op patient B. Helping a patient brush her teeth C. Intervening when a colleague is not following proper aseptic technique D. Educating a patient with a broken hip about physical therapy

Answer: C Rationale: Administering medications, aiding with personal hygiene, and referring patients for further healthcare all fall under beneficence, which menas "doing good". Nonmaleficence, on the other hand, means to "do no harm". Preventing the improper use of aseptic technique is an example of doing no harm. (source: textbook, pages 85-86, and Dr. Saulo- Lewis lecture)

3. A nurse states "My patients family just offered me some pasta they made from scratch...but cmon', only Italians like me know how to make pasta!" What does this statement indicate? A. Prejudice B. Discrimination C. Ethnocentrism D. Stereotyping

Answer: C Rationale: Ethnocentrism is the belief that ones own culture or lifestyle is superior to others. The nurse felt that only Italians like herself can make good pasta. (Berman e.g., p.317)

3. You are assigned to take care of a patient who just had an abortion, but your beliefs are against abortions. It is best if you: A) Tell the charge nurse why you cannot take care of the patient. B) Take care of the patient because you are in a professional role. C) Ask another nurse is he/she could cover your shift with the patient. D) Forget about your own beliefs and assist the patient with her needs.

Answer: B. According to the ANA code of ethics for Nurses, the nurse's primary commitment is to the patient. In addition, the International Council of Nurses Code of Ethics mentions that the nurse's primary professional responsibility is to people requiring nursing care. A nurse does not necessarily have to forget about his/her own beliefs, but rather just put them aside and not let them conflict with their professional role. A nurse's responsibility is to give the best quality care and be non-judgmental towards patient's decisions. (Berman, 87-88)

2. There is an 80-year old man suffering from bone marrow cancer. The patient is extremely depressed and no longer wants to live. They have requested that the nurse please give them a lethal dose of morphine to let them die peacefully and without anymore pain. The nurse refuses, what is the client asking the nurse to perform? A. Passive Euthanasia B. Active Euthanasia C. Termination of life-sustaining treatment D. Withdrawing

Answer: B. In this case the client is asking the nurse to perform active euthanasia, or "mercy killing". This is illegal and would result in criminal murder charges against the nurse if they had gone through with the act. This scenario involves a patient asking the nurse to administer lethal medication to end their suffering. (Berman, p. 92)

3) Patient is fighting end-stage of ovarian cancer. In the patient's advance directives, it specifically states to withhold special attempts to revive. This is an example of which end-of-life issue? a) Active euthanasia b) Assisted suicide c) Passive euthanasia d) General suicide

Answer: C Rationale: Passive euthanasia is commonly referred to as WWLST, withdrawing or withholding life-sustaining therapy that involves the withdrawal of extraordinary means of life support and allowing patient to die of the underlying medical condition. Active euthanasia involves actions to bring client's death directly (with or without client's consent). Assisted suicide is providing client with resources to kill themselves under his/her request. Berman, pg. 92

3. A client who has upper respiratory congestion is less congested in a supine raised head position but is in increased pain in this position due to recent rectal surgery. Which critical thinking attitude does the nurse utilize when quickly responding to the clients needs by suggesting they try a raised side lying position? a. Intuition b.The nursing process c. The trial-and-error method d. The research method

Answer: a Rational: When utilizing intuition experience is key to understanding needs; this nurse knew without consultation to others or research that this would be a likely solution. Trial-and-error includes several approaches and if this new position were unsuccessful, the nurse would likely move to a trial-and-error approach. (Berman text, p.168)

Q2. A 19 year girl was rushed to hospital, had a miscarriage and was not aware that she was even pregnant. The parents arrived to the hospital not knowing what has gone wrong. The girls asked the doctor and the nurse not to tell her parents about the miscarriage. What be the Nurse response when the parents ask about their girls health? a) Tell them the truth and inform them that their daughter did not want them to know. b) Tell them it is none of their business as their daughter is over the age of 18. c) Tell them their daughter is well and due to patients privacy they are not able to disclose any information. d) Talk aloud in front of doctor about the girl's condition so her parents could over hear the case.

Answer: C: Nurse and Doctor have to respect the patient's wishes and request for their privacy. Also, present the information to their parents in an ethical way of not offending or disrespecting like in the answer B. The patient has the right to decide whether she wants to disclose her information to her parents or not and as a Nurse you have to respect that decision and honor it in every way so talking aloud so parents could hear would also violate this ethics. (PowerPoint, Nursing Ethics, slide 35-39)

2. Which of the following would least likely help develop psychological homeostasis? A. A life experience that provide satisfactions B. A family environment that includes parents who are healthy role models C. Having parents that give kind but firm consistent discipline D. A social environment that encourages values of honesty, giving and tolerance.

Answer: D Rationale: Healthy role models, appropriate discipline, and a life experience that provides satisfactions are all examples of developing psychological homeostasis. Social values like honesty and tolerance are more specific to the family unit. (Berman e.g., p.277)

1. A 16-year old girl comes into your clinic pregnant and seeking an abortion. Based on your personal religious beliefs you are against abortion, and thus do not feel comfortable continuing care with this patient. What would be the more appropriate response? A. Preach your religious faith and try to "save" the client by stopping her from receiving an abortion. B. Give her a pamphlet on why abortion is wrong, however say that the decision is up to her. C. Tell her you are against abortion and that she cannot seek treatment there. D. Refer to a clinic that can help her with the appropriate treatment options that she is seeking.

Answer: D. Most states have laws allowing nurses to refuse to assist in an abortion is it violates religious or moral principles. But, based on the code of ethics, nurses must support the right for clients to be informed and have counseling to make informed decisions free of judgment and without coercion. (Berman, p. 91)

2. You are about to take a patient's blood pressure and the patient physically withdraws his/her arm. You should: A) Assume the patient's arm hurts and assess the other one. B) Continue the procedure and check the patient's vitals. C) Ask the patient if something is bothering him/her. D) Step back and inform the patient about the procedure.

Answer: D. Patients may physically withdraw from nurses and other health care providers if they feel that he/she is too close. The concept of personal space depends on the culture. For instance, Western societies tend to be more territorial and will either move back or mention that someone is in his/her space. Stepping back and letting the patient know what is going to be done prior to the assessment should be considered. (Berman, 326).

Q1. A Senior Nurse always watching your work and points out all the errors you make. One day the same Senior Nurse was about to see a patient and gets an equipment that had a label stating, not functioning effectively and is set for repair. The Senior Nurse forgets to check and takes the equipment and you notice this happening. What would be your reaction? a) Let the Senior Nurse finish using the equipment and then tell her. b) Tell in front of everyone that Senior Nurse should check labels on the equipment before using it. c) Ignore what you saw and let the Senior Nurse do her job and eventually would find out that the equipments is not working. d) Go to the Senior Nurse personally and let her know that equipment is set for repair.

Answer: D: A Nurse job is not to just focus on her own work, but prevent evil or harm and remove evil or harm as a moral principal. Letting the Senior Nurse be aware about the equipment is also protecting the patient and the Senior Nurse. Safety of yourself, others staff members, and patients is very important and putting aside your personal feeling toward anyone. (PowerPoint, Nursing Ethics, slide 25 -26)

Q3) When a nurse tells the patient that she is going to get him a warm blankets. Client takes such promises seriously, so should the nurse, this is referred to as? a) Attitudes b) Autonomy c) Justice d) Fidelity

Answer: D: Fidelity refers to being faithful to agreements and promises. Attitudes are mental positions or feelings toward a person, object or idea. Autonomy refers to rights to make one's own decision. Justice is frequently referred to as fairness. (Berman, Page 85-86)

An example of the nurse's moral obligation according to the ANA Code of Ethics is: a) Withholding food and fluids to a dying patient if it is determined to be more harmful to administer them then to withhold them. b) Ensuring that the family members of the patient are aware of the advance directive and agree to the terms. c) Assisting with an abortion even if it is against the nurse's beliefs. d) Assisting a terminal patient's request to end his life by participating in active euthanasia.

Answer: a) According to the ANA Code of Ethics for Nurses (2005), this position is supported through the nurse's role as a client advocate and through the moral principle of autonomy. Rationale for incorrect answers: b) the family members do not have to agree to the advance directives if they are already in place by the patient. c) Most states have conscience clauses, which enables a nurse to have the choice of not assisting with abortions if it is against their beliefs. d) While assisted suicide is legal is some states, the ANA's position on euthanasia is that both active euthanasia and assisted suicide are in violation of the Code for Nurses. Berman, A. & Snyder, S. Kozier & Erb's Fundamentals of Nursing. pg 91-92

2. Which of the following would not apply to the nurse's role as an advocate? a. Convincing a patient that he or she should ultimately be making medical decisions for his or herself. b. Allowing a home-care patient to revert back to his or her unhealthy habits after being released from the hospital. c. Working at the government level to gain wins for the nursing profession in pertinent areas of public health. d. Providing a patient with the necessary information to make his or her own medical decisions and supporting those decisions.

Answer: a. Western tradition values a patient's control in making his or her own medical decisions. In other cultures, these responsibilities may be held by another individual, such as an elder or an entire community. The nurse needs to respect and accept these traditions, even if they don't correspond with his or her own values. Berman text, p. 93.

2. A physically combative client with AIDS is admitted to the emergency room for a bacterial infection. The emergency room is understaffed and the client is sent to the AIDS ward. The nurse on duty is directed to administer an antibiotic by intramuscular injection. Does the nurse have a moral obligation to care for this client? a. Yes, unless the risk is greater than the responsibility. b. No, the nurse can refuse on religious values and beliefs. c. Yes, the nurse's primary obligation is to the client. d. Yes, but not until an orderly is present to restrain the client.

Answer: a. Yes, but if a client is physically combative it may place the nurse at risk for a needle stick injury; the risk would exceed the responsibility b. the nurse cannot refuse on religious values and beliefs c. and d. Yes, but not if the risk is greater than the responsibility (Berman text, page 91)

Which of the following is a purpose of the nursing code of ethics: (Select all that apply) a) Guide the profession in self-regulation b) Provide ethical standards for professional behavior c) Enacting the conscience clause regarding personal beliefs and care. d) Strive for collaborative practice

Answer: a.b Nursing code of ethics have the following purposes: 1) Inform the public about the minimum standards of the profession and help them understand professional nursing conduct. 2) Provide a sign of the profession's commitment to the public it serves. 3) Outline the major ethical considerations of the profession. 4) provide ethical standards for professional behavior. 5) Guide the profession in self-regulation. 6) Remind nurses of the special responsibility they assume when caring for the sick. Berman, A. & Snyder, S. Kozier & Erb's Fundamentals of Nursing. pg 87

3. A nurse is directed to have a client sign a consent form for electromagnetic therapy. The nurse is responsible for which actions: 1. Explaining the procedure to the client and obtaining the client's voluntary signature. 2. Witnessing the client's signature and verifying the client received enough information. 3. The nurse is not responsible for obtaining a client's signature; only the physician. 4. Encouraging the client to sign the form, because the client will benefit from the surgery.

Answer: b. The nurse should witness the signature and advocate for the client by verifying that the client received enough information a. The nurse could be liable for providing incorrect information to the client. If the nurse has doubts about the client's understanding the nurse should notify the health provider c. It is the responsibility of the nurse to witness the client's signature d. The client's signature should be voluntary and not influenced by the nurse. (Berman text, page 59)

1. A nurse is dealing with an extremely uncooperative patient who will not take his medicine. What would be an appropriate response? a. Telling the patient, "You have to take your meds. It's what the doctor ordered, and it is in your best interest." b. Crushing the meds in the patient's food so that he gets them anyway, because he really needs to take them to get better. c. Informing the patient of the possible ramifications of not taking his meds, but accepting that he does not have to take them if that is his decision. d. Telling another nurse not to force the patient to take his meds because it is his decision not to take them. And, if he does not care about getting better why should his nurses.

Answer: c. Choice (a) violates the essential nursing value of autonomy. Choice (b) violates the essential nursing value of integrity. Choice (d) violates the essential nursing value of altruism. Berman text, p. 81.

1. A 75 year old woman with ovarian cancer rejects radiation and chemotherapy treatments, because she fears their effects. She wants to only pursue a natural, holistic treatment, because she believes it is the least painful option. What nursing action would be most helpful? a. Honoring the client's decision and not interfere with her choice to avoid a painful treatment. b. Helping her research the most effective, holistic treatments and choosing the best option. c. Verifying the client has accurate information and understands the consequences of her decision. d. Informing the client that radiation and chemotherapy are the best options for her survival.

Answer: c. Nurses need to help clarify client's values by examining the possible consequences of their choices; make sure the client has thought about possible results of each action. a. The client may not have accurate information. Not providing accurate information would be violating nonmaleficence. b. and d. These actions would be imposing the nurse's values on the client, which should never be done. (Berman text, page 82)

2. According to the American Nurses Association, participation in assisted suicide, or assisted euthanasia by a nurse is: a. currently upheld by the Supreme Court in the state of Oregon. b. permissible so long as it is by means of passive euthanasia. c. in accordance with the code of ethics with a physician's order. d. currently considered a violation within the Code for Nurses.

Answer: d Rational: The ANA considers both active and assisted euthanasia in violation of the Code for Nurses. Passive euthanasia is the cessation of life supporting means and is more commonly accepted and practiced than assisted or active euthanasia. (Berman text, p.92)

3. Which of the following is not an acceptable example of giving informed consent? a. A father signing a consent for a tonsillectomy for her 16 year-old daughter who is worried the surgery will affect her singing voice. b. A husband giving consent for his comatose wife to receive a new treatment that is still in its trial stages. c. A surgeon assuming given-consent for an emergency procedure for an unconscious client whose next-of-kin cannot be located. d. A mother signing consent for her married 17 year-old son to participate in a research trial for a new ADHD medicine.

Answer: d. Minors who are married, pregnant, parents, members of the military, or emancipated are legally permitted to provide their own consent. The general rule under Maryland law indicates that if guardians and minors fitting these categories differ in opinion on consent, the IRB will go with the minor's decision. Therefore, a mother signing a consent for a married minor may not always be valid. Berman text, p. 60-62. http://www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/informed_consent_minors <--- under "Minors who are Married or the Parent of a Child"

Nonmaleficence is best portrayed by: a) Promising to return to a patient in a timely manner and following through. b) Agreeing to not tell the patient that they are terminal at the request of the family. c) Assisting a patient with their DNR paperwork d) Being unsure about wish medication to administer and asking for clarification.

Answer: d: Nonmaleficence is the duty to "do no harm". This includes intentional harm, unintentional harm, and placing someone at risk for harm. Asking for clarification about a medication that a nurse is unsure of, ensures that the patient is not harmed by the incorrect medication. a) is an example of fidelity. b) is an example of not following veracity. c) is an example of honoring autonomy of the patient. Berman, A. & Snyder, S. Kozier & Erb's Fundamentals of Nursing. pg 85-86. Powerpoint presentation by Mileva Saulo Lewis, EdD, RN. Slide 13, 25, 26.

1. A nurse has passed medications to a client per the physician's orders. The client has experienced an adverse reaction to the administered drugs. What level of maleficence is this described as in Fundamentals of Nursing, chapter 5? a. placing negligent harm b. placing intentional harm c. placing unintentional harm d. placing malevolent harm e. placing client at risk of harm

Answer: e Rational: There is a known risk of harm when administering medications with the intention to be helpful as the possibility of adverse reactions is always present. Berman describes this as, "placing someone at risk of harm." (Berman text, p.86-87)

3. The hospital's neonatal unit was understaffed due to a flu outbreak. As a result, a nurse was given too many patients and was unable to provide adequate care for all of them. Which would be an acceptable delegation of care by the nurse? Select all that apply. 1. asking a nurse from the intensive care unit for assistance with insertion of feeding tubes 2. asking a student nurse to administer parenteral medication to a baby in a stable condition 3. asking a new nurse to take the vital signs of a baby whose condition is not stable 4. asking a nursing assistant to teach the mother how to change her baby's dressing

Answers: 1 and 3 Rationale: Nursing delegation means entrusting the performance of selected nursing duties to individuals who are qualified, competent and legally able to perform such duties. The nurse is responsible for assessing the competency of other nurses and health care personnel before transferring or assigning care duties of patients to them. Choices 1 and 3 are correct because both nurses are qualified and have the knowledge and skill to perform assigned task. Choices 2 and 4 are not correct because unlicensed assistive personnel such as the student nurse and nursing assistant cannot be delegated tasks such as administering parenteral medications and client education. ((sources: ANA Code of Ethics pdf handout; Berman text, pgs. 524-525)

1. A client asked their nurse to please help with the pain she currently has from a surgery she had done a couple of hours ago. When the nurse replies, "I will be right back with your pain medication," and she follows through with that promise, the nurse is practicing: 1. Beneficence 2. Fidelity 3. Justice 4. Veracity

Best answer- 2 Rationale: 1- Beneficence is the obligation for nurses to do good, to implement actions that benefit clients and their support persons. 2- This is the best answer because fidelity means to be faithful to agreements and promises. 3- Justice is fairness. 4- Veracity refers to telling the truth- does not lie, because it could lead to loss of trust. (Berman p. 86)

1. Which of the following would be considered a violation of the ANA Code of Ethics for Nurses (2005) for end of life issues? 1. A nurse honoring competent and informed client's decision to withhold food and fluids. 2. A nurse withholding food and fluids because it is determined to be harmful by the physician. 3. A nurse withholding life sustaining treatment because she knows the client is about to die. 4. A nurse keeping clients families informed that they can reevaluate life sustaining decisions.

Best answer- 3 Rationale: 1- The nurse is honoring the patient's decision which is competent and informed. 2- The nurse is honoring that sustaining life is more harmful, as decided by physician. 3- Best answer, this is not the nurse's decision to make, it is up to the client, family or physician. 4- The nurse is allowing the family to know their alternatives, so they are well informed. (Berman p. 92)

1. A frail elderly client has decided that he does not want any more surgeries, but his family and surgeon insist he continue these surgeries. Which of the following is an example of caring-based reasoning? 1. "This surgery, which he may not even survive, will cause him to suffer more and his family will feel guilty later." 2. "This is violating this clients right to autonomy, this man has a right to choose what happens to his body." 3. "My relationship with this man makes me want to protect him; I must help his family understand his needs." 4. "If this man doesn't want the surgery, we shouldn't do it, he may die from the surgery and it will be a waste."

Best answer: 3 Rationale: 1- The nurse is practicing principles-based reasoning which involves logical and formal processes and emphasizes individual rights, duties, and obligations. 2- This is practicing reasoning based on autonomy which is the right to make one's own decisions. 3- Is the best answer because caring-based reasoning stresses courage, generosity, commitment, and the need to nurture and maintain relationships. 4- Is a consequence-based reasoning which looks at outcomes (consequences) of an action judging whether that action is right or wrong. (Berman p. 84-85)

1. A patient immediately experiences sharp, shooting pain in his left arm in response to the IV the nurse is inserting. The nurse is experienced and quickly removes the IV upon witnessing the patient's reaction, however, it is later determined that the patient suffered nerve damage as a result of the procedure. A tort is filed on the patient's behave citing an act of _________ on the nurses part. a. commission b. omission c. unprofessional conduct d. gross negligence

Correct Answer: a. While inserting the IV the nurse hit a nerve causing the patient pain. The nurse was assigned fault based on incorrectly inserting the IV, which is an example of an act of commission. Incorrect Answer: b. An act of omission would assume the nurse did not do something that should have been done. In this case the nurse immediately withdrew the IV upon seeing the patient's response, which is exactly what should have been done. c. Unprofessional conduct refers more to how a nurse behaves around with patient. In this case the nurse makes a mistake inserting the IV, but there is no evidence of poor professional behavior. d. Gross negligence would imply that it was the nurse's "extreme lack of knowledge, skill, or decision making" that caused the problem. On the contrary the nurse used correct decision-making skills when she acted quickly to remove the IV. Furthermore, since the nurse is "experienced" it is unlikely that a knowledge/skill deficit caused the incident. Berman pg. 68

2. Which of the following situations are appropriate for lawsuits that fall under the doctrine of res ipsa loquitur? a. A patient is delivered a wrong diagnosis because the nurse couldn't work the ultrasound machine properly. b. A patient develops an infection after surgery in response to a piece of gauze that was left inside him. c. A patient is given the wrong medication after the nurse mixes up two similar looking vials. d. A patient is subjected to prolonged smoke inhalation because the nurse couldn't locate the fire extinguisher.

Correct Answer: b. This doctrine encompasses the cases that cannot be traced back to a specific nurse or doctor. In this case, it cannot be determined which health care provider left the gauze in the patient. Incorrect Answers: a, c, d. These are examples that fall under the doctrine of respondeat superior. A specific employee can be blamed for the harm. In situations a and d a lawsuit can also be filed against the employer for lack of training and proper facility orientation. Berman pg. 68

3. An off duty nurses witnesses an accident involving a tree and a bicyclist in which the bicyclist is thrown from his bike. The nurse decides to take action under the Good Samaritan Act. Which of the following is the appropriate action the nurse should take? a. Stabilize the injured cyclist and then go get help. b. Insist on applying pressure to any obvious wound. c. Provide general first aid while waiting for additional help. d. Stay on scene without touching the bicyclist until help arrives.

Correct Answer: c. The guidelines for nurses who wish to render emergency services under the Good Samaritan Act suggest the nurse, "limits actions to those normally considered first aid". It also states that the person providing emergency care should not leave the scene until another qualified person arrives. Incorrect Answers: a. Leaving the injured person to get help is not recommended. b. The person rendering emergency care should only offer assistance, not insist upon giving it. d. The Good Samaritan Act protects those that provide assistance against malpractice claims. Therefore, a health care provider should not be afraid to give hands on care if necessary. Berman pg. 73

Question #3 The nurse understands the idea of autonomy by: A. Thoroughly explaining the procedures with possible outcomes using easily understood language. B. Respecting the patient's rights by allowing them to smoke in the hospital room. C. Suggesting that the nurse favor one procedure over another due to their personal opinion D. Give an unbiased, informative description of the different procedures available to the patient.

Correct Answer: A (A) By explaining the procedures and possible outcomes the nurse allows the patient to practice their right to autonomy. (D) The nurse provides unbiased information to the patient, but by not describing the possible outcomes the patient is unable to make a fully informed decision. Berman, Audrey., Snyder, Shirley. Fundamentals of Nursing.New Jersey: Pearson Education, Inc., 2012. Print. (Chapter 5, page 85)

2) The nurse is preparing an English-speaking client of Hispanic background for a pacemaker insertion procedure. The client has pinned a religious medal to her hospital gown and carries it with her at all times. The nurse knows that the client must remove her gown in the OR. What is the best way to care for this client? a) Remove the medal without informing the client before surgery and put it back after. b) Send the medal to the OR with a note explaining the significance of it to the client. c) Explain to the client that the medal does not have any healing power or value. d) Say, "I will hold the medal for you until you return from the operation room."

Correct Answer: B Rationale: When nursing care fails to be compatible with the patient's beliefs and values, there may be signs of conflict, noncompliance and stress. Culturally compatible care is provided by preserving the client's familiar life-way and by making accommodations in care that is satisfying to the client. (Berman, 8th ed, Ch 25, p.450)

Question #1 Which action best represents the nurse understands provision 1 in the ANA Code of Ethics? A. The nurse believes they are capable of making a treatment decision for a patient due to their inability to speak. B. The nurse acts in a manner to relieve a dying patient's pain, although it poses the risk of hastening the patient's death. C. The nurse doesn't report a charting error made by their colleague in order to maintain a positive relationship with that colleague. D. The nurse attempts to allot equal time to each patient, regardless of their condition, attempting to respect the worth of each patient.

Correct Answer: B (B) The measures that the nurse takes to comfort a patient outweighs the possible risk of a hastened death. Reference: ANA Code of Ethics. Nursing World. Provision 1. (Pages 3-5) Berman, Audrey., Snyder, Shirley. Fundamentals of Nursing.New Jersey: Pearson Education, Inc., 2012. Print. (Chapter 5, page 86)

1) A nurse is working with an elderly client and his wife to prepare discharging the husband. The wife wants to provide care for her husband at home despite repeated requests by the family to admit him to a long term nursing facility. What is the nurse's role in family disagreements? a) Help the wife to understand family's concern. b) Be an advocate for the husband and wife. c) Say, "you need to discuss it with your family." d) Do not interfere and let the family decide.

Correct Answer: B Rationale: Nurses are advocates for both the client and the family. Through advocacy, nurses are champions for their clients. They empower clients and families through activities that enhance well-being, understanding, and self-care. (Berman, 8th ed, Ch 25, p.451)

Question #2 Veracity is best demonstrated by: A. A nurse ruling out a strenuous exercise program that would improve the patient's general health, but puts the patient at risk for a heart attack. B. A nurse promises a patient that she will be back in 5 minutes due to the need to assist another patient. The nurse returns in 5 minutes. C. A nurse clearly explaining that car accident that the patient survived from resulted in the death of the patient's spouse. D. A nurse catches a patient that is falling while incidentally leaving a dark blue bruise on the patient's arm.

Correct Answer: C (C) This demonstrates that veracity involves telling the truth, even though the resulting truth could lead to the patient feeling anxiety and fear. (B) The nurse speaks the truth to the patient, however the fulfillment of a promise more closely resembles adherence to fidelity. Berman, Audrey., Snyder, Shirley. Fundamentals of Nursing.New Jersey: Pearson Education, Inc., 2012. Print. (Chapter 5, pages 85-86)

3) The nurse has been asked by the head nurse to work a third double shift during one week. The head nurse begs the exhausted nurse to stay until midnight. What should she respond: a) Say yes, otherwise leaving would be considered abandonment. b) Say no and tell her to find someone else who is less tired to work. c) Say no, but tell her that you can stay until the next nursing shift begins. d) Say yes, but ask for the weekend off to compensate the overtime work.

Correct Answer: C Rationale: It is vital that nurses attend to their own needs, because caring for self is central to caring for others. Self-care is important for professional nurses. (Berman, 8th ed, Ch 25, p. 452)

2. A middle aged, obese woman repeatedly returns to her healthcare provider complaining of ankle pain but does not attempt to lose weight. The best response by the nurse when clarifying the client's values would be: a) "Have you thought about losing weight as that will help alleviate the pain?" b) "Let's look over the various actions that could possibly help alleviate the pain." c) "We have a great program for losing weight. Would you like more information? d) "It is important to follow the plan of care. Are you following the doctor's orders?"

Correct answer (b). Listing alternatives may help a client become aware of all actions available if the client appears to hold unclear or conflicting values related to a particular health problem. The nurse assists client to think through each question but does not impose personal values. Behavior that may indicate unclear value: Numerous admissions to a health agency for the same problem. (Berman, p.82-83)

3. A nurse is completing a health history on her 34 year-old female patient. When the nurse arrives at the sexual history section, the first question she asks is if the patient is using birth control. The client responds no. What should this nurse ask next: a) "What is the reason for not using anything?" b) "Are you pregnant or trying to get pregnant?" c) "Are your partners male? female? Both?" d) "Have you used birth control in the past?"

Correct answer (c). Cultural competency is a ongoing process where the nurse strives to work effectively within cultural context of a client. It's important to establish what might be the sexual activity concerns of this patient by inquiring about partners. The original question about birth control in the stem already assumes heterosexuality and is not the best question to ask in the first place. Answer A could be the answer but may put the patient in awkward position of how she answers. Answer B assumes the patient is not using birth control because she is pregnant rather than understanding that this patient may not have male partners. Answer D isn't necessarily relevant at this stage of the assessment.

1. Which are guidelines for the Good Samaritan Act? Select all that apply. 1. Insist on giving emergency treatment. 2. Have someone go get help or call 911. 3. Leave after you've done your part. 4. Accept payment from the client or family.

Correct answer is B. (Did I trick you with the select all that apply??) It is necessary that appropriate care and transportation is provided to the client. The nurse should assign someone to call 911 or get assistance. Why not.... A: You should offer, not insist. C: You should stay until the client has been transferred or care is passed off. D: There should be no compensation. Berman & Snyder page 73

1. A client is in the hospital with terminal cancer. He states that he doesn't want parenteral nutritional therapy when he starts to decline. The nurse knows that he should create an advance directive. The information she should give the patient is in which of the following? 1. The patient's bill of rights 2. Nursing standards of practice 3. The patient self-determination act 4. The patient protection act 5. The bible

Correct answer is C. The patient self-determination act requires that patients have the right to accept or refuse care and use an advance directive. Berman & Snyder page 22

1. The Healthy People 2020 Initiative explains there are a powerful, complex relationships that exist which influence an individual's or populations health. These factors are called determinates of health, which include the following (circle all that apply) a) literacy level b) racism c) legislative policies d) birth order e) socioeconomic status

Correct answer: all except d. "Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual's or population's health, are known as determinants of health." http://www.healthypeople.gov/2020/about/DisparitiesAbout.aspx

Question 3 A patient is being disrespectful to a nurse who is treating them. In an effort to control the patient the nurse places restraints on them. This is an example of: 1. Invasion of privacy. 2. False Imprisonment. 3. Battery. 4. Negligence

Number 2 is correct. As defined by Berman, false imprisonment is the "unjustifiable detention of a person without legal warrant to confine the person." Numbers 1, 3 and 4 are incorrect. Invasion of privacy is a breach of confidentiality. Battery would be touching the patient in an inappropriate way. Negligence is a failure to perform at the expected level. Berman pgs. 67 and 69 Berman, Audrey, and Barbara Kozier. Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. Upper Saddle River, NJ: Pearson Prentice Hall, 2012.

En elderly patient has a terminal illness. Their physician explains to them that additional treatment is futile and the patient agrees that a do not resuscitate (DNR) order is appropriate. In this case the client is: 1. Incompetent. A proxy decision is responsible for their decision. 2. Competent. The DNR order should be documented. 3. Lacking decisional capacity. The client is unable to make the decision. 4. Withdrawn. Their living will should decide their treatment.

Number 2 is correct. The patient has been given information by their physician and a competent client's values should always be given highest priority. Number 1, 3 and 4 are incorrect as there is nothing to imply that the patient's decision making is impaired. The physician has given the patient information and believes that a DNR is appropriate. The patient does not need a proxy decision maker or living will unless they choose so. Berman pg. 66

A patient informs the nurse that he or she participates in regular yoga and meditation classes to "increase my mental health and overall well-being." The nurse can conclude the patient practices which health behavior? 1.) Health protection 2.) Health promotion 3.) Secondary prevention 4.) Tertiary prevention

Number 2 is correct. The patient is seeking exercise to expand mental health, and increase his or her wellness. Number 1 is incorrect because the patient did not specify that practicing yoga or meditation was disease-specific. Number 3 and 4 are not applicable; secondary and tertiary prevention behaviors focus on identification, intervention and rehabilitation for specific diseases and illnesses. Berman pgs. 281 and 282

Question 2 A nurse is shopping at a mall and sees a crowd gathered around a person on the ground who is clutching their chest. Emergency Service is not yet on the scene. The nurse is unsure if they remember how to perform CPR correctly, should they administer care anyway? 1. Without the permission of the client, the nurse should not administer aid. 2. The nurse should administer aid regardless because the client's life is at risk. 3. The nurse should not do CPR because they are unsure how to perform it. 4. The nurse should perform CPR since they cannot be held liable.

Number 3 is correct. The nurse should not administer CPR. The nurse is unsure and it would be malpractice to perform below the standard of what is expected. The nurse may be held liable for any damages that occur from performing CPR incorrectly. Number 1 is incorrect. The nurse should not administer CPR because they are unsure how to perform it. Number 2 is also incorrect for this reason. Number 4 is incorrect. The nurse should not perform actions that they do not know how to do. If malpractice causes an injury, the nurse is held liable for damages that may be compensated. Berman pgs. 67-68

A nurse is caring for a patient from Thailand. The patient has been provided with several options of care for a pre-existing disease, yet the patient refuses to move forward with a decision about his care without his wife being present. How should the nurse proceed? 1.) "Would you like for me to bring a translator in to discuss your care?" 2.) "Your wife can provide advice, but your care is your choice." 3.) "I will refer you and your wife to your social worker for further information." 4.) "I will wait until your wife arrives to provide you information about your care."

Number 4 is correct. A nurse should provide culturally responsive care and recognize that patients from Southeast Asia may apply a group perspective to decision making, and not want to make decisions regarding their healthcare without family present. Number 3, 2 and 1 are incorrect. Number one and three are irrelevant to the topic. Number two is inconsiderate of the patient's cultural background and beliefs. Berman pg. 59

3. The ANA code of ethics Provision 5 states that the nurse owes the same duties to self as to others. In what ways might this be true? Select all that apply. a. moral self respect: respecting the worth and dignity of all human beings extends to the self as well b. wholeness of character: the nurse owes it to self to integrate professional and personal values so to be part of a moral community c. professional growth and maintenance of competence: the nurse owes it to self to continue personal and professional growth d. preservation of integrity: the nurse may be faced with compromise but must maintain the integrity of personal and professional values

Rationale: A,B,C and D, all of the above. Respect for oneself, taking care of oneself, and treating oneself with the same integrity, value system and moral respect that one uses with others is important! ANA Code of Ethics, Provision 5

2. While doing her rounds in the hospital a nurse overhears a conversation between two family members regarding the nurse's patient. The conversation makes her suspect that the family physician has not been completely honest with them about the patient's condition. She is confronted with an ethical dilemma: her loyalties are torn between the patient and the doctor. What should she do? a. the ethical decision making process is a linear one, the nurse has her own moral compass and she should make a decision and stick with it b. the ethical decision making process is a linear one, the nurse knows that lying to a patient is a black- and-white situation and what the doctor has done is wrong, regardless of the reasoning behind the decision c. the ethical decision-making process is not a linear one, she should develop her reasoning, uncover any assumptions she may be making and evaluate alternative views before making a decision d. the ethical decision-making process is not a linear one, the nurse should report to the charge nurse so that her suspicions can be confirmed, ensuring that someone with the proper authority takes charge of the situation

Rationale: C is correct. The ethical decision making process is not linear and involves developing reasoning, uncovering assumptions and evaluating alternative views among other things. A and B are incorrect because the process is not linear. D is incorrect because it relieves the nurse of her own role in following the code of ethics Berman and Snyder, Fundamentals of Nursing Pg.90-91

1. A patient with chronic pain has been dropping hints to her nurse that she is considering using marijuana in addition to her prescription analgesics even though it is illegal. However, it is clear that the patient is unsure of herself and would feel more comfortable if her decision were supported in some manner by her health care professionals. The nurse is aware that there are multiple scientific studies showing that marijuana is effective for treating long term pain, and is considering informing her patient. What should she do? a. the nurse should ask herself "Am I doing the right thing?" As long as the nurse can defend the morality of her own actions her decision is the right one b. the wellbeing of the patient is the nurse's first priority, she should do whatever she can to help her patient regardless of whether it is legal or not c. the nurse should report the conversation to her charge nurse to protect herself from potential repercussions should anyone find out about the conversation d. the nurse should check what the hospital policies are with regards to illegal drug use before she says anything to her patient

Rationale: The correct answer is A. Conflicting loyalties and obligations make ethical decision making more difficult. However, in the end the most important thing is to be able to defend the morality of your own actions. The nurse must consider the legality of actions taken and cannot simply disregard the law as a matter of course (B), reporting the conversation violates the patients privacy and is not ethical (C) the patient is not using illegal drugs in the hospital, so the nurse does not need to check with hospital policies on drug use/abuse(D). Berman and Snyder, Fundamentals of Nursing Pg.88-91

2. The nurse is assigned as the team leader on a busy medical/surgical unit. Which of the following BEST describes the "rights" of delegation the nurse must consider when assigning tasks to other members of the health care team? A. Right task, right timing, right client, right person, and right date B. Right task, right client, right direction, right supervision, and right date C. Right client, right direction, right day, right medication, and right unit D. Right task, right circumstance, right person, right direction, and right supervision.

The answer is D. Rationale: These are the five rights of delegation. Option A refers to the five rights of dispensing medications. Option B it still refers to medications. Option C does not refer to the delegation of tasks. Reference: Irwin, J. Barbara and Burckhardt, A. Judith. Kaplan 2013-2014 NCLEX-RN Strategies, Practice And Review (page 320).

3. The new staff nurse working on the intensive care unit is concerned about her client's status. The client has continued to decline throughout the shift. The client's blood pressure, heart rate, and oxygen saturation have progressively dropped in a relatively short period of time. The nurse inquires with the charge nurse assigned to that shift. The charge nurse says "Don't worry, the client will be fine, he always does that." Which of the following actions should the nurse take? A. The nurse should call the nursing supervisor on duty to assist. B. the nurse should wait and see how the client does. C. The nurse should agree with the charge nurse because that nurse has more experience. D. The nurse should discuss this with other nurses on the unit.

The answer is A. Rationale: The nurse should escalate up the chain of command to advocate for the client. Option B, is incorrect because the client is exhibiting serious symptoms that could represent a grave diagnosis. Option C is incorrect because the nurse must trust her own clinical judgement even if it is in conflict with a more senior nurse. Option D, this might be an appropriate strategy, but a supervisor can provide more immediate assistance. Reference: Irwin, J. Barbara and Burckhardt, A. Judith. Kaplan 2013-2014 NCLEX-RN Strategies, Practice And Review (page 326).

1. The nurse discovers that the last dose of intravenous antibiotic administered to a client was the wrong dose. which of the following should the nurse do? A. Document the event in the client's medical record only. B. File an incident report, and document the event in the client's medical record. C. Document in the client's medical record that an incident report was filed. D. File an incident report, but don't document the event in the client's medical record, because information about the incident is protected.

The answer is B. Rationale: The event should be filed in an incident report and in the client's medical record. Option A the event should be filed both in an incident report and in the clients medical record. Option C, nurses should not document in the client's medical record that an incident report was filed. The incident report is for internal purposes of learning for the institution. Reference: Irwin, J. Barbara and Burckhardt, A. Judith. Kaplan 2013-2014 NCLEX-RN Strategies, Practice And Review (page 141).

3. During an assessment of a patient with a severe forehead injury, the nurse notices the patient has a red dot on their forehead. Which action by the nurse is appropriate? A) Work around the red dot and do not come in contact with it B) Ask the patient about the item and its significance C) Have the item temporarily removed to complete the examination D) No action is necessary

The answer is B. Rationale: The nurse should inquire about the red dot's meaning. These symbols are often seen as an important means of protection keeping one's health, spiritual protection, or ceremonious following a religious event. Reference: Berman, Audrey., Snyder, Shirley. Fundamentals of Nursing. New Jersey: Pearson Education, Inc., 2012. Print. (Chapter 18, pages 320-322)

1. A nurse is caring for a client who is pregnant and unsure about whether or not she should have an abortion. The nurse begins to question herself by asking "Can I accept this?" and "What would I do in this situation?" What is the nurse doing in this situation? A. Gaining awareness of her professional values B. Questioning her professional beliefs C. Gaining awareness of her personal values D. Questioning her personal beliefs

The answer is C. According to Berman, reflecting on values about life, death, happiness and illness is important in dealing with ethical problems. One way for nurses to gain awareness of their personal values is by asking themselves to consider their own attitudes about issues such as abortion by asking questions such as "Can I live with this?" "Can I accept this?" and "What would I want done in this scenario?" By asking herself these questions, the nurse is attempting to gain awareness of her personal values. (Berman text, p. 82)

3. A client's family asked the nurse not to tell the client of his diagnosis because they believe the truth may eliminate hope. The client later asks the nurse for information regarding his condition. What should the nurse do in this situation? A. Withhold information because the truth will cause fear and anxiety B. Respect the family's request by not telling the client about his diagnosis C. Tell the client the truth despite knowing this may eliminate hope or cause harm D. Ask the client to discuss his diagnosis with his family since they know the truth

The answer is C. One of the moral principles includes veracity which means truth telling. The choice to tell the truth may not always be clear especially when a nurse knows it might cause harm. However, lying to a patient is rarely the correct thing to do since this causes a loss of trust. The nurse's loyalty is always to the client first. (Berman text, p. 86-88)

2. A female patient arrives in the hospital unconscious and needs to be put on life support to survive. It is discovered that before the patient was married, she had created an advanced directive to not be put on life support. What should the nurse do if the husband is requesting his wife be put on life support? A) Allow the patient to be put on life support per the husband's wishes B) Check the organization's and state's healthcare policies C) Adhere to the advanced directive D) Allow the patient to be put on life support if the chances of recovery are high

The answer is C. Rationale: All 50 of the United States have enacted advance directive legislation which is a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. Reference: Berman, Audrey., Snyder, Shirley. Fundamentals of Nursing. New Jersey: Pearson Education, Inc., 2012. Print. (Chapter 5, page 92)

2. A patient who is terminally ill and has stage IV breast cancer decides she no longer wants to proceed with her treatment and is contemplating on the idea of euthanasia. The patient turns to her nurse and says "Please be honest. What would you do in my situation?" How should the nurse handle this scenario? A. Be honest and answer the question from the nurse's personal view B. Tell the patient there are other alternatives to euthanasia C. Ignore the question and change the topic because it is unethical D. Ask the patient "Are you considering other courses of action?"

The answer is D. According to Berman, it is the nurse's job to explore the client's value through discussion. The patient is unsure about what she should do and her conflicting values might be detrimental to her health. Therefore, the nurse should use value clarification as an intervention. However, the nurse should never impose her personal value, even if the patient asks for it since the nurse's decision would not be relevant to the patient's situation. Instead the nurse should redirect the question back to the client by asking questions such as "Are you considering other courses of action?" (Berman text, p. 82)

1. What is the correct course of action to help an elderly male patient, who is terminally ill of cancer and in a high intensity of pain, would like be euthanized? A) Participate if the laws in your state allow for assisted suicide B) Participate only if your religion/morals beliefs agree with this practice C) Obtain consent from the patient (or the person with the power of attorney) before assisting D) Do nothing as euthanasia is a violation of the Code for Nurses

The answer is D. Rationale: While euthanasia and assisted suicide is has been upheld by the Supreme Court in the state of Oregon, the American Nurses Association's position that active euthanasia and assisted suicide are in violation of the Code for Nurses. Reference: Berman, Audrey., Snyder, Shirley. Fundamentals of Nursing. New Jersey: Pearson Education, Inc., 2012. Print. (Chapter 5, page 92)

2. Which of the following is an example of beneficence? A. A nurse advised a patient at risk of seizures to incorporate a treatment involving bright flashing light to treat a separate disease B. A nurse advised a smoker at risk of lung disease of a plan to limit and/or quit the use of cigarettes C. A nurse advised a patient at risk of a heart attack about a strenuous exercise program to improve health D. A nurse advised a patient with a history of stomach ulcers to incorporate a healthy diet that includes citric fruit juices

The correct answer is B. Beneficence means "doing good." Sometimes, doing good can also pose a risk for doing harm, so it is important to know all the risks the patient has and to incorporate the whole health of the person into a specific plan. A, C, and D are all incorrect because they pose a risk of doing harm because the nurse has not taken into account all the risk factors the person may have. Berman, 8th ed. p 85

A nurse is helping a client to quit drinking alcohol. The nurse suggests to the client that the client remove all pint and shot glasses from the home. This strategy can help the nurse conclude the patient is in which stage of change? 1.) Contemplation 2.) Preparation 3.) Action 4.) Maintenance

The correct answer is Number 3. During the action stage, the nurse can encourage the client to "modify the environment to reduce stimulus to a problem behavior." By encouraging the client to remove alcohol-related items in the home, the client will be better able to implement a permanent behavior change. Contemplation is incorrect because during this stage, the client has not yet identified the behavior that he or she would like to change. Preparation is incorrect because the client has already begun his or her behavior change. Lastly, maintenance is incorrect because, in this stage, the client has already implemented and adapted to a new behavior change. Berman, pg. 294

1. Which of the following examples is reflective of a nurse who is properly utilizing contingency planning? (Select all that apply) A. The nurse set the brakes of the wheelchair before attempting to transfer the patient from the bed to the wheelchair B. The nurse lowered all the side rails on the bed so that the incontinent patient could have easier access to the bathroom at night C. The nurse set up an emesis tray at the patient's bedside because a certain procedure has a post-op risk of vomiting D. The nurse placed restraints on an adult to ensure they wouldn't move while placing a feeding tube

The correct answers are A and C. Contingency planning was discussed by Dr. Lewis; it is used for risk management when an exceptional risk that, though unlikely, would have catastrophic consequences. A contingency plan is a plan devised for an outcome other that in the usual expected plan. In A, the nurse planned for the possibility of the wheelchair rolling away while transferring the patient, so she placed the brakes ahead of time. In C, the nurse is aware that a certain procedure has a risk of vomiting, so by setting up an emesis tray ahead of time, he or she won't have to deal with a patient who decides to try and get up to vomit just after surgery, or won't vomit on themselves or elsewhere. B is incorrect because lowering all the side rails is unsafe. D is incorrect because it is illegal to place restraints without a doctor's order or to make a procedure easier.

What is the legal purpose for defining the scope of nursing practice, licensing requirements, and standards of care? 1. To protect the public 2. To protect the care giver 3. To protect the hospital 4. To protect nurses

answer: 1. rationale: by following the Nursing Practice Acts, nurses are establishing a standard of care that ensures that their patients are cared for in a safe manner. (Berman, p. 55)

A nurse anesthetist is preparing to adminster anesthesia to a client prior to a procedure that a surgeon will perform. What would the proper action be to aquire the patient's consent for the anesthesia? 1. The doctor performing the surgeory should make sure that the patient signs the consent form 2. The Anesthesiologist should make sure that the patient signs the consent form 3. The nurse anesthetist should make sure that the patient signs the consent form 4. The hospital needs to make sure that the patient signs the consent form

answer: 3. rationale: The person performing the procedure is responsible for obtaining the proper consent from the patient. Because the nurse anesthetist will be administering the anesthesia, she should be sure that the patient has signed the consent document, orally consented, or epressed the nonverbal behavior that implies agreement.(Berman, p. 60)

Question 3: Which of the following has not been established by the courts? 1. the right to refuse treatment 2. the right to information 3. the right to self determination 4. the right to active euthanasia

answer: 4 correct answer because the question of suicide and active euthanasia remains a controversial subject. The ANA states that active euthanasia is a violation of the Code for Nurses. 1, 2, 3 are incorrect because the courts have mandated laws for the right to refuse treatment, the right to information, and right to self determination. Berman text pg. 92

2) A fully alert and competent 82-year-old client has end-stage kidney disease. The client says, "I'm ready to die," and refuses dialysis. The family urges the nurse to set up dialysis. What is the nurse's moral responsibility? a. request a nephrologist come speak with the family. b. honor the client's decision c. make arrangements for dialysis due to lack of written documentation stating the patient's wishes d. try to convince the client to change his mind

answer: B rationale: Fundamentals of Nursing, page 85, Nurses must honor patients' autonomy, even when their own choices may not seem to be in their best interest.

1) The ANA Code of Ethics makes provisions for all the the following EXCEPT: a. Right to self-determination b. Right to die c. Respect for human dignity d. Primacy of the patient's interests

answer: B rationale: according to our presenter Dr. Saulo-Lewis, we do not have a constitutional right to die, and no such provision is made in the ANA Code of Ethics.

3) Which of the following would NOT be considered a case of nursing malpractice? a. the client cannot be revived due to nurse's inability to operate new equipment b. the client complains of abdominal pain and the nurse does not note it in the chart. The client's appendix ruptures. c. the nurse leaves a baby unattended on a bath table and the baby falls and is injured. d. the nurse unintentionally gives the patient a double dose of vicodin.

answer: D rationale: Fundamentals of Nursing, pg 67. To prove a case of malpractice, 6 elements must be present: duty, breach of duty, foreseeability, causation, harm/injury, damages. In all of the above cases EXCEPT the last, there was injury to the patient. Although medication errors can be serious and result in death, the aforementioned did not explicitly state harm and would not fall under the definition of malpractice.

1. The process by which an individual slowly develops a new cultural identity by resembling the members of the prevailing group is known as: a. assimilation b. acculturation c. mingling d. socializing

answer: a rationale: Assimilation is to become like the members of the dominant culture. (b) Acculturation occurs when people integrate traits from other cultures. (b & c) Neither of these answers fit the description. (Berman text, p. 319)

3. A terminally ill patient is suffering from uncontrollable pain. The patient asks the doctor to provide her with a lethal dose of pills to end her misery. This is an example of what of end of life ethical issue? a. active euthanasia b. assisted suicide c. passive euthanasia d. termination

answer: b rationale: Assisted suicide gives the patient the means to take their own life if they request it. (a) Active euthanasia involves bringing about the client's death with or without the client's consent. (c) Passive euthanasia is the withdrawal of extraordinary means of life support, such as a ventilator. (d) Termination is not a type of assisted suicide. (Berman text, p. 92)

2. A serious car accident left the patient in a persistent and vegetative state. The patient's advanced directive instructed that, if left without cognitive or neurological functions, to terminate all life-sustaining treatment. What is the role of the patient's nurse? a. withdraw care to patient b. comfort the patient's family c. focus on the other patients d. continue to care for the patient

answer: d rationale: The nurse must continue to provide sensitive care and comfort measures even though life-sustaining treatment has been terminated. (a & c) The decision to withdraw treatment is not a decision to withdraw care. (b) Comforting the patient's family does not become the primary role for the nurse. (Berman text, p. 92)