leadership E2TB

The new nurse-manager has committed to modeling the leadership roles associated with applying ethics in the workplace. What is the manager's best action? A. Demonstrate self-awareness about his or her own beliefs, morals, and values. B. Ensure that individual rights are always prioritized over collective rights. C. Delegate ethical decision making to staff nurses whenever possible. D. Ensure nurses are responsible for scrutinizing each other's behavior to monitor for ethical violations.

ANS: A Feedback: A core competency for ethical leadership is evaluating one's own values and beliefs. This form of self-reflection is foundational for providing ethical care and promoting in others. The balance between individual and collective rights is situation-specific; individual rights are not always priorities over group interests. The manager must show leadership in ethical decision making and cannot always delegate this important function to staff. Ethical nurses are observant for violations, but this should not result in an environment where each nurse is "scrutinizing" colleagues' practice.

Which leadership role is most closely associated with advocacy? A. Creating a climate where advocacy and its associated risk taking are valued B. Giving subordinates and clients adequate information to make informed decisions C. Ensuring that the workplace environment is safe D. Seeking appropriate consultation when advocacy results in intrapersonal or interpersonal conflict

ANS: A Feedback: A leadership role associated with advocacy is to create a climate where advocacy and its associated risk taking are valued. Management functions include giving subordinates and clients adequate information to make informed decisions and seeking appropriate consultation when advocacy results in intrapersonal or interpersonal conflict. Workplace safety is more closely aligned with a management role than a leadership role.

The manager of a community health center is committed to acting as an advocate. What action by the manager best promotes this goal? A. Taking prompt action when working conditions appear unsafe B. Seeking formal and informal interactions with the media C. Communicating a vision that advocacy is something highly valued in the organization D. Pushing for the creation of a binding, national Bill of Rights for Patients

ANS: A Feedback: A management function associated with advocacy is taking prompt action when there is a lack of safety in the workplace. Leaders generally interact with the media more than managers do, and communicating vision is more closely aligned with a leadership role. Similarly, advocating for a national Bill of Rights for Patients is more closely aligned with leadership than management.

Which activity best demonstrates a nursing unit manager's attention to ANA standards for ethics required of that position? A. Refers complex dilemmas to the institution's ethics board B. Terminates a staff member for absenteeism C. Assures staff and patients that unit decisions are ethically sound D. Maintains current licensure

ANS: A Feedback: ANA standards for ethics related to nurse administrators identifies participants on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes as a criteria measurement. The remaining options, although addressing ethical behaviors on the administrator's part, are not as directly identified by the ANA.

The principle of autonomy would have the greatest bearing on what clinical situation? A. A client is discussing a do-not-resuscitate order with the care team. B. A client is unable to afford the treatment that carries the best chance for a cure. C. A nurse is considering whether to report a colleague's rough treatment of a client. D. The nurse is caring for two clients in pain and must choose which to treat first.

ANS: A Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for one's choice. Deciding on resuscitation options involves this principle because the client's preference is the final determinant on the matter. Situations involving scarce resources or time are more closely aligned with issues of justice. The nurse's ethical decision making around reporting bad practice align most closely with duty-based reasoning and beneficence for clients.

A nurse-manager is focusing on management controlling functions that are associated with quality control. What task best addresses this goal? A. Periodically evaluating the unit mission and philosophy B. Creating the daily client care assignments to distribute workload evenly C. Contributing to the development of the annual budget D. Distributing staffing policies related to the choice of vacation time

ANS: A Feedback: Examples of management controlling functions include the periodic evaluation of unit philosophy, mission, goals, and objectives; the measurement of individual and group performance against preestablished standards; and the auditing of patient goals and outcomes. Scheduling and budgeting are less directly related to controlling functions related to quality control.

A registered nurse has admitted to the manager that she obtained her license on false pretenses and that she never actually graduated from a nursing education program. What is most likely to take place next? A. An investigation by the board of nursing B. A civil lawsuit by the health-care facility C. Criminal charges D. A fine levied by the jurisdiction where the event took place

ANS: A Feedback: Following a complaint, the board of nursing completes an investigation. The facility may or may not pursue a lawsuit and is more likely to focus solely on dismissal. This would be more likely to be handled administratively by the board of nursing than criminally, by the court system. A ban from the profession would be more likely than a fine.

In which situation would the nurse be justified in overriding a client's right to confidentiality? A. An older adult client discloses to the nurse that her son occasionally hits her. B. A client states that he does not want to know the results of his recent diagnostic test. C. A client does not want her husband to know that she is a client on the unit. D. A teenage client asks the nurse not to tell her parents that she is pregnant.

ANS: A Feedback: Health-care managers are required by law to report certain cases, such as drug abuse in employees, elder abuse, and child abuse. This is considered a justifiable violation of confidentiality. The manager is obliged to respect client confidentiality around disclosing pregnancy, acknowledging a hospital admission, or not wanting to know diagnostic results.

The preoperative admitting nurse witnessed a client sign an operative consent form. The nurse then cosigned the same document as a witness. The client suffered an injury during surgery and names the nurse in the suit because the nurse witnessed the consent form. What is the most likely outcome? A. The nurse is not likely liable because the signature only specifies that the nurse witnessed the client signing the consent form. B. The nurse is likely not liable because surgery is beyond the nurse's scope of practice. C. The nurse may be liable because cosigning the consent form makes the nurse an equal member of the surgical team. D. The nurse is liable because cosigning the consent form confirms that the client fully understood the risks of surgery.

ANS: A Feedback: Informed consent is obtained by a physician; therefore, in most cases, a nurse is not legally responsible for informed consent but is confirming that the client signed the consent form. If the nurse acts solely in the role of a witness, there are not likely to be legal consequences for the nurse. The nurse would not be considered to be a full member of the surgical team if his or her role was limited to admitting the client. Surgery is beyond the nurse's scope of practice, but this does not form the basis for the nurse's likely exemption from liability.

The nurse is practicing in a challenging environment where ethical and moral issues must often be dealt with. Which statement describes how moral uncertainty occurs? A. An individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. B. An individual knows the right thing to do, but organizational constraints make it difficult to take the right course of action. C. An individual witnesses the immoral act of another but feels powerless to stop it. D. An individual is forced to choose between two or more undesirable alternatives.

ANS: A Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Ethical dilemma is being forced to choose between two or more undesirable alternatives.

What initiative is most likely to promote open communication between clients and practitioners? A. Involving health-care consumers as active members of the health-care team B. Promoting the creation of cultures of client safety in health-care organizations C. Establishing a federal leadership locus for advocacy of client safety and health-care quality D. Building an evidence-based information and technology system that impacts client safety

ANS: A Feedback: One way to promote open communication between clients and practitioners is involving health-care consumers as active members of the health-care team. Pursuing client safety initiatives prevent medical injury by promoting the creation of cultures of client safety in health-care organizations, establishing a federal leadership locus for advocacy of client safety and health-care quality, and building an evidence-based information and technology system impacts client safety.

Which statement is true regarding political action committees (PACs)? A. They attempt to persuade legislators to vote in a particular way. B. They are composed of volunteers who are interested in politics. C. Their focus is usually on defeating specific pieces of legislature. D. They appear to have less influence on lawmakers than in the past.

ANS: A Feedback: PACs attempt to persuade legislators to vote in a particular way. Lobbyists of the PAC may be members of a group interested in a particular law or paid agents of the group that wants a specific bill passed or defeated. Currently, PACs appear to have a significant amount of influence on lawmakers and the legislative process. There is no evidence that their influence is waning.

A state Nurse Practice Act is an example of which source of law? a. Statutes b. Constitution c. Administrative d. Judicial

ANS: A Feedback: Statutes are the only laws made by official enactment by the legislative body. A Nurse Practice Act is an example of a "law that governs." As a statute, a Nurse Practice Act is not a form of constitutional, administrative, or judicial law.

The nurse-manager is overseeing the care of a client who is taking a passive role in his care. How should the nurse begin to act in the role of an advocate? A. Inform the client of his rights and help him to understand them B. Teach the client the benefits of taking an active and assertive role in his care C. Assess the size and quality of the client's social support network D. Role-play with the client in order to teach him assertiveness skills

ANS: A Feedback: The advocate informs others of their rights and makes certain they have sufficient information to make decisions. This contextualizes any further teaching or dialogue, such as role modeling or educating him about the benefits of being more assertive. As well, not every client has the desire or skills necessary to be assertive and an active participant in care. It is important to assess clients' social support networks, but this is not directly related to advocacy.

The nurse has applied the MORAL decision-making model to a situation that involved an ethical dilemma. The nurse should complete the process by: A. evaluating the effectiveness of the decision-making process. B. reaffirming the nurse's relationships with stakeholders. C. disseminating the results of the process to other nurses. D. leading the implementation plan.

ANS: A Feedback: The final phase of the MORAL decision-making model involves "looking back." That is, evaluating the decision-making process. This model does not explicitly involve reaffirming relationships or disseminating the results, even though the model does not preclude these actions. Implementing the decision precedes the evaluation phase.

The nurse is reviewing the provisions of legislation that relates to nursing practice in the jurisdiction where the nurse provides care. The nurse should identify what primary purpose of this legislation? A. Protecting clients' rights and safety B. Organizing the overall structure of the health-care system C. Promoting a unique role for nursing in promoting wellness D. Ensuring nurses provide care that is ethical and moral

ANS: A Feedback: The legislative controls of nursing practice primarily protect the rights of clients. Legislation is not primarily aimed at organizing the health system, which is an administrative role, not a legislative function. Legislation is not aimed at promoting the role of nursing. Ethical practice is addressed primarily by codes of ethics, not binding legislation.

A nurse is facing a malpractice suit after a client was injured in a fall. When establishing whether the nurse committed a breach of duty, the court will consult with: A. other nurses who practice in similar settings and specialties. B. members of public who have been treated in similar care settings. C. the administrators of the health facility where the fall occurred. D. medical experts from the same area of specialty.

ANS: A Feedback: The testimony of other nurses in the same specialty as the defendant may be used to prove breach of duty. These people are considered a reliable and valid source of information by the court, more so than members of the public, administrators, or medical experts.

Which statement is correct regarding the distinction between legal and ethical obligations in decision making? A. Ethical controls are clearer and philosophically impartial. B. Ethical controls are much clearer and individualized. C. Legal controls are clearer and philosophically impartial. D. Legal controls are much less clear and individualized.

ANS: C Feedback: In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized.

Which statement is true regarding criminal law cases in the context of nursing? Select all that apply. A. Incarceration is a likely consequence of being found guilty of a criminal offense. B. Intentionally giving an overdose of a potent narcotic is a criminal offense. C. A guilty verdict requires evidence beyond a reasonable doubt. D. Most malpractice cases are tried in criminal court. E. A serious, inadvertent drug error is likely to bring criminal charges.

ANS: A, B, C Feedback: In criminal cases, the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to clients would be charged in a criminal court. Most malpractice cases are tried in civil court. In most cases, unintentional errors do not result in criminal charges.

The nurse has navigating a difficult situation that involved an ethical dilemma. Which factors should be considered when assessing the quality of the nurse's ethical problem-solving process? Select all that apply. A. The outcomes of the process B. The process that was used to arrive at a decision C. The number of alternatives that the nurse initially generated D. The process the nurse used for data gathering E. Precedents in the organization involving similar situations

ANS: A, B, C Feedback: Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving because many variables affect outcomes that have no reflection on whether the problem solving was appropriate. Quality, instead, should be evaluated both by the outcome and the process used to make the decision. Rigorous data gathering enhances the decision-making process, but this is not the criteria by which the overall process is gauged. Similarly, precedents can be used to inform decision making but do not constitute the basis for evaluating the overall process. Generating multiple alternatives aids the problem-solving process by identifying as many options as possible.

Which statements concerning autonomy are true? Select all that apply. A. It is a form of personal liberty. B. Its legal equivalent is self-determination. C. It is based on a person's right to make a choice. D. It supports the process of progressive employee discipline. E. It overrides paternalism but not beneficence.

ANS: A, B, C, D Feedback: A form of personal liberty, autonomy is also called freedom of choice or accepting the responsibility for one's choice. The legal right of self-determination supports this moral principle. The use of progressive discipline recognizes the autonomy of the employee. The employee, in essence, has the choice to meet organizational expectations or to be disciplined further. If the employee's continued behavior warrants termination, the principle of autonomy says that the employee has made the choice to be terminated by virtue of his or her actions, not by that of the manager. Ethical situations always differ, so it is impossible to state that one particular principle always overrides another.

A nurse is facing a malpractice suit after an incident where a client received the wrong dose of medication. Which elements must be present to prove malpractice. SATA A. Breach of duty B. Presence of injury C. Ability to foresee harm D. Causal relationship between inadequate care and injury E. Intent to cause harm

ANS: A, B, C, D Feedback: A lawsuit pertaining to malpractice must include a standard of care, breach of duty, injury, a causal relationship between breach of duty and injury, and a foreseeability of harm. Malicious intent does not need to be present or proven. The presence of malice would be more suggestive of a criminal act than professional malpractice.

The nurse-manager of a hospital unit has set a goal of increasing client advocacy. What activities are likely to help the manager attain this goal? Select all that apply. A. Staffing the unit with a sufficient number of care providers B. Orienting staff on the safe use of a new mechanical lift C. Providing an in-service on culturally meeting clients' end-of-life needs D. Arranging for a client to have a meeting with a member of the financial office E. Organizing an equitable system for distributing vacation time to staff

ANS: A, B, C, D Feedback: Common areas for managers to advocate for clients include distribution of resources, use of technology, end-of-life decisions, and health-care reimbursement. Issues around scheduling and vacation are areas where the manager could advocate for subordinates, but this matter has little direct impact on clients.

A nurse is preparing for a television interview to address an aspect of health care. What actions should the nurse perform? Select all that apply. A. Being focused on key points B. Introducing statistics that support the key points C. Repeating key points several times during the interview D. Providing background material related to the key points E. Using technical vocabulary to ensure precise communication

ANS: A, B, C, D Feedback: The best strategies for a television interview are to be prepared and to stick to three or four key points that will drive home your message and repeat them during the interview. Concentrating on popular points is not necessarily where the focus should be directed. It is best to avoid technical jargon because it will be not be understood by most people.

A nurse-manager has been asked to write an article for the newspaper addressing a health-care issue of local concern. Which statement demonstrates the nurse's understandings of the appropriate way to respond to such a request? Select all that apply. A. "I'll include the latest data on the subject." B. "When will you need to have the final draft of my article?" C. "Are you comfortable with me focusing on three key points related to this topic?" D. "That isn't my field of expertise but I will contact a peer with that knowledge." E. "Working with the media is outside my scope of practice, but I'll recommend you to someone else."

ANS: A, B, C, D Feedback: Tips for effective interaction with the media include respecting and meeting their deadlines, having key facts ready to include, limiting key points to two or three, and not being afraid to say you lack that specific expertise. Working with the media is not something that is beyond the nursing scope or practice.

The nurse-manager can implement workplace advocacy and subordinate advocacy by performing what actions? Select all that apply. A. Creating an atmosphere that is free of violence or the threat of violence B. Providing education about injury prevention and safety C. Making efforts to ensure that nurses have reasonable and predictable work schedules D. Including nurses in the decisions that must be made at the facility E. Encouraging clients to provide feedback about the care they provide when they are discharged

ANS: A, B, C, D Feedback: Workplace and subordinate advocacy includes such actions as preventing violence, promoting safety, creating workable schedules, and including nurses in the decision-making process. Asking clients to provide feedback about their care may be helpful in promoting good practice, but this does not directly relate to subordinate advocacy or workplace advocacy.

Which characteristics associated with being a client of the health-care system increase the need for advocacy? Select all that apply. A. Loss of physical freedom as a result of extended hospitalizations B. Decreased independence due to physical or psychosocial limitations C. Loss of legal rights due to being a client in a health-care facility D. Physical or psychosocial limitations negatively impacting autonomy E. Increased vulnerability due to impaired communication

ANS: A, B, D, E Feedback: Patient advocacy is necessary because disease almost always results in decreased independence, loss of freedom, and interference with the ability to make choices autonomously. In addition, aging, as well as physical, mental, or social disability, may make individuals more vulnerable and in need of advocacy. Admission to a health-care facility does not result in a loss of legal rights.

Which nurse could face discipline for committing an intentional tort? Select all that apply. a. A nurse who slapped a client when the client became verbally abusive A. A nurse who applied restraints to a client as a punitive measure B. A nurse who increased a client's analgesia dosage without a prescription C. A nurse who neglected to supervise a client, leading to a fall D. A nurse who threatened an elderly client when the client did not participate in care

ANS: A, B, E Feedback: Whereas professional negligence is considered to be an unintentional tort, assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts. Failing to supervise a client or practicing outside the scope of practice (changing a medication dose) would be classified as unintentional torts. Slapping a client is battery. Threatening a client is assault, and applying restraints inappropriately is a form of false imprisonment.

A nurse is concerned about the implications of a new piece of legislation that is being debated by lawmakers. The nurse has decided to draft a letter to a legislator and should do what actions? Select all that apply. A. Self-identify as a constituent in the first paragraph. B. State the reason for writing in the second paragraph. C. Sign the letter and include contact information. D. Address the legislator by his or her title. E. Hand deliver the letter to the legislator's office, if possible.

ANS: A, C, D Feedback: The nurse should be sure to address the legislator properly by title and establish credibility early in the letter as both a constituent and a health-care expert. It is best to state your reason for writing the letter in the first paragraph and refer to the specific bill that you are writing about. Then, state your position on the issue and give personal examples as necessary to support your position. Personal letters are more effective than other formats, but there is no reason to hand delivery the letter to the legislator's office.

Which nursing intervention demonstrates attention to the nursing values central to client advocacy? Select all that apply. A. Assuring clients that their wishes will be respected regarding the care they receive B. Reassuring the client that he or she will always make the right decision C. Identifying the client's religious dietary practices when discussing a prescribed diet D. Answering the client's questions regarding the alternatives to a proposed procedure E. Suggesting to a client that a social services consult would help with discharge needs

ANS: A, C, D, E Feedback: The nursing values central to advocacy emphasize caring, autonomy, respect, and empowerment. Telling a client that she will certainly make the right decision is false reassurance, which is not a valid form of advocacy.

High-achieving nursing students were found to have studied in small groups, attended class 100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet for 1 week before the examination. What type of audit provided data about the students' preparation? a. Structure b. Process c. Outcome d. Concurrent

ANS: B Feedback: A process audit assumes that a relationship exists between the process used and the quality of the result. The details of the students' preparation are not an outcome or a structure. These data are retrospective and not concurrent.

A nurse is integrating the code of ethics when making a decision about the best response to a challenging situation. What information will the nurse be able to obtain from this document? A. Legal guidelines to help the nurse make an ethical decision B. The principles that are most valued in nursing practice C. A model that will guide the nurse to make an ethical decision D. Guidelines that will help the nurse clarify his or her own values

ANS: B Feedback: A professional code of ethics is a set of principles, established by a profession, to guide the individual practitioner. It is not, however, a decision-making model or a tool for clarifying one's own values. Codes of ethics are not legally binding documents.

The nurse-manager has learned there is conflict between a nonresponsive client's family members about the best plan of care. The manager recognizes the complex ethics of this situation. What is the manager's best action? A. Base a decision on the most recent precedent in the organization. B. Make contact with the hospital's ethics committee. C. Refer the family to the hospital's spiritual care service. D. Ask an impartial staff member to mediate.

ANS: B Feedback: An ethics committee can bring needed experience, perspective, and insight to challenging ethical situations. Precedent cannot always be used as a guide because each situation is unique even if they appear superficially similar. Clients and families often benefit from spiritual care, but this does not help the manager make a good decision. Mediation can sometimes be beneficial, but this does not release the nurse-manager from addressing the situation as best as he or she can.

. A nurse has been asked to stay after a shift and work overtime because three nurses have called in sick. The nurse is reluctant to work the overtime because of a social commitment. Duty-based reasoning would dictate that the nurse: A. carefully weigh the effect of the decision on workplace relationships. B. work overtime because of the responsibility owed to clients. C. base the decision on recent precedents in the health-care organization. D. contact the three nurses to remind them of their obligations.

ANS: B Feedback: Duty-based reasoning is an ethical framework stating that some decisions must be made because there is a duty to do something or to refrain from doing something. In this case, it could be construed that the nurse has a duty to care for clients that supersedes social activities. Duty-based reasoning would not prioritize the effect on relationships over the nurse's moral duty. Precedents would not necessarily indicate what the nurse's duty is. Duty-based reasoning emphasizes the nurse's own duty, not that of colleagues.

The nurse is admitting a new client who is facing a serious health problem. The nurse can best apply the skills of advocacy when working with this client by: A. seeking opportunities to demonstrate professionalism. B. engaging closely and genuinely with the client and family. C. making decisions for the client and family in order to lessen their responsibilities. D. providing evidence-based care.

ANS: B Feedback: Engagement has been identified as a key factor in advocating for clients and families when they are in the health-care system. Demonstrating professionalism and providing evidence-based care support good outcomes and may put the client and family at ease, but these actions do not necessarily demonstrate or promote advocacy. The nurse should always support the family's decision-making process rather than taking on this role

A nurse is off-duty, in the community, and witnesses an adult suddenly collapse. The individual appears to be unconscious. How should the nurse apply Good Samaritan laws to this situation? A. The nurse should intervene because of the legal obligation to do so. B. The nurse is not required to intervene, even though intervening is an ethical act. C. The nurse should attempt to contact emergency services before intervening. D. The nurse attempt to determine if the individual has an advance directive before intervening.

ANS: B Feedback: Good Samaritan laws vary by jurisdiction, but they generally do not create a legal requirement for a nurse to intervene, although the ethical obligations for beneficence still apply to nurses. A nurse is not obliged to contact emergency services before acting. It is rarely possible or practical to determine a stranger's end-of-life wishes in a situation like this.

The nurse-manager oversees the care of several dozen nurses. With which nurse should the manager review the provisions of the Health Insurance Portability and Accountability Act (HIPAA)? A. A nurse who has discussed a client's status with a physician over the telephone B. A nurse who confirmed a new client's admission to the unit to a relative who telephoned C. A nurse who completed a client's documentation outside of the client's room D. A nurse who has initiated contact with the social worker to discuss a client's discharge planning

ANS: B Feedback: HIPAA states that a client's privacy and confidentiality must be maintained. Confirming a new client's presence on a unit can be problematic because the identity of the person speaking cannot be confirmed. Communicating by telephone with other members of the care team is acceptable, provided efforts are taken to protect the client's privacy from others who may overhear. Documentation can be completed in any setting, provided it is guarded from view of unauthorized persons. There is no prohibition against initiating contact for referrals.

A charge nurse has discovered that a medication error was made on the previous shift. What is the nurse's best action? a. Share that information with the charge nurse on the previous shift. b. Document the incident and follow it up as per hospital policy. c. Write a memo to the nurse who made the error requesting an incident report be written. d. Document in the client's chart that an incident report will be completed.

ANS: B Feedback: It is the responsibility as manager to immediately document the error according to hospital policy. Because policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the client's chart. Speaking to another nurse or manager is not a sufficient response, although this may be one part of the follow-up process.

A nurse has recognized that many older adult clients on the unit do not receive enough nutrition because they are unable to feed themselves independently. What action by a manager would be most likely to resolve the nurse's moral distress? A. Acknowledging and validating the nurse's observation B. Hiring more nursing assistants to help feed these clients C.Arranging to have the clients' diets changed so they are more nutrient-dense D. Providing a reference so the nurse can seek new employment

ANS: B Feedback: Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. In this case, the nurse knows what needs to be done (the clients need assistance with feeding) and arranging for more employees to do this function would remove the organizational constraint. Validation is of no value if it is not followed up by action. Changing the clients' diets is not helpful if they cannot be fed the new diet. Helping the nurse seek employment elsewhere does not benefit the clients and may not relieve the nurse's moral distress.

A nurse has repeatedly witnessed a physician being dismissive of clients' reports of pain and anxiety. The nurse recognizes that the best action would be to address this behavior with the physician, but the nurse strongly suspects that these concerns would be dismissed. What phenomenon is this nurse experiencing? A. Moral conflict B. Moral outrage C. Ethical relativism D. Ethical universalism

ANS: B Feedback: Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Ethical relativism suggests that individuals make decisions based only on what seems right or reasonable according to their value system or culture. Ethical universalism holds that ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences

Two registered nurses have disagreed about their scope of practice regarding medication administration. What resource should the nurse consult? A. The attorney general's office B. The Nurse Practice Act C. The nursing standards of practice D.The code of ethics

ANS: B Feedback: Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. An attorney general's office cannot supersede the provisions of a Nurse Practice Act. Ethical guidelines do not establish a nurse's scope of practice. Standards of practice describe the quality of a nurse's care but not the legal scope.

Which action should the nurse prioritize when trying to prevent malpractice claims? A. Always carrying a personal liability insurance policy B. Always functioning with the scope of the nursing practice act C. Asking for assistance when engaged in complicated procedures D. Devoting time to establishing an effective nurse-client relationship

ANS: B Feedback: Nurses can reduce the risk of malpractice claims by practicing within the scope of the Nurse Practice Act. Nurses should purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help to protect a nurse from financial ruin should there be a malpractice claim. Asking for assistance when needed is prudent nursing practice, but staying within the scope of practice is a more important guideline. Similarly, good nurse-client relationship has been shown to reduce the likelihood of malpractice, but this is a less significant guideline than staying in the scope of practice, which is paramount.

Which statement best describes the impact that the concept of responded superior has on the issue of nursing liability? A. It allows for equal liability among physicians, nurses, and health-care organizations. B. It supports the sharing of blame among all involved sources of health-care services. C. It encourages legal intervention when health care is thought to be substandard. D. It implies that the institution is responsible for errors, not the employee.

ANS: B Feedback: Nurses must remember that the purpose of respondeat superior is not to shift the burden of blame from the employee to the organization but rather to share the blame, increasing the possibility of larger financial compensation to the injured party. Liability is not always apportioned equally in every situation, and it does not wholly release employees from liability.

The nurse is admitting a client to the health-care facility who is in the late stages of pancreatic cancer. In order to comply with the terms of the Patient Self-Determination Act (PSDA), the nurse should: A. ensure the client clearly understands each treatment option. B. determine whether the client has established an advance directive. C. document that the client's family has been included in care planning. D. assess the client's expectations for recovery.

ANS: B Feedback: The PSDA requires acute care facilities to document on the medical record whether a patient has an AD and to provide written information to patients who do not. This legislation does not directly address such matters as ensuring the client's understanding of treatment options, including the family in care planning, and determining the client's

The nurse-manager is applying the MORAL decision-making model to a decision around a client's plan of care. The manager has engaged all the necessary stakeholders and collected as much data about the situation as possible. What should the manager do next? A. Assess the client's values and beliefs. B. Identify as many alternatives as possible. C. Choose the option that best aligns with ethical principles. D. Arrange to meet with the institution's ethics board.

ANS: B Feedback: The initial step in the MORAL decision-making model involves collecting data and determining who should be involved in the decision-making process. After this, the nurse identifies alternatives and then chooses the best option. Engaging with an ethics committee should take place in the first step when the manager decides who to involve. Assessing the client's values should take place early in the decision-making process.

he policies in a long-term care facility specify that immobile residents should be repositioned at least every 2 hours. Despite this, it is well known that many residents endure long periods without being repositioned. How should the nurse best interpret this situation? A. It is necessary for the nurses at the facility to review the code of ethics. B. There is a need for actions to address this theory-practice-ethics gap. C. The nurses at the facility are experiencing intrapersonal conflict that affects their practice. D. The nurses at the facility should apply the MORAL decision-making model to address this.

ANS: B Feedback: Theory-practice-ethics gaps exist when there is incongruence between what nurses know they should or must do and what they actually do. Intrapersonal conflict is internal discontent resulting from inconsistency between what should be done and what a nurse can realistically do. However, there is no evidence that this is the case. Reviewing a code of ethics is unlikely to bring about meaningful change without the addition of other incentives. The MORAL decision-making model guides ethical decision making but does not address these gaps between what should be done and what is actually done.

For which client would right to die laws most likely apply? A. An adult client with major depression B. An adult client who has a terminal diagnosis C. A client who lives with intractable pain D. A client who has expressed suicidal ideation

ANS: B Feedback: Typically, right to die laws apply only to patients who are at least 18 years old, with the capacity to make medical decisions, with a terminal disease expected to result in death within 6 months. Depression and pain are not normally considered to be terminal diseases, and suicidal ideation in and of itself does not mean that this legislation would apply.

What is the best reason that nurse-managers have an ongoing responsibility to be aware of legislation affecting nursing practice? a. Laws are created by people who are not nurses. b. Laws are fluid and subject to change. c. Awareness will help ensure ethical practice. d. Awareness is included in nursing standards of practice.

ANS: B charge nurse has discovered that a medication error was made on the previous shift. What Feedback: When using doctrines as a guide for nursing practice, the nurse must remember that all laws are fluid and subject to change. Laws are not static. It is the responsibility of each manager to keep abreast of legislation and laws affecting both nursing practice and management practice. It is true that laws are made by people who are not nurses, but this does not necessarily create a need for managers to stay abreast of laws. Standards of practice do not explicitly guide nurses to remain aware of changes in legislation. Awareness is unlikely to have a direct effect on ethical practice, which is rooted in values and beliefs about what is good.

A nurse has been hired to manage a busy medical-surgical unit. What actions should the nurse-manager perform to ensure compliance with legal issues? Select all that apply. A. Develop a vision for the organization's future and communicates this vision. B. Remain current on all institutional policies and procedures. C. Delegate with consideration to appropriate scopes of practice. D. Require physical proof of appropriate professional licensure. E. Ensure client-nurse ratios do not exceed 3:1.

ANS: B, C, D Feedback: Sound management functions regarding legal issues include understanding and adhering to institutional policies and procedures; delegating to subordinates wisely; and monitoring subordinates to ensure they have a valid, current, and appropriate license to practice nursing. Some jurisdictions have legal requirements around client-nurse ratios, but these ratios vary according to the care setting; in many cases, a ratio of greater than 3:1 is permitted. Developing and communicating a vision is an essential leadership function, but this does not apply to management of legal matters.

Which are common areas requiring nurse-client advocacy? Select all that apply. a. Maintaining current licensure B. Securing client informed consents C. Preventing medication errors D. Facilitating access to health-care services E. Promoting respect for client dignity and cultural values

ANS: B, C, D, E Feedback: Common areas requiring nurse-client advocacy include inadequate client consents, medical errors, access to health care, and respect for client dignity and cultural values. Although nurses must maintain current licensure, this does not involve client advocacy.

In which situations does the nurse-manager have a legal responsibility for reporting? Select all that apply. A. A nurse had to work 2 hours of overtime because another nurse failed to report for a shift. B. A nursing assistant has reported a suspected incident of elder abuse. C. A nurse is suspected of providing substandard medical care. D. A pediatric client reports physical abuse in the home. E. There is a confirmed case of a reportable infectious disease.

ANS: B, C, D, E Feedback: The manager, like all professional nurses, is responsible for reporting improper or substandard medical care, child and elder abuse, and communicable diseases, as specified by the Centers for Disease Control and Prevention. Staffing issues are not mandated reportable situations.

A nurse-manager is reviewing the provisions of the Consumer Bill of Rights and Responsibilities (Patient's Bill of Rights) with a group of new nurses. The manager should address what goals of this legislation? Select all that apply. A. Ensuring every client has access to quality, affordable health care B. Promoting strong relationships between clients and health-care providers C. Promoting clear communication between members of the health-care team D. Helping clients feel confident in the health-care system E. Assisting clients with understanding the provisions of their health insurance

ANS: B, D Feedback: The provisions of the Patient's Bill of Rights are threefold: (a) to help patients feel more confident in the US health-care system, (b) to stress the importance of a strong relationship between patients and their health-care providers, and (c) to stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and health-care providers. This legislation does not explicitly address access to health care, communication in the health-care team, or teaching clients about their insuranc

Which of the following would be considered sentinel events that should be reported to The Joint Commission? Select all that apply. A. A client with ischemic heart disease dies of a myocardial infarction. B. A client with dementia falls and suffers a hip fracture while trying to walk to the bathroom. C. A client files a formal complaint about the inattention of staff while he was in the hospital. D. A client experiences nephrotoxicity and requires dialysis because of a medication error. E. A client experiences a transfusion reaction after receiving the wrong type of packed red blood cells.

ANS: B, D, E Feedback: Drug errors causing harm, falls causing injury, and blood transfusion reactions are considered sentinel events. Deaths related to an underlying diagnosis and client dissatisfaction are not considered sentinel events.

What task will best allow a health-care organization to benchmark its performance? A. Comparing its performance on key indicators to its performance the previous year B. Setting ambitious but realistic goals for the coming year C. Comparing the organization's performance with that of best performing institutions D. Seeking input from clients and families about the organization's performance

ANS: C Feedback: In benchmarking, an organization compares its performance with that of best performing institutions. Benchmarking is not achieved by comparing with the previous year's performance. Seeking input from clients and setting useful goals are valid components of quality improvement and quality control, but these actions are not part of benchmarking.

A nurse failed to supervise a confused client, and the client fell while transferring to the bathroom. The client was unharmed, but the client's family has launched a malpractice suit, citing the nurse's breach of duty. What is the most likely outcome of this case? A. The outcome will depend on the extent to which the client was responsible for the incident. B. It will likely be successful, provided the family can prove the event was reasonably foreseeable. C. It will likely be unsuccessful because the client was not injured. D. The outcome will depend on how the nurse's actions compare to the established standard of care.

ANS: C Feedback: A malpractice suit requires evidence of actual injury to the offended party. The fact that this client was unharmed would likely jeopardize the suit, regardless of the client's role or the standard of care. Even if the event was foreseeable, the absence of injury removes a key criterion of malpractice.

When applying the principles of advocacy, a nurse-manager should: A. defer to a leader whenever possible because advocacy is primarily a leadership function. B. prioritize the needs of subordinates over the needs of the organization. C. balance the need to advocate for several different individuals, groups, and organizations. D. recognize that advocacy can only be provided for individuals, not groups or organizations.

ANS: C Feedback: Advocacy is helping others to grow and self-actualize. The manager must be an advocate for clients, subordinates, and the nursing profession. Advocacy is not limited to leaders. It is simplistic to claim that the needs of subordinates always trump those of the organization; every situation is different.

Thirty-eight percent of the people who attended a smoking cessation clinic were not smoking 1 year after completing treatment. What type of audit provided this type of data? a. Structure b. Process c. Outcome d. Concurrent

ANS: C Feedback: An outcome audit determines what outcomes resulted from specific nursing interventions for clients. In a smoking cessation program, abstinence from tobacco would be desired outcome. This does not meet the criteria for a structure, process, or concurrent outcome.

A nurse is distressed by some of the examples of substandard care in the workplace and is considering whistleblowing. What is the nurse's best initial action? A. Seek contacts in the local media. B. Inform the manager of the nurse's intent. C. Carefully consider the possible ramifications of whistleblowing. D. Hire an attorney to assist with the whistleblowing process.

ANS: C Feedback: Before taking action, it is important for the nurse to consider the possible ramifications of whistleblowing, which could be serious. This must precede efforts such as hiring a lawyer or contacting the media. Depending on the circumstances, it may be inadvisable to dialogue with the manager before whistleblowing.

A client is preparing to be discharged from the health-care facility and has told the nurse that he would like to read his medical record. What is the nurse's best initial action? A. Arrange for the medical record to be provided to the client. B. Inform the client that this request will be communicated to the facility's ethics committee. C. Confirm the facility's policy around providing medical records to clients. d. Check whether this provision is included in the jurisdiction's Nurse Practice Act.

ANS: C Feedback: Clients possess a right to view their medical records, but the protocols for facilitating this vary. Consequently, the nurse should check this facility's policy before acting. It would likely be premature for the nurse to provide the medical record to the client before communicating with other members of the care team or administrators to ensure policy is followed. This matter is outside the purview of ethics committees because it does not involve a dilemma. The Nurse Practice Act focuses on scope of practice and other regulatory issues, not client rights.

The nurse has been caring for a medical client for several shifts and the client has expressed frustration with his slow recovery. At the beginning of the shift, the client states to the nurse, "That's it. I want to read what they've written in my chart." What is the nurse's best response? A. "Certainly. I'll go and get it for you." B. "You'll have to get permission to do so, but I'll definitely pass on your request to the care team." C. "It sounds like you might have some questions about your health and your care. Can we talk about that?" D. "That's definitely within your rights, but you'll likely find that it's difficult to understand because of medical jargon."

ANS: C Feedback: Clients' requests to read their health records are often motivated by confusion or dissatisfaction with care. The nurse should offer to address the clients concerns. Doing so is not a refusal of the client's right to view his or her health records. Protocol must be followed when a client requests access, so it would be inappropriate for the nurse to immediately provide the client with the record. Even though protocol must be followed, clients still have the right to view their records and do not require permission under normal circumstances. The nurse should not attempt to dissuade the client by warning him or her about medical jargon, even though this is likely to be a barrier to understanding.

A nurse feels strongly that a proposed piece of legislation would be contrary to the interests of clients. How can the nurse most effectively oppose this legislation? a. Address the issue on social media sites as often as possible. b. Send e-mails to legislators' offices expressing concerns. c. Collaborate with a group of professionals who feel the same way. d. Contact media outlets and ask to be interviewed.

ANS: C Feedback: Collective action is generally considered to be more effective than individual action. E-mails are easy to ignore and are less effective than personalized letters. Addressing the issue on social media may make more people aware of the issue, but it may or may not result in action change. Media outlets normally initiate interest in news interviews; they rarely respond to people's requests to be interviewed.

What action by the manager of a community health center best demonstrates workplace advocacy? A. Phoning the home of a nurse who has called in sick to confirm that the nurse is genuinely ill B. Asking clients to provide feedback on the care that they have received in their homes C. Ensuring nurses have all the personal protective equipment they need to perform home visits D. Assigning a different nurse to a client who had personality differences with his original nurse

ANS: C Feedback: Ensuring the safety or workers is one of the major demonstrations of workplace advocacy. Checking on a nurse who states that he or she is sick is likely to be perceived as an act of mistrust, not of advocacy. Asking for clients' feedback and assigning a client a new nurse are suggestive of client advocacy, not workplace advocacy.

The nurse at a long-term care facility became frustrated with a client who has dementia and is unable to be redirected from wandering. The nurse applied restraints to keep the client in bed during a night shift despite there being no order to do so. How should this nurse's actions be best interpreted? A. The nurse is guilty of malpractice. B. The nurse's action is permissible if it was in the client's best interest. C. The nurse could face charges of false imprisonment. D. The nurse's action may be grounds for an assault charge.

ANS: C Feedback: Inappropriate use of restraints constitutes false imprisonment. Assault, however, is characterized by a verbal threat of harm. Malpractice is an unintentional tort, but this nurse's action is an intentional tort. Even if the nurse's felt that he or she was acting in the client's best interests, there are still grounds for false imprisonment charges.

The novice nurse can reduce the likelihood of being sued for malpractice by: A. beginning his or her career in a lower acuity setting. B. avoiding performing interventions without a witness present. C. establishing positive, therapeutic relationships with clients and families. D. engaging in lifelong learning.

ANS: C Feedback: It has been shown that despite technical competence, nurses who have difficulty establishing positive interpersonal relationships with patients and their families are at greater risk for being sued. Relationship building is a skill that consequently has the potential to reduce a nurse's risk of a lawsuit. Many malpractice suits originate in lower acuity settings, such as long-term care, so practicing in such an environment may not necessarily reduce the nurse's risk of a lawsuit. It is unrealistic and unnecessary to perform all interventions with a witness, and there is no evidence that this would reduce the risk of a lawsuit. Lifelong learning is beneficial but is not noted to reduce the nurse's risk of a lawsuit.

A client has provided informed consent for surgery and is being assessed by the nurse. What statement by the client should prompt the nurse to contact the surgeon? A. "Why am I not allowed to eat and drink before the surgery?" B. "How long do you think I'll stay in the recovery room?" C. "Do you think this surgery is actually safe and necessary?" D. "What is the difference between the surgeon and the anesthesiologist?"

ANS: C Feedback: Nurses are obligated to provide teaching and to clarify information given to patients by their physicians. This could include such topics as the different roles of the OR team, typical recovery times, and the rationale for fasting. However, nurses must be careful not to give new information or to go outside the scope of practice. Addressing the safety and relative risks of a surgery, or the necessity for surgery, would be beyond the nurse's scope.

The interdisciplinary team is considering whether to apply the principle of paternalism in the care of a client. What question should guide the team's decision? A. Does the client have strong social or family support? B. What is the client's most likely prognosis? C.Is the client competent to make decisions? D. What interventions are in the client's best interest?

ANS: C Feedback: Paternalism can be invoked when a client is unable to make sound decisions for himself or herself. Consequently, the client's ability to make decisions underlies the question of whether acting paternalistic is justified or not? The presence or absence of social and family support does not justify or rule out paternalism. Likewise, the particulars of the client's prognosis do not determine whether it is appropriate to be paternalistic. The client's competence decides whether the care team is justified in stepping in to act in the client's "best interest."

Which ethical principle is demonstrated when an adult child is legally given the right to make medical decisions for a cognitively impaired parent? a. Justice b. Fidelity c. Paternalism d. Beneficence

ANS: C Feedback: Paternalism is when one individual assumes the right to make decisions for another. Justice requires that a person seek fairness, treat "equals" equally, and treat "unequals" according to their differences. Fidelity involves the need to keep promises. Beneficence involves actions that are taken in an effort to promote good.

A nurse is deeply concerned about a proposed piece of legislation. Which action will best influence a local legislator who will be voting on the legislation? A. Signing an online petition B. Phoning the legislator's office repeatedly C. Writing a succinct, personalized letter to the legislator D. Forwarding the legislator online articles that related to the legislation

ANS: C Feedback: Personalized letters can have a significant influence on a legislator, likely more so than telephone calls. It is not normally possible to outline one's ideas in a telephone message and a nurse cannot provide any detail by signing a petition. E-mail forward is very likely to be ignored and not opened.

Which is a true statement regarding TQM? A. It is based on the premise that the organization knows what is best for the consumer. B. Its guiding purpose is to save the organization money. C. It recognizes that the customer is the focal element on which production and service depend. D. It assumes that inspection and removal of errors lead to the delivery of quality services.

ANS: C Feedback: TQM is based on the premise that the customer is the focal element on which production and service depend and that the customer knows best. The primary focus is on quality and not cost. The avoidance of errors does not necessarily guarantee high quality.

A nurse-manager is overseeing an organization that uses the Nursing Minimum Data Set (NMDS). What will the use of the NMDS achieve? A. Comparing the quality of nursing care and medical care with reference to standardized data B. Identifying minimal levels of quality necessary for nurses to maintain licensure C. Standardizing the collection of nursing data for use by multiple users D. Identify only "nursing-sensitive" client outcome measures

ANS: C Feedback: The NMDS standardizes the collection of nursing data for use by multiple data users. The NMDS is not designed for comparing nursing interventions with medical interventions, and it does not lay out criteria for licensure. It is not limited to nursing-sensitive outcome measures.

A novice nurse-manager is a member of a team that will oversee quality control in a health-care organization. What action should the nurse and the other members off the team perform first? A. Take corrective action to address standards that are known to be challenging. B. Collect the essential data that will give a general overview of performance data. C. Determine the specific criteria and standards by which quality will be measured. D. Assign tasks between the team members to address identified standards.

ANS: C Feedback: The first step in quality control is to determine criteria and standards. Measuring performance, assigning tasks, or making corrections is impossible if standards have not been clearly established.

A nurse is applying the MORAL decision-making model to a dilemma involving a colleague's possible dishonesty in documentation. What is the nurse's initial action? A.Perform a critical self-reflection of the nurse's own morals and values. B. Think of as many alternatives as possible. C.Gather as much information about the situation as possible. D. Engage the colleague in the decision-making process.

ANS: C Feedback: The first step of the MORAL decision-making model is to "massage the dilemma." This involves collecting data about the ethical problem and who should be involved in the decision-making process. However, this does not necessarily mean that the nurse must engage the colleague who is the object of the decision. Outlining options (alternatives) is the second step in the model. It is presumed that a nurse will engage in self-reflection when addressing dilemmas, but this is not an explicit component of the MORAL model.

The nurse made a medication error that injured a hospital client. The nurse's attorney has cited the concept of respondeat superior during the trial. This argument would focus on: A. the resources that were available to the nurse. B. the intent of the nurse's actions. C.the hospital's responsibility for the injury. D. the provisions of the nurse's malpractice insurance.

ANS: C Feedback: The legal concept of respondeat superior states that an employer should be held legally liable for the conduct of employees whose actions he or she has a right to direct or control. Consequently, there is no direct reference to the nurse's resources, intent, or insurance coverage.

A nurse has applied for a management position in a new organization. How can the manager best prevent intrapersonal conflict related to ethical issues in this role? a. Determine whether nurses in the organization are required to follow a code of ethics B. Identify a mentor in the organization who maintains high ethical standards C. Clarify his or her own values and beliefs and compare to those of the organization D. Become familiar with the nurse practice act in the jurisdiction where the organization is located

ANS: C Feedback: The likelihood of intrapersonal conflict resulting from disagreement between a manager's values and those of the organization is reduced if the manager clarifies his or her own values and those of the organization. A mentor cannot necessarily help a manager do this because values are personal. All nurses must follow a code of ethics, so this is not a variable. Becoming familiar with the nurse practice act is beneficial, but this legislation does not address ethical issues and values.

A health-care provider prescribes a medical procedure that the staff nurse has reason to believe will harm the client. Which principle should guide the nurse's choice of action? A.The staff nurse cannot be held legally liable for any harm to the client if the procedure is carried out with due care. B. The nurse may lose his or her license by refusing to carry out the procedure. C. The nurse can be held legally liable for any harm if the procedure is carried out without questioning it. D. Liability rests with the health-care provider, not the nurse.

ANS: C Feedback: The rule of personal liability says that every person is liable for his or her own conduct, even if someone else prescribed the intervention. The law does not permit a wrongdoer to avoid legal liability for his or her own wrongdoing, even though someone else also may be sued and held legally liable. "Due care" does not negate the consequences of the nurse's actions or release the nurse from liability if he or she knowingly committed an unsafe act. Refusal to carry out the procedure would not be a basis for losing a nursing license.

A nurse is being sued for malpractice after a client completed suicide on the medical-surgical unit. The nurse's attorney has pointed out that the client had no history of suicide attempts, had no history of mental illness, and denied suicidality on the standard intake assessment. This argument calls into question what component of a malpractice suit? A. Breach of duty B. Failure to meet standard of care C. Foreseeability of harm D. A causal relationship

ANS: C Feedback: This argument suggests that there is no obvious reason why the nurse should have predicted a suicide attempt. This may negate the criterion of foreseeability. There is no evidence that the attorney is addressing the nurse's standards of care or the nurse's ability to perform his or her duties. The attorney is not questioning the relationship between the nurse's actions and the outcomes.

What role has The Joint Commission assumed in ensuring quality at the organizational level? A. Establishing clinical practice guidelines B. Reducing diagnosis-related group reimbursement levels C. Standardizing clinical outcome data collection D. Assessing monetary fines for organizations that fail to meet standards

ANS: C Feedback: Under ORYX, The Joint Commission ensures quality at the organizational level by requiring participating organizations to choose from among 60 acceptable performance measurement systems. The Joint Commission is not actively involved in any of the other options.

The care team is working with a client who has mental illness and who has been deemed a threat to self and others. It may be justified to take away the client's right to: a. justice. b. confidentiality. c. self-determination. d. beneficence.

ANS: C Feedback: When an individual's impaired decision making poses a threat to self or others, it may be in the interests of the client and other people to temporarily remove the client's right to self-determination. That is, to remove the client's right to reject treatment. This is ultimately an act of beneficence, even though the client may perceive otherwise. Justice is more closely aligned with the distribution of benefits between people. Confidentiality is maintained whether or not the client's right to self-determination remains in place.

Which statements accurately describe the implications of a Good Samaritan law for a registered nurse? Select all that apply. A. A nurse has a legal responsibility to provide emergency services. B. Such laws are universally worded so as to minimize differences between jurisdictions. C. To be protected, nurses must provide care that is within their legal scope of practice. D. A nurse who provided out-of-scope care is not protected by the Good Samaritan law. E. A nurse can be held responsible for a person's injuries if he or she does not intervene.

ANS: C, D Feedback: Nurses are not required to stop and provide emergency services as a matter of law, although most health-care workers feel ethically compelled to do so. Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. Good Samaritan laws vary between jurisdictions.

Which statement is true concerning political action of nurses? A. Political action is often contrary to codes of ethics. B. Political action mainly takes place through the American Nurses Association (ANA). C. Nurses' primary focus is to speak out on consumer health-related issues. d. Nurses have not yet recognized the full potential of political activity.

ANS: D Feedback: As a whole, the nursing profession has not yet recognized the full potential of collective political activity. Political action is not contrary to ethical practice and may in fact support it. The ANA is not the main venue for political action among nurses, which can take many forms. Nurses can speak to many aspects of health care and the nursing profession, not only consumer issues.

Even after a lengthy discussion concerning the ramifications, a client wants to leave the hospital against medical advice (AMA). What should the nurse do in the role of client advocate? A. Instruct the client to wait until morning to leave the hospital. B. Ask family members to help talk the client out of the decision. c. Encourage the client to leave and assist with the transition.d. D. Make sure the client has appropriate follow-up appointments.

ANS: D Feedback: As advocate for this client, it is important to make sure the client is informed of the ramifications of leaving AMA; however, it is a client's right to refuse treatment. However, this does not mean that the nurse is obliged to actively encourage the client to leave, which would be inappropriate. The nurse should dialogue with the client about the risks of leaving but avoid making the decision for the client or coercing the client to stay.

A nurse has become dismayed at repeated instances of false documentation in the health-care organization. The nurse has become aware that documentation has been altered so that acts of negligence appear to be accidents. When preparing to blow the whistle on this behavior, the nurse should: A. attempt to edit the false documentation so that it is more accurate. B. resign from the health-care facility to reduce the risk of retaliation. C. seek permission from the nurse's immediate supervisor and head of the organization. D. carefully document any prior attempts to address the issue with supervisors.

ANS: D Feedback: Before whistleblowing, the nurse should carefully document any prior attempts to resolve the situation. It is unrealistic to expect supervisors to support whistleblowing, which is only necessary when the normal chain of authority has failed to respond to an issue. The nurse may eventually be forced to resign, but this is not a precondition for whistleblowing in every situation. Attempting to edit documentation may set the nurse up for legal consequences.

A nurse has accepted a new position as the manager at an ambulatory clinic. The nurse can best model subordinate advocacy in this new position by: A. abolishing formal performance reviews. B. increasing the number of part-time employees and reducing the number of full-time employees. C. adopting a laissez-faire leadership style. D. encouraging employees to participate in decision making.

ANS: D Feedback: Collaborative decision making is associated with subordinate advocacy. However, the manager does not need to abolish rigorous practices (such as performance reviews) or adopt a laissez-faire style of leadership in order to promote subordinate advocacy. Doing away with full-time positions in favor of part-time positions is unlikely to be accepted as an example of advocacy; this will likely be perceived as threatening.

Which strategy best demonstrates an understanding of the managers role as an advocate for his or her subordinates? A. Posting a copy of the code of ethics in the staff room B. Addressing an employee's high rate of absenteeism C. Establishing friendships with as many of the nurses as possible D. Working with primary care providers to expand standing nursing orders

ANS: D Feedback: Promoting nurse autonomy in the form of increased standing orders is an example of advocating for subordinates. Publicizing the code of ethics may be beneficial for nurses but does not advocate on their behalf. In the same way, a manager is being responsible by addressing absenteeism, but this is unlikely to entail an advocacy role. The manager should seek professional relationships, not friendships.

Which nurse is experiencing moral distress? A. A nurse witnesses a colleague using a racial slur in a conversation with another nurse. B. The children of a terminally ill client do not want the client's prognosis communicated to the client. C. A nurse knows that a colleague called in sick to work because the colleague had a social engagement. abirb.com/test D. A heavy workload prevents a nurse from providing the care that each client requires.

ANS: D Feedback: Each of the listed situations has an ethical element. However, moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. A nurse who lacks the time and energy to give clients what they need is likely to experience moral distress. Issues of respect, honesty, and confidentiality require ethical decision making, but they do not directly involve a disconnect between the desire and the ability to do the right thing.

The nurse is faced with a situation that requires ethical decision making. What statement should guide the nurse's action? A. Outcomes are the main criterion for evaluating ethical decision making. B. Only desirable alternatives should be identified when solving ethical dilemmas. C. Critical ethical decisions should be made quickly so the situation does not worsen. D. Accepting some ambiguity and uncertainty is a part of ethical decision making.

ANS: D Feedback: Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. Processes must be considered during ethical decision making, not only outcomes. The nurse should identify as many alternatives as possible during the early stages of decision making, not only desirable alternatives. Ethical decisions often require a careful and methodical approach rather than a quick decision.

2. A nurse is facing an ethical dilemma about whether to report a colleague's offensive comment, an action which is likely to jeopardize their relationship. What is a characteristic of this nurse's ethical dilemma? A. The dilemma can be solved by applying empirical data. B. The situation involves a breach of the law. C. The dilemma has no realistic solution. D. The situation involves two or more undesirable alternatives.

ANS: D Feedback: Ethical dilemmas involve being forced to choose between two or more undesirable alternatives. Ethical dilemmas are often not amenable to being solved with empirical data; they involve values and beliefs, not only facts. Most ethical dilemmas do not involve a breach of the law; legal issues often have a more clear and unambiguous response. Even though ethical dilemmas are difficult to manage, this does not mean that there is no possibility of a realistic solution.

1. Which statement best describes ethics? A.How our lives and relationships are led in day-to-day circumstances B. How people make decisions they see as legally and morally appropriate C. The conflict, power, and interdependency associated with the way we live D. What our conduct and actions should be regarding what is right and good

ANS: D Feedback: Ethics is the systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are. It is not the study of what people actually do in their daily lives or how they live but rather what they should do. Ethics is related to legality and morality, but it is not synonymous with these concepts.

An RN is a supervisor in an organization that has total quality management (TQM) as the basis for its organizational goals and objectives for quality control. How should the RN practice TQM on the unit? A. Encourage colleagues to create vision and mission statements. B. Develop a quota system for number of clients cared for. C. Explain to the staff that "if it's not broke, don't fix it." D. Promote teamwork rather than individual accomplishments.

ANS: D Feedback: In TQM, team efforts are favored over individual accomplishments. Quota systems and maintaining the status quo work against quality in this philosophy. It is beneficial for a unit to have a mission and vision statement, but these are not core components of the TQM philosophy.

The managers of a hospital unit have been approached by a nurse educator who wants to conduct research into a particular nursing intervention. In order to ensure that the rights of clients who may participate are protected, the managers should: A. ask the hospital ethics committee to approve or deny the application. B. discuss the educator's values, beliefs, and ethics. C. compare the study methodology to the code of ethics. D. refer the educator to the institutional review board.

ANS: D Feedback: Institutional review boards (IRBs) are primarily formed to protect the rights and welfare of research subjects. They are the main gatekeepers for research that takes place in the institution. Ethics committees more often deal with specific situations involved in client care. Discussing the educator's values and beliefs is insufficient to protect the rights of participants. There may be some benefit in comparing the research proposal to the code of ethics, but ultimately, this is within the jurisdiction of the IRB.

Which statement by a nurse most clearly demonstrates an intuitionist framework for ethical decision making? A. "I'll make the best decision if I choose the option that comes to mind first rather than overanalyzing the situation." B. I'm trying to think of as many different options as I can rather than focusing on those that look most attractive." C. "It's important that I consider the effect of my decision on the organization, not just the people who are directly involved." D. "I've got to look at this situation on the basis of its unique characteristics, not by comparing it to other situations."

ANS: D Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Consequently, there is a focus on the specific characteristics of a situation, not its commonalities with other situations. Thinking of as many options as possible is a good practice for ethical decision making, but it is not specifically aligned with an intuitionist framework. Similarly, considering the effects on the organization is not a particular characteristic of this framework. Intuition does not entail choosing the option that first comes to mind, without any further analysis or considerati

A nurse-manager is discussing a proposed change in practice the interdisciplinary team. What question by the manager best reflects a utilitarian perspective? A. "Have we asked clients and families what they think?" B. "Does our code of ethics address this?" C. "Are the benefits greater than the risks?" D. "How many people will this benefit?"

ANS: D Feedback: Utilitarianism prioritizes the greatest good for the largest number of people. For this reason, a question about how many individuals would benefit would be more indicative of utilitarianism than issues related to consulting clients, weighing risks and benefits, and consulting the code of ethics.

A client has been diagnosed with a degenerative neurologic disease and has expressed interest in physician-assisted suicide. How should the nurse best advocate in this situation? A. Document the client's statements verbatim in the medical record as a resource for the care team. B. Clearly explain the moral and ethical implications of physician-assisted suicide. C. Implement interventions that directly address the client's fear and anxiety. D. Ask the client and family questions that help them identify and explore their values and beliefs.

ANS: D Feedback: Providing the client and family with the tools necessary to make an informed decision is the best demonstration of client advocacy. Documentation is important in this situation, but this action does not necessarily demonstrate advocacy. The moral implications of physician-assisted suicide must be identified by the family rather than provided by the nurse; these are subjective and this will be part of the family's decision-making process. The nurse should avoid presuming that the client is fearful and anxious. This may not necessarily be the motivation behind the client's request.

The Genetic Information Nondiscrimination Act (GINA) protects which individual from discrimination? A. A client who has chosen genetic testing for her child B. A client who has received gene therapy C. A client who has been diagnosed with a health disorder that has a genetic component D. A client who is known to have a genetic predisposition to a disease

ANS: D Feedback: Some legally binding legislation has been passed to safeguard vulnerable populations. One such legislation, the Genetic Information Nondiscrimination Act (GINA), is a federal law passed in 2008, making it illegal for health insurers or employers to discriminate against individuals based on their genetic information.

A nurse is involved in a challenging clinical situation which requires the nurse to consider many people's interests. How can the nurse best implement Standard VII of the American Nurses Association (ANA) Scope and Standards of Practice? A. Allow the client to read the documentation about the situation. B. Seek legal advice promptly. C. Advocate for the organization's interests above those of individuals. D. Carefully consider the ethical aspects of the situation.

ANS: D Feedback: Standard VII of the American Nurses Association (ANA) Scope and Standards of Practice (2015) states that the registered nurse practices ethically. Consequently, this standard is more closely related to issues around ethics than issues around documentation or legality. It is simplistic and inaccurate to presume that the organization's interests always supersede the individual's interests.

For which client are the provisions of the Patient Self-Determination Act (PSDA) most likely to be significant? A. A client who has recently been diagnosed with HIV B. A client whose neonate has just died of sudden infant death syndrome (SIDS) C. A client whose reduced ability to perform activities of daily living (ADLs) has required an admission to long-term care D. A client who has just experienced an ischemic stroke and whose prognosis is poor

ANS: D Feedback: The PSDA applies to all clients, but it is especially relevant to clients and families who are facing decisions around end-of-life care. A client whose infant has died, a client with a new HIV diagnosis, and a client whose ADLs are compromised are not facing imminent decisions about end-of-life care. However, this is not the case for a client with a fresh stroke and poor prognosis.

The nurse is working with a client who has a terminal diagnosis and who is facing difficult decisions around end-of-life care? . How can the nurse best advocate for this client? A. Teach the client how to make an effective decision. B. Offer to facilitate a referral to social work or spiritual care. C. Arrange for the client to meet an individual who has faced the same decision. D. Ensure the client receives all the necessary information to make an informed choice.

ANS: D Feedback: The main advocacy role for nurses involves giving clients all they need to make informed decisions. Teaching the client how to make a decision is likely to be perceived as paternalistic. Referrals may be helpful for the client, but this does not advocate for the client's need to make a decision. Introducing a client to another client in similar circumstances can be ethically challenging and may or may not be perceived as helpful.

The A nurse is applying the ethical principle of justice when providing care for clients. What action best exemplifies this principle? A. Meeting continuing education requirements for license renewal B. Prioritizing actions that will benefit the largest number of clients C. Respecting clients' rights to make decisions about their care abirb.com/test D. Ensuring that time and resources are distributed equitably to clients

ANS: D Feedback: The principle of justice states that equals should be treated equally and that unequals should be treated according to their differences; this is the principle of equity. Justice is frequently applied when there are scarcities or competition for resources or benefits. Meeting requirements for licensure is a legal issue, not a principle of ethics. The principle of utility involves prioritizing actions that will benefit the largest number of clients. Respecting clients' rights to make decisions demonstrates autonomy.

The only treatment alternative left for a client diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. Some individuals are arguing that the high cost of the procedure could be better spent providing well-baby screening for 2,000 residents in the service area. What ethical principle is most directly involved in this situation? A. Unethical conduct B. Maleficence C. Paternalism D. Utility

ANS: D Feedback: The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficent (harmful) behavior. Paternalism would be characterized by decisions being made without the client having input.

The nurse-manager is working with colleagues to update the policies and procedures at a health-care facility. To ensure that the policies align with the provisions of Title VII, the team should focus on what aspect of care? A. Falls prevention B. Timely and accurate documentation C. Relationships between practical and registered nurses D. Avoiding discrimination against clients

ANS: D Feedback: Title VII is the Civil Rights Act which covers many different manifestations of diversity. The major focus of Title VII is civil rights and the avoidance of discrimination. Topics such as injury prevention, documentation, and interprofessional relationships are not normally within the scope of civil rights.