Term 4 C7 Mod 1-5

What important points should the nurse keep in mind when witnessing consent forms? Select all that apply. 1 Confirm that the client's signature is authentic. 2 Ensure that the client has given the consent voluntarily. 3 Refrain from asking the student nurse to witness consent forms. 4 Instruct the family member to assist if the client denies understanding of the procedure. 5 Check if the client's caregiver has understood the procedures written in the consent form.

1, 2, 3 When witnessing the consent form, the nurse should confirm that the client's signature is authentic. The nurse should also ensure that the client has given the consent voluntarily. The nurse should never ask the student nurse to witness consent forms because it is a legal document. The nurse should inform the primary healthcare provider or nursing supervisor if the client denies understanding of the procedure in the consent form. It is important for the nurse to check if the client, rather than the caregiver, has understood the procedures written in the consent form.

A nursing student is discussing aspects of the American Nurses Association (ANA) code of ethics. Which ANA Code of Ethics statements discussed by the nursing student are accurately stated? Select all that apply. 1 "The nurse coordinates with other healthcare providers to meet health needs." 2 "The nurse is responsible and accountable for the nursing practice of the entire hospital." 3 "The nurse promotes, advocates for, and strives to protect the rights of the client's visitors." 4 "The nurse takes part in the advancement of the profession by contributing to the practice and education." 5 "The nurse's primary commitment is to the client, whether it be an individual, family, group, or community."

1, 4, 5 According to the ANA code of ethics, the nurse should coordinate with other healthcare providers to meet health needs. The nurse should take part in the advancement of the profession by contributing to the practice and education. The nurse should remember that his or her primary commitment is to the client, whether it be an individual, family, group, or community. The nurse is responsible and accountable for his or her individual nursing practices to provide optimum client care. The nurse should promote, advocate for, and strive to protect the rights of the client.

A nurse assisting in a research study calculates the risk-benefit ratio and concludes that there were no harmful effects associated with a survey of diabetic clients. This researcher was applying which principle? 1 Human dignity 2 Human rights 3 Beneficence 4 Utilitarianism

3 Beneficence is defined as the promotion of well-being and abstaining from the injuring of others as well as doing good and being kind and charitable. In this situation, the possible benefits outweigh the possible harm for the clients participating in a research study. Human dignity and human rights are underlying principles of research ethics but are not directly related to the risk-benefit ratio here. Utilitarianism relates to the ethical doctrine that virtue is based on utility, and that conduct should be directed toward promoting the greatest good for the greatest number of people.

A staff member is planning to start a new job but is worried about the impact it might have on future growth opportunities. The nurse leader is helping the staff member understand all the implications. Which ethical principle is the nurse manager as a leader following? 1 Justice 2 Veracity 3 Paternalism 4 Non-maleficence

3 Paternalism is assisting people to make decisions when they do not have sufficient data or expertise. Helping the staff member understand all effects of a possible career change and how the potential change could impact his or her future growth reflects the leader nurse following paternalism .Justice is the principle of treating all persons equally and fairly. By following veracity, the nurse manager tells the truth and demands that the truth be told completely. The principle of non-maleficence states that one should do no harm to others.

It is determined that a staff nurse has a drug abuse problem. What approach to the staff nurse's addiction should be taken as an initial intervention? 1 Counseled by the staff psychiatrist 2 Dismissed from the job immediately 3 Referred to the employee assistance program 4 Forced to promise to abstain from drugs in the future

3 Referral to the employee assistance program is a nonpunitive approach that attempts to help the nurse as an individual and as a professional. Counseling by the staff psychiatrist may be necessary for long-term therapy but is not the initial approach. Dismissing the nurse from the job immediately is a punitive nontherapeutic response that offers no chance of rehabilitation. The client has an addiction problem; promises will not keep the client from abusing drugs.

An elderly adult suffered an injury after falling down in the washroom. The primary healthcare provider performed a surgical procedure on the client and orders a blood transfusion. A family member of the client mentions that blood transfusions are not permitted in their community. What should the nurse do in order to handle the situation? 1 The nurse should wait for the court's order to give blood to the client. 2 The nurse should proceed with the transfusion in order to save the client's life. 3 The nurse should inform the primary healthcare provider and not give blood to the client. 4 The nurse should explain to the family member that the client needs this transfusion.

3 The client or the client's family member has the right to refuse treatment and the nurse should value their beliefs and traditions. Therefore, the nurse should inform the primary healthcare provider and not perform the blood transfusion. The nurse should not wait for a court's order or explain or convince the family member to change his or her mind. The nurse should not proceed with the treatment because this may cause severe legal implications.

A nurse receives abnormal results of diagnostic testing. What action should the nurse take first? 1 Inform the client of the results. 2 Ensure that the results are placed in the client's medical record. 3 Notify the client's primary healthcare provider of the results. 4 Obtain results of the other lab tests that were performed.

3 The nurse is most ethically and legally accountable for reporting diagnostic testing results to the client's primary healthcare provider, whether the results are normal or, more important, abnormal. Informing the client of the results is an incorrect action in this situation. Placing the results in the client's record and obtaining normal values of the results from the lab are acceptable actions for the nurse after notifying the primary healthcare provider of the abnormal results.

The family of an older adult who is aphasic reports to the nurse manager that the primary nurse failed to obtain a signed consent before inserting an indwelling catheter to measure hourly output. What should the nurse manager consider before responding? 1 Procedures for a client's benefit do not require a signed consent. 2 Clients who are aphasic are incapable of signing an informed consent. 3 A separate signed informed consent for routine treatments is unnecessary. 4 A specific intervention without a client's signed consent is an invasion of rights.

3 This is considered a routine procedure to meet basic physiologic needs and is covered by a consent signed at the time of admission. The need for consent is not negated because the procedure is beneficial. This treatment does not require special consent.

A nurse withholds a prescribed opioid medication from a client with intractable pain because the nurse fears the client will become addicted. In this situation the nurse is adhering to which ethical principle? 1 Veracity 2 Autonomy 3 Paternalism 4 Beneficence

4 Beneficence commonly is referred to as "doing of good"; it is related to the nurse's duty to help clients further their legitimate interest within the boundaries of safety. Unfortunately in this situation the client's priority is relief from pain and the nurse should be working with other health team members to achieve this objective. Veracity is defined as telling the truth. Autonomy, as an ethical principle, means that the nurse respects the client and the choices that are made. Paternalism occurs if the nurse interferes with the individual's autonomy by disregarding the client's choices.

What should the nurse do initially when obtaining consent for surgery? 1 Describe the risks involved in the surgery. 2 Explain that obtaining the signature is routine for any surgery. 3 Witness the client's signature, which the nurse's signature will document. 4 Determine whether the client's knowledge level is sufficient to give consent.

4 Informed consent means the client must comprehend the surgery, the alternatives, and the consequences. Describing the risks involved in the surgery is not within nursing's domain. Although obtaining a signature is routine, explaining that obtaining the signature is routine for any surgery does not determine the client's ability to give informed consent. Although witnessing the client's signature will be done, the nurse first should assess the client's knowledge of the surgery.

How does a nurse adopt the element of right circumstances during a task delegation? 1 By giving a clear and concise description of the task 2 By providing appropriate monitoring, evaluation, and intervention as needed 3 By delegating right tasks to the right person to be performed on the right person 4 By considering the appropriate client setting, available resources, and other relevant factors

4 The nurse adopts the element of right circumstance by considering the appropriate client setting, available resources, and other relevant factors during task delegation. By giving a clear and concise description of the task, the nurse adopts the element of right direction/communication. By providing appropriate monitoring, evaluation, and intervention as needed, the nurse adopts the element of right supervision/evaluation during task delegation. By giving the right tasks to the right person to be performed on a client, the nurse adopts the element of right person.

A new nurse needs further teaching when stating a valid consent involves which action? A. It must be presented to the patient by a nurse. B. The consent includes information about the risks and benefits of the procedure. C. The patient must have the capacity to give consent. D. The patient must voluntarily give consent.

A

Which of the following would be a violation of the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986? A. The hospital emergency room physician suspects that a patient is not competent in making decisions for his post-care treatment. The physician does not complete a competency evaluation prior to transfer for a non-emergent treatment and allows the patient with suspected incompetence to sign the consent for transfer. B. After providing a medical screening examination, the patient's attending physician determines that transfer for a psychiatric service is necessary and not provided by the hospital. The attending seeks consent from the competent surrogate decision maker for the patient prior to transfer. C. The patient's attending physician determines the patient to be in stable condition after completing the medical screening examination and stabilizing the patient. The patient's condition would deteriorate without a life-saving procedure not available at the hospital. The physician explains the risks of staying at the hospital and the risks of the transfer to the patient's power of attorney. Informed consent is received from the patient's power of attorney for the transfer. D. The hospital does not contract with the patient's insurance company. The emergency room physician completes a medical screening examination and stabilizes the patient for discharge. The patient financial services department informs the patient of insurance status after discharge and arranges for payment options.

A

If a nurse threatens to strike a patient while rushing toward the patient in an angry manner, which intentional tort has been committed? a. Assault b. Battery c. Negligence d. Invasion of privacy

A (Assault takes place when a threat of bodily harm is associated with a feeling of imminent harm and a demonstration of force by the perpetrator. Actual physical harm must have occurred in order for the offense to be considered battery. Negligence is an unintentional tort, and invasion of privacy relates to disclosure of private information or simple intrusion into a person's personal space.)

Which statement is true regarding codes of ethics and laws? a. Ethical codes hold professionals to a higher standard than the law. b. Laws limit the scope of codes of ethics in most professions. c. Breaking the law is not always an ethical code violation. d. Codes of ethics delineate punishments for breaking laws.

A (Professional ethical code requirements exceed legal standards of practice. Codes of ethics expand on legal requirements rather than being limited by the law. Breaking any law is a violation of ethical standards, and punishment for breaking laws is established by the legal system.)

On which ethical theory do nurses implement their care when they act on the basis of the needs of one specific patient rather than the potential consequences to other patients? a. Deontology b. Autonomy c. Utilitarianism d. Nonmaleficence

A (The ethical theory of deontology focuses on the act rather than on the consequences. Autonomy is an ethical concept that values an individual's right to make personal decisions. Utilitarianism is an ethical theory that focuses on the consequences of an action and the good of many rather than of an individual. The ethical principle of nonmaleficence asserts an obligation to "do no harm.")

One of the major attributes of health care law is a. it defines the expected behavior of persons in the business of health care. b. the law or rule is easy to interpret and comply with. c. it is established by any health care authority. d. the creator must be an expert in health care.

A A health care law or rule defines expected behavior of persons in the business of health care or in health care relationships. Health care law is not easy to interpret or comply with and can only be established by organizations with legal authority for law making. Creators of health care law are often not experts in health care.

A new registered nurse asks the registered nurse (RN) preceptor what could be done to become more professional. The best response of the preceptor is a. Attend nursing educational meetings. b. Listen to other nurses. c. Read the agency newsletter. d. Pass the licensing exam.

A Knowledge and commitment are essential components of professionalism. Attending nursing educational meetings can promote collaborative learning with peers and maintenance of competence in an ever-changing health care environment. Listening can promote professionalism, and communication is certainly a component of professionalism; however, there is also a social sense to listening, and without the educational/learning component, this is not the best answer. An agency newsletter could include information about professional opportunities, but it is not the best answer. The new nurse would have already passed the licensing exam, the legal requirement to be considered a nurse.

Recommendations published in the IOMs report The future of nursing: Leading change, advancing health include that nurses a. teach, advocate, assess, and nurture. b. should have a graduate degree to practice. c. diagnose and recommend treatments. d. must have continuing education.

A Professional nurses teach, advocate, assess, and nurture. The IOM recommends that 80% of nurses have a minimum baccalaureate degree (not graduate degree) by 2020. Physicians diagnose and recommend treatments, and nurses provide the majority of these treatments. Lifelong learning is recommended, and some, not all, states require continuing education.

Which of the following is an example of a nurse violating the Health Insurance Portability and Accountability Act (HIPAA) of 1996? a. The nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital. b. A group of fellow employees are discussing a patients clinical status in a public place. The nurse manager requests that they step into private room to complete the discussion. c. After entering the progress notes on a patients electronic medical record, the nurse logs off the computer to allow her coworker to use the terminal. d. As a family approaches the nursing desk, the nurse removes the patient census sheet from view on the counter.

A When the nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital, the nurse is accessing protected health information not required for the nurse to perform his or her job. This is a violation of privacy even if it is a relative. The other choices are all actions that are consistent with protecting a patient's privacy right as defined by HIPAA.

What consequences may a nurse experience if the nurse is convicted of a crime? (Select all that apply.) a. Loss of nursing licensure b. Employment affirmation c. Monetary penalty d. Imprisonment e. Promotion

A C D (Nurses who are convicted of a crime may have their nursing licenses revoked, be required to pay fines or pay restitution to patients or their families for damages, and be incarcerated for various periods, depending on the severity of the crime. Nurses who commit crimes are most often placed on probation pending the outcome of court proceedings or dismissed from their employment, not affirmed or promoted.)

A nurse on the unit makes a error in the calculation of the dose of medication for a critically ill patient. The patient suffered no ill consequences from the administration. The nurse decides not to report the error or file an incident report. The nurse is violating which principle of ethics? a. Fidelity b. Individuality c. Justice d. Values clarification

ANS: A Fidelity is the principle that requires us to act in ways that are loyal. In the role of a nurse, such action includes keeping your promises, doing what is expected of you, performing your duties, and being trustworthy. Individuality is something that distinguishes one person or thing from others. Injustice is when a person is denied a right or entitlement. Values clarification is a tool that allows the nurse to examine personal values in terms of ethical situations.

The nurse administrator is doing a study that entails gathering data about new employees over a 10-year period. Which research method would be the best one to use for this type of study? a. Quantitative longitude cohort b. Qualitative longitudinal c. Qualitative interview d. Qualitative case study

ANS: A Quantitative research has been defined as being "focused on the testing of a hypothesis through objective observation and validation". The types of studies that make up this category include randomized controlled studies, cohort studies, longitudinal studies, case-controlled studies, and case reports. The other options are examples of qualitative, not quantitative, studies.

When there is evidence that supports a screening for an individual patient but not for the general population, the nurse would expect the United States Preventive Services Task Force Grading to be what? a. No recommendation for or against b. Recommends c. Recommends against d. Strongly recommends

ANS: A The United States Preventive Services Task Force Grading is an example of how evidence is used to make guidelines and determine priority. When there is evidence that supports a screening for an individual patient but not for the general population, there is no recommendation for or against screening the general population. Recommends is the grading when there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is the grading when there is moderate or high certainty that the intervention has no net benefit or that the harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the net benefit is substantial.

A 28-year-old married woman received word that she is pregnant. Sadly, the patient is not able to carry the pregnancy because she suffers from long QT syndrome, which causes an abnormality of the heart, meaning any rush of adrenaline could prove fatal. The pregnant patient states, "I want to have this baby." The nurse realizes that this is a conflict that involves the ethical principle of a. utilitarianism. b. deontology. c. autonomy. d. veracity.

ANS: A Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Veracity is telling the truth in personal communication as a moral and ethical requirement. Deontology is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Autonomy is the principle of respect for the individual person. All persons have unconditional intrinsic value. People are self-determining agents who are entitled to decide their own destiny.

The focus of quality health care should be on which of the following items? (Select all that apply.) a. Excellent services b. Comprehensive communication c. Private hospital rooms d. Health team collaboration e. Culturally competent care

ANS: A, B, D, E Excellent services, communication, collaboration, and culturally competent care brings quality to the health care delivered to the patient. Private hospital rooms may be a preference by some patients, but they do not add to the quality of care.

How does the Iowa model transcend mere nursing care? (Select all that apply.) a. It includes formalized internal feedback loops. b. Its triggers can have their origins practically anywhere. c. It generates change in practice solely through research. d. It implies a layer of policy development. e. It addresses multiple disciplines' impacts on quality.

ANS: A, B, D, E The triggers addressed within the Iowa model process can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from the institutional standards committee. Because the Iowa model is often implemented at a fairly high level of nursing or hospital administration, it scrutinizes the input of nursing and other disciplines in its process. Its output is applied as widely as possible throughout the organization, and it can affect policy within a multihospital system and even across systems. The success of EBP is determined by all involved, including health care agencies, administrators, nurses, physicians, and other health care professionals.

The nurse is conducting a review of the literature for pain management techniques. Which of the following would the nurse consider when conducting research that yields solid EBP? (Select all that apply.) a. Search the literature to uncover evidence to answer the question. b. Evaluate the outcome. c. Use the nursing process to evaluate evidence. d. Evaluate the evidence found. e. Develop an answerable question. f. Develop a question that has not been answered. g. Apply the evidence to the practice situation.

ANS: A, B, D, E, G To facilitate the use of evidence, steps have been developed to systematically approach a question of patient care. The steps are outlined as follows: Develop an answerable question Search the literature to uncover evidence to answer the question Evaluate the evidence found Apply the evidence to the practice situation Evaluate the outcome The nursing process is a method of problem solving and can be used to develop a plan of care. Formulating a question that has not been answered in the research would be considered primary research. Therefore, there is no evidence in which to draw from.

What are the major attributes of health care quality? (Select all that apply.) a. Conforms to standards b. Sound decision making c. High acuity patients d. Low health care costs e. Identifies adverse events

ANS: A, B, E Major attributes of health care quality include conformation to standards set by regulatory agencies, sound decision making regarding care, and identifying potential adverse events. High acuity of patients does not contribute to quality health care, because the care demand is increased, and low health care costs mean fewer services may be available.

The nurse in the outpatient setting would like to conduct a research study that compares patients who take tramadol (Ultracet) to patients who take oxycodone hydrochloride and acetaminophen (Percocet) for managing back pain. Which quantitative research method should yield the best results? a. Longitude study b. Controlled study c. Systematic reviews/meta-analysis d. Survey study

ANS: B A controlled study is a type of quantitative research that seeks to control and examine the variables to determine effectiveness. In this case, the variables would be those that were administered tramadol (Ultracet) and those that were administered hydrochloride and acetaminophen (Percocet) for managing back pain. Correlational research methods help determine association between or among variables. A longitudinal study examines variables over a designated course of time. A systematic reviews/meta-analysis is a type of literature review and not a research method. A survey study is a type of qualitative research method.

An unconscious patient is treated in the emergency department for head trauma. The patient is unconscious and on life support for 2 weeks prior to making a full recovery. The initial actions of the medical team are based on which ethical principle? a. Utilitarianism b. Deontology c. Autonomy d. Veracity

ANS: B Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontologic theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Autonomy is the principle of respect for the individual person. People are free to form their own judgments and perform whatever actions they choose. Veracity is defined as telling the truth in personal communication as a moral and ethical requirement.

A patient states that everything has been going great; however, the nurse observe the patient biting his nails and fidgeting. What assessment can the nurse make? The patient's communication type is a. linguistic. b. paralinguistic. c. explicit. d. inadequate.

ANS: B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

A patient suffered a brain injury from a motor vehicle accident and has no brain activity. The patient has a living will which states no heroic measures. The family requests that no additional heroic measures be instituted for their son. The nurse respects this decision in keeping with the principle of a. accountability. b. autonomy. c. nonmaleficence. d. veracity

ANS: B Patients and families must be treated in a way that respects their autonomy and their ability to express their wishes and make informed choices about their treatment. Accountability is inherent in the nurse's ethical obligation to uphold the highest standards of practice and care, assume full personal and professional responsibility for every action, and commit to maintaining quality in the skill and knowledge base of the profession. Nonmaleficence is a principle that implies a duty not to inflict harm. In ethical terms, nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. Veracity means telling the truth as a moral and ethical requirement.

A student nurse is talking with his instructor. The student asks how quality of care is evaluated. The best response by the instructor is "Quality of care is evaluated a. by the patient getting well." b. on the basis of process and outcomes." c. by the physician's assessment." d. by the patient's satisfaction."

ANS: B Quality of care is evaluated by process and outcomes. If the outcomes are achieved, then the care has achieved what is was designed to do. The patient getting well may be an action of the body doing what it is supposed to do and not quality of care; the same can be said of the physician's assessment. The patient's satisfaction is subjective according to his or her perceptions and not the quality of care.

The focus for The Joint Commission (TJC) is _____ and _____ in the delivery of health care. a. cost containment; safety b. safety; quality c. quality; assessment d. assessment; evaluation

ANS: B The focus of TJC is quality and safety for patient care. TJC does not address cost containment, assessment of care, or evaluation of care.

A male patient suffered a brain injury from a motor vehicle accident and has no brain activity. The spouse has come up to see the patient every day for the past 2 months. She asks the nurse, "Do you think when he moves his hands he is responding to my voice?" The nurse feels bad because she believes the movements are involuntary, and the prognosis is grim for this patient. She states, "He can hear you, and it appears he did respond to your voice." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology

ANS: B Veracity is the principle of telling the truth in a given situation. Autonomy is the principle of respect for the individual person; this concept states that humans have incalculable worth or moral dignity. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Giving the spouse false reassurance is not a good consequence. Deontologic theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Persons are to be treated as ends in themselves and never as means to the ends of others.

Which statements are true about the Iowa model of EBP? (Select all that apply.) a. It addresses utilization of research findings at an individual level. b. It prioritizes pressing items of interest related to quality of care. c. Individual nurses enact an Iowa decision tree when they examine risk management data. d. It identifies triggers capable of posing hazard or benefit. e. It reiterates that innovators embrace change far earlier than laggards.

ANS: B, D The Iowa model of EBP provides direction for the development of EBP in a clinical agency. This EBP model was initially developed in 1994 and revised in 2001. In a health care agency, there are triggers that initiate the need for change, and the focus should always be to make changes based on best evidence. These triggers can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from an institutional standards committee.

If a student nurse is asked by a staff nurse to complete a patient care procedure that the student has previously performed only in lab, what response by the student best exemplifies an ethical commitment to both safe practice and learning? a. Asking the staff nurse to perform the care procedure while the student observes b. Locating the clinical instructor to provide the patient care procedure with student oversight c. Reviewing the procedure prior to initiating the patient care with supervision of a registered nurse d. Requesting the help of another student who has previously performed the patient care procedure

ANS: C First reviewing the procedure and then completing it under the supervision of a registered nurse provide for both the patient's safety and the student's learning. Students should take every opportunity to apply their lab skills in real patient care settings. Asking the instructor or a fellow student to complete a procedure that has already been practiced in lab does not indicate an ethical commitment to learning.

The nurse in the psychiatric unit is involved in a research study for a depression medication. In the study, patients are randomly assigned to one depression medication and the other group is receiving no medication to treat the depression. What method of research are the patients involved with? a. Descriptive b. Correlational c. Quasi-experimental d. Experimental

ANS: D Experimental tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment. Descriptive defines the magnitude of a concept and its characteristics. Correlational determines association between or among variables. Quasi-experimental tests an intervention and lacks either a control group or random assignment.

One of the first nurse researchers to document evidence-based practice for nursing was Florence Nightingale. What did Nightingale incorporate into her practice that made her practice different from her colleagues? a. Nightingale gathered scientific data. b. Nightingale calculated statistics to report her findings. c. Nightingale communicated her findings to powerful others. d. Nightingale based her nursing practice on her findings.

ANS: D Florence Nightingale had tried to develop the role of researcher by using evidence from her practice and implementing these findings. Evidence-based practice (EBP) includes conducting quality studies, synthesizing the study findings into the best research evidence available, and using that research evidence effectively in practice. Although gathering scientific data, calculating statistics to report findings, and communicating findings to powerful others are all important components of conducting research, Nightingale's action that most appropriately reflects the current nursing research priority is that she based her nursing practice on her findings.

A nurse protecting a patient's right to consent to a procedure is represented in which of the following answers? A. Finding that the informed consent document is not with the chart, the nurse gives the patient another consent document to sign before the procedure. B. When the nurse finds that the informed consent document is not yet complete, she holds the patient's pre-procedure narcotics until the physician can obtain patient consent. C. The nurse finds that the consent form is unsigned in the chart and waits until after the procedure to get the document signed. D. Knowing the patient is not competent to sign a consent form, the nurse asks the friend who came with the patient to sign it.

B

If an adult patient is mentally incompetent to make personal health care decisions, to which aspect of a patient's advance directives should the nurse refer first prior to seeking who is able to give informed consent on the patient's behalf? a. Living will b. Health care proxy c. Do not resuscitate orders d. Durable power of attorney

B (A patient's health care proxy specifies who is to make health care decisions for individuals who are unable to comprehend information. It limits the scope of power of the designated individual to health care and treatment decisions. If a patient has not established a health care proxy, then the nurse would default to contacting a patient's durable power of attorney, who may be charged with the responsibility of making all legal decisions on behalf of the patient. A living will specifies treatment desired by patients if they are no longer capable of making decisions. Do not resuscitate orders are written by a patient's primary health care provider in consultation with patients, their immediate family members, and/or their health care proxy or durable power of attorney, if a health care proxy is not designated.)

What nursing intervention best demonstrates a commitment to patient autonomy? a. Encouraging a patient to ambulate independently following surgery b. Collaborating with a patient while developing the patient's care plan c. Establishing patient-centered goals for decreased chronic pain d. Assessing a patient for potential postprocedural complications

B (Patient autonomy is supported when patients are encouraged to participate in personal care decisions. Encouraging patient ambulation and completing a patient assessment are responsibilities of the nurse to promote patient wellness. Writing patient-centered goals without input from the patient does not indicate a commitment to autonomy.)

What is the best way for a nurse to avoid crossing professional practice boundaries with patients? a. Spend extensive time with a patient without visitors b. Focus on the needs of patients and their families c. Intervene in problematic patient relationships d. Discuss personal information excessively

B (The best way to avoid breaching professional practice boundaries is to focus on the patient's needs and those of the patient's family. Nurses should consistently avoid excessive self-disclosure of personal information, intervening in patient relationships, and spending excessive amounts of time with one patient. In addition to keeping patients' secrets, gaining personally from a relationship with a patient, and engaging in sexual overtures or behavior with a patient, these actions are considered violations of professional boundaries.)

Which of the following is false regarding state licensure laws? a. These laws establish the requirements for licensure to practice. b. Licensure is not necessary if the individual has completed training. c. The state regulatory agencies such as the state board of nursing are responsible for creating and enforcing these rules. d. The scope of practice defines what the professional can and cannot do within the scope of their licensure.

B Licensure is required to practice after the completion of all required training for the profession. The state laws establish the requirements to practice and the state regulatory agencies are responsible for creating and enforcing the rules. The scope of practice defines what activities the professional is legally authorized to perform.

Which of the following is true about health care legislation? a. The US Constitution addresses health care law specifically to give the federal government the ability to license professionals and institutions. b. The power of the US Constitution does not have a direct relationship to health care and reserves most of the power to the states. c. State laws are considered the highest source of health care law and trump the federal laws. d. The federal government asserts its power over health care legislation through the US Constitution.

B The power of the US Constitution does not have a direct relationship to health care and reserves most of the power to the states. The other statements are false. The US Constitution does not address health care specifically. Either state or federal laws can be considered the highest source of law depending on which law has the stricter regulation or rule.

Nursing students are held to which standard by the Code of Ethics for Nurses? (Select all that apply.) a. Clinical skills performance equal to that of an experienced nurse b. Demonstration of respect for all individuals with whom the student interacts c. Avoidance of behavior that shows disregard for the effect of those actions on others d. Accepting responsibility for resolving conflicts in a professional manner e. Incorporating families in patient care regardless of patient preference

B C D (Nursing students are expected to demonstrate respect, avoid hurting others by their actions, and take responsibility for resolving conflicts in a professional manner, much the same as professional nurses. Student nurses are not required to perform clinical skills at the level of expertise exhibited by an experienced nurse. Involving a patient's family in care without the patient's approval indicates a lack of respect for patient autonomy.)

Which components must exist for nursing malpractice to be established? (Select all that apply.) a. Intent of harm to the patient b. Omitted or substandard care c. Injury resulting from care provided d. Responsibility to provide nursing care

B, C, D (Dereliction, direct cause, and duty (and damages) must all be established in cases of malpractice. Intent to harm someone is not a requirement for malpractice.)

The nurse utilizing evidence-based practice (EBP) considers which factors when planning care? (Select all that apply.) a. Cost-saving measures b. Nurses expertise c. Client preferences d. Research findings e. Values of the client

BCDE

Which of the following is an example of a medical malpractice tort liability? A. A patient is informed of all known side effects of a medication and voluntarily takes the medication. The patient experiences an adverse effect from a medication prescribed by a physician. B. A nurse follows the standard of care for initiating an intravenous line, but the patient's vein bursts, causing a hematoma and the need for minor surgery to evacuate the fluid. C. A surgeon does not complete the postprocedure count process, and a sponge is retained in the patient's abdominal cavity. D. The Department of Justice fines an organization for releasing protected health information to a pharmaceutical company without individual patient consent

C

Which nursing intervention is the best example of patient advocacy? a. Collecting blood samples according to the physician's order each morning b. Assessing the vital signs of a patient who is receiving a blood transfusion c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain d. Accompanying an ambulating patient who is walking for the first time after undergoing surgery

C (Advocacy requires a nurse to work on behalf of others who may be unable to speak for themselves. When a patient is in pain and the physician or primary care provider is not present, a nurse must advocate for the patient's needs by initiating contact with the person responsible for addressing an immediate need. In this case, an order for additional pain medication is needed, which requires collaboration with the patient's physician. Collecting blood samples, assessing vital signs, and assisting a patient with ambulation are primary responsibilities of the nurse that do not require advocacy to meet the patient's need.)

Making prejudicial, untrue statements about another person during conversation may expose a nurse to being charged with what offense? a. Libel b. Assault c. Slander d. Malpractice

C (Conversation that includes prejudicial and false statements about another person is an example of oral defamation of character or slander. Libel is the written form of defamation of character. Assault is a threat of bodily harm accompanied by a sense of imminent danger. Malpractice is professional negligence caused by unsafe practice.)

What nursing intervention is best when a patient is struggling with the decision to abort an abnormally developing fetus discovered during genetic testing in the first trimester of pregnancy? a. Recommend additional testing b. Refer the patient to an abortion clinic c. Listen to the patient's concerns d. Discuss regional adoption agencies

C (Listening is the best option for the nurse when patients are considering ethical care decisions. Patients often need someone to listen to their verbalized concerns to sort out feelings about the situation and make decisions that are best for them. The patient's primary care provider is responsible for recommending further testing or making requested patient referrals.)

Which action by the nurse best illustrates the ethical concept of fidelity? a. Caring for an incarcerated patient without expressing disdain b. Weighing the benefits versus the risks of medical treatment c. Ensuring that patients receive care that is promised d. Endorsing equal access to health care for everyone

C (Nurses demonstrate the ethical concept of fidelity by keeping their promises, which serves to enhance trust levels among themselves and their patients. Weighing the benefits and risks of medical treatment is necessary for sound decision making but is not an illustration of fidelity. Caring for all patients regardless of their actions and endorsing equal access to health care are both examples of a commitment to justice.)

Decisions regarding the legality of licensed practical nurses administering intravenous therapy established in the Nurse Practice Act are determined by which type of law? a. Constitutional b. Statutory c. Regulatory d. Case

C (Regulatory law outlines how the requirements of statutory laws, such as the Nurse Practice Act, will be met. Constitutional law defines powers of governments and responsibilities of elected officials. Judicial decisions on specific court cases establish case law.)

Veracity mandates which action by the nurse if a cancer patient inquires about diagnostic test results that show further metastasis (spread) of the patient's cancer? a. Telling the patient that the diagnostic test results are not available yet from the laboratory b. Avoiding further contact with the patient to prevent accidental disclosure of the information c. Encouraging the patient to discuss the results with the physician who ordered the diagnostic tests d. Sharing that the test results do not appear to indicate any significant changes at this time

C (Veracity requires that a person tell the truth. Since the physician who ordered the diagnostic tests has the most extensive knowledge of the patient's case, it would be best for the patient to discuss the results with that physician. In this way the patient can receive the diagnostic test results and immediately discuss possible implications and treatment options. Nurses should try always to be honest with their patients and resist the urge to avoid uncomfortable situations.)

In which of the following answers is the hospital in compliance with the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA)? a. The emergency department staff asks a patient to stay in the waiting room until the patients with insurance are treated. b. The emergency registration personnel explain to a patient that they must have proper identification to receive treatment. c. A patient with chest pain is triaged directly to a room for evaluation and registration information is obtained after the patient is stabilized. d. The emergency department physician discharges and instructs a patient who is actively suicidal to go the neighbor facility that has psychiatric services.

C EMTALA requires that any hospital that operates an emergency department and receives Medicare funds provide an appropriate screening exam to anyone who presented and stabilize any emergency medical condition prior to transfer to another facility. The other choices are in conflict with EMTALA because a medical screening exam must be provided without consideration of the patient's insurance, whether the patient has identification, or the facility's services.

The scope of professional nursing practice is determined by the rules promulgated by which organization? a. American Nurses Association (ANA) b. Institute of Medicine (IOM) c. States Board of Nursing d. States Nursing Association

C Professional nursing practice is regulated by each state's Board of Nursing. The ANA is the professional organization of registered nursing in the United States and may influence, but it does not regulate. The IOM collaborated with the Robert Wood Johnson Foundation to improve the fractured health care system in the United States, and it makes recommendations, not rules. The state nursing associations are state organizations of the ANA and may collaborate with the public and boards of nursing to promote nursing rules which improve health care.

The ANA outlines expectations of the nursing profession in the a. Gallup poll. b. Goldman report. c. Social Policy Statement. d. social identity theory.

C The ANA's Nursing's Social Policy Statement outlines expectations of nurses. The national Gallup poll has found nursing to be one of the most trusted professions for their honesty and ethical standards almost every year, but it does not outline expectations. Emma Goldman was a radical anarchist nurse who advocated and cared for indigent women in New York. She demonstrated the expectations of a professional nurse. Social identity theory posits that social identity is derived from group membership and that most people work to attain a positive social identity, and it not specific to nursing.

Nursing demonstrates dedication to improving public health through a. changing health care standards. b. legal regulations. c. scope of practice. d. technology.

C Through the scope of practice, specialized knowledge, and code of ethics, the discipline of nursing has demonstrated its dedication to improving public health. The changing health care environment is one of the challenges to nursing, not an indicator of dedication. Legal regulations are generally promulgated by legislators rather than nurses to protect the public. A highly technological environment is considered a challenge to nursing rather than an indicator of dedication.

Which of the following statements is true regarding The Joint Commission's authority relating to health care organizations? A. The Joint Commission standards have the same effect as law, and organizations can be fined by The Joint Commission for noncompliance. B. The Joint Commission regulations have no effect on the legal process in health care. C. The Joint Commission serves as an advisor to the federal government in establishing fines related to noncompliance. D. The Joint Commission regulations may be seen as having the effect of law because they accredit organizations to bill Medicare and the standards are frequently used in malpractice cases

D

What action should nurses who demonstrate accountability take if they forget to administer a patient's medication at the ordered time? a. Document the medication as refused by the patient. b. Administer the medication as soon as the error is discovered. c. Record the medication as given after making sure the patient is okay. d. Follow the administration and documentation procedures for medication errors.

D (Agency procedures must be followed after every medication error. Care must be taken to adhere to medication administration recommendations and documentation requirements to legally record the incident and provide patient safety. Documenting that the patient refused or already took the medication, when that is not factual, is illegal and unethical, regardless of the patient's condition. Administering the medication as soon as the error is discovered may not be recommended, depending on the medication's potency and frequency of administration.)

If a student nurse overhears a peer speaking disrespectfully about a patient, nurse, faculty member, or classmate, what is the most ethical first action for the student nurse to take? a. Discuss the peer's actions during group clinical conference b. Ignore the initial occurrence and observe if it happens again c. Report the actions of the classmate to the clinical instructor d. Speak to the peer privately to prevent further occurrences

D (Alerting the peer who has acted disrespectfully in a private setting is the most professional way to approach this situation. It is never appropriate for a professional to belittle or reprimand a peer in front of others. Ignoring disrespectful behavior may only perpetuate its occurrence. Seeking help from a clinical instructor would be appropriate if the peer does not respond to the initial intervention from the fellow student.)

What action by the nurse at the site of a motor vehicle accident is critical in order for requirements of the Good Samaritan Act to be met? a. Accepting compensation for professional services b. Transferring rescue efforts to family members c. Providing all needed emergency intervention d. Performing within nursing standards of care

D (Good Samaritan laws in all states require that nurses provide care within their scope of knowledge and standards of care. This is the only way for nurses to avoid charges of negligence, even in the case of an emergency. No fees can be accepted or charged for services in order for a nurse's actions to be covered by a Good Samaritan Act. Rescue efforts should be transferred to equally competent professionals such as paramedics or emergency room personnel if the nurse is discontinuing care. Each nurse has a legal responsibility to provide only emergency care that is within his or her scope of nursing practice.)

In the United States, practicing nursing without a license is what type of offense? a. Misdemeanor b. Malpractice c. Battery d. Felony

D (Practicing nursing without a license in the United States is a felony rather than a misdemeanor due to the serious nature of the offense. Battery involves causing physical harm, which may not always occur as a result of someone impersonating a nurse. Malpractice is professional negligence.)

What action should a nurse take if a patient who needs to sign an informed-consent form for nonemergency surgery appears to be under the influence of drugs or alcohol? a. Contact the physician to see what should be done. b. Ask the patient's spouse to sign the informed-consent form. c. Request permission to bypass the need for a signed consent form. d. Wait to have the informed-consent form signed when the patient is alert and oriented.

D (When a normally competent patient is assessed to be under the influence of alcohol or drugs, it is the nurse's responsibility to delay a nonemergency procedure until legal informed consent can be obtained from the patient. Only in the case of an emergency is it possible to obtain informed consent from a spouse or designated power of attorney for a temporarily impaired adult. It is not necessary to contact the physician for guidance on what should be done because there is an established legal procedure to follow. The nurse should contact the surgeon who is scheduled to perform the surgery and the operating room staff regarding the need to delay due to the patient's status.)

The admission personnel working to comply with the Patient Self Determination Act of 1991 would do which of the following? a. Request identification from the patient to complete the registration process. b. Ask the patient if they would like a private or semi-private room. c. Inquire about the patients reason for their visit. d. Ask the patient or representative if the patient has an advanced directive and advise them of their right to participate in their medical decisions.

D Inquiring about a patient's advanced directive is a requirement of the Patient Self Determination Act of 1991. Inquiring about identification, type of room requested, and reason for visit are not addressed by the Patient Self Determination Act.

An example of the regulatory power to make law is the a. Joint Commission establishing a medication reconciliation standard. b. Centers for Disease Control and Prevention (CDC) developing recommendations for childhood immunizations. c. Institute of Medicine (IOM) defining the approximate number of medication errors that result in significant patient harm or death. d. Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals.

D The Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals refers to the enactment of law, while the other answers discuss the development of standards and recommendations that do not have the authority of law. There are some health care rules that may define expected behavior, but if these rules were not created by a government entity with legal authority, then they are not health care laws.

The qualities of leadership, clinical expertise and judgment, mentorship, and lifelong learning would describe a nurse who is a(n) a. administrator. b. certified nurse specialist. c. practitioner. d. professional.

D The qualities listed are those of a professional nurse. The other options are all nurses who may have these qualities, but the focus of their title includes qualities not essential for the professional nurse. The administrator would have management qualities; the clinical nurse specialist would have specialty area knowledge; and the practitioner would meet legal requirements as a health care provider.

A patient states, I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which response by the nurse would be an example of interpersonal therapeutic communication? a. It sounds as though you were uncomfortable with the content of your dream. b. I understand what youre saying. Bad dreams leave me feeling tired, too. c. So, all in all, you feel as though you had a rather poor nights sleep? d. Can you give me an example of what you mean by a bad nightmare?

D The technique of clarification is therapeutic and helps the nurse examine meaning. The distracters focus on patient feelings but fail to clarify the meaning of the patient's comment.

A nurse manager in an outpatient clinic notices that a sharp increase in medication errors has occurred over the past 3 months. The manager develops a project to track medication administration from the initiation of the patient chart through the documentation of patient medications. When giving approval for the project, nursing administrators understand that this is an example of the process known as which process? A. Health policy development B. Evidence-based research C. Utilization review D. Quality improvement

D. Quality improvement