Unit 13-16 (Practice Study Questions)

A nurse who is working with a client who has been diagnosed with AIDS reveals the client's name and diagnosis with a co-worker on the way downstairs in an elevator. Unknowingly, a friend of the client that happens to be sharing the elevator and hears the entire story. The nurse who shared the information may be held liable for: 1. Slander 2. Assault 3. Malpractice 4. Invasion of privacy

ANS: 1 A nurse can be held liable for slander if he or she shares private client information that can be overheard by others. Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary. The nurse in this situation has not committed assault. Malpractice is negligence committed by a professional such as a nurse or physician. Nursing malpractice results when care falls below the standard of care. This case is not an example of malpractice. Invasion of privacy occurs when the client has unwanted intrusion into his or her private affairs. This case is not an example of invasion of privacy. This instance falls under the category of defamation of character.

The nurse knows that when making choices concerning the adoption of evidence-based practice, the literature must be reviewed regarding its: (Select all that apply) 1. Content 2. Relevance 3. Reliability 4. Ethical soundness 5. Economic feasibility 6. Transcultural versatility

ANS: 1, 2, 3, 4 Nurses make choices regarding evidence-based practice proposals based on content, relevance, reliability, and the ethical implications to their practice. The remaining options are not typically considered when evaluating the global usefulness of research findings.

While working as a nursing assistant, a nursing student is asked to reinsert a Foley catheter by the RN. Which of the following reflects the most appropriate initial student response to the request? 1. Notify the nursing supervisor of the inappropriate request. 2. Tell the RN that she can only perform as a nursing assistant. 3. Agree to perform the task but with the supervision of the RN. 4. Jointly read the nursing assistant job description with the RN.

ANS: 2 When students work as nursing assistants or nurses' aides, they should not perform tasks that do not appear in a job description for a nurses' aide or assistant. The remaining options do not appropriately address the immediate situation.

In the event that a nursing license is revoked, which of the following is correct? 1. The hearings are usually held in court. 2. Due process rights are waived by the nurse. 3. Appeals may be made regarding the decisions. 4. The federal government becomes involved in the procedures.

ANS: 3 Because a license is viewed as a property right, due process must be followed before a license can be suspended or revoked. Due process means that nurses must be notified of the charges brought against them, and that the nurses have an opportunity to defend against the charges in a hearing. Hearings for suspension or revocation of a license do not occur in court but are usually conducted by a hearing panel of professionals. Due process must be followed. They do not have to be waived by the nurse. Some states, not the federal government, provide administrative and judicial review of such cases after nurses have exhausted all other forms of appeal.

The correct sequence for attaining the resolution of an ethical problem is: 1. Examine values, evaluate, and identify the problem 2. Evaluate the outcomes, gather data, and consider actions 3. Gather facts, verbalize the problem, and consider actions 4. Recognize the dilemma, evaluate, and gather information

ANS: 3 The correct sequence for resolving ethical problems is recognizing the dilemma, gathering facts, examining one's own values, verbalizing the problem, considering actions, negotiating the outcome, and evaluating the action.

The nurse realizes that sharing one's computer password is a violation of which of the professional nursing principles? 1. Advocacy 2. Responsibility 3. Accountability 4. Confidentiality

ANS: 4 When medical records are computerized, computer security measures include special access codes for all authorized users; sharing private passwords is a breech of client confidentiality because it allows unauthorized individuals to access client information. The remaining options are reflective of other professional principles

There are issues concerning death and dying may influence nursing practice which the nurse recognizes. Concerning the legalities of death and dying issues, which of the following is true? 1. Passive euthanasia is illegal in all states. 2. Assisted suicide is a constitutional right. 3. Organ donation must be attempted if it will save the recipient's life. 4. Feedings may be refused by competent individuals who are unable to self-feed.

ANS: 4 Competent clients have the right to refuse treatment. This includes life-saving hydration and nutrition. This is not a true statement. Furthermore, physician-assisted suicide is legal in the state of Oregon. In 1997 the Supreme Court ruled that there is no fundamental constitutional right to assisted suicide. Organ donation does not have to be attempted to save a recipient's life

A patient has obstructive sleep apnea. Which assessment is the priority? a. Gastrointestinal function b. Neurological function c. Respiratory status d. Circulatory status

ANS: C In obstructive sleep apnea, the upper airway becomes partially or completely blocked, diminishing nasal airflow or stopping it. The person still attempts to breathe because the chest and abdominal movement continue, which results in loud snoring and snorting sounds. According to the ABCs of prioritizing care, airway and respiratory status takes priority over gastrointestinal, circulatory, and neurologic functioning.

The nurse is caring for a postpartum patient. The patient's labor has lasted over 28 hours within the hospital; the patient has not slept and is disoriented to date and time. Which nursing diagnosis will the nurse document in the patient's care plan? a. Insomnia b. Impaired parenting c. Ineffective coping d. Sleep deprivation

ANS: D This patient has been deprived of sleep by staying awake during a 28-hour labor. Disorientation is one potential sign of sleep deprivation. In this scenario, there is a clear cause for the patient's lack of sleep, and it is a one-time episode. Insomnia, on the other hand, is a chronic disorder whereby patients have difficulty falling asleep, awaken frequently, or sleep only for a short time. This scenario does not indicate that this has been a chronic problem for this patient. Although ineffective coping can manifest as a sleep disturbance, clear evidence shows that it was labor that deprived this patient of sleep, not an inability to cope. It could be difficult to care for an infant when sleep deprived; however, this scenario gives no evidence that this mother displays impaired parenting and is not caring adequately for her child or lacks the skills to do so

An experienced pediatric nurse is reassigned to an adult oncology floor because of staffing issues and immediately recognizes a lack of experience in this specialty. Which of the following nursing actions shows a lack of professionalism? 1. Politely declining the assignment 2. Filling out a report noting her dissatisfaction 3. Asking to work with another oncology nurse 4. Notifying the state board of nursing of the problem

ANS: 1 A nurse who refuses to accept an assignment may be considered insubordinate, and clients will not benefit from having less staff available. This is an unprofessional attempt to resolve the problem. Asking to work with another oncology nurse, sending a written protest, and notifying the state nursing board would be appropriates action, and so are not examples of unprofessional behavior.

The client states that she needs to exercise regularly, watch her weight, and reduce her fat intake. This demonstrates that the client: 1. Values health promotion activities 2. Believes she will not become sick 3. Believes she will have a heart attack 4. Has unrealistic expectations for herself

ANS: 1 A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. The client is expressing her value of health promotion activities. A belief is a conviction of the truth or reality of a thing. The client does not state she believes these health promotion activities will keep her from becoming sick. A belief is a conviction of the truth of a thing. The client's statement does not indicate she believes she will have a heart attack. These are not unrealistic expectations

Which one of the following individuals may legally give informed consent? 1. A 16-year-old for her newborn child 2. A sedated 42-year-old preoperative client 3. The friend of an 84-year-old married client 4. A 56-year-old who does not understand the proposed treatment plan

ANS: 1 An emancipated minor, one who is below the age of 18 but who is a parent, can legally give informed consent for the care of her newborn. An emancipated minor can also be someone below the age of 18 who is legally married. A person who has been sedated cannot legally give informed consent. Consent should be obtained before a sedative is administered. If the 84-year-old client were unable to give consent, then the client's wife would be the person legally authorized to do so on the client's behalf. In order for a friend to be legally able to give consent, he or she would have to possess power of attorney or legal guardianship of the client. If a client does not understand the proposed treatment plan, the nurse must notify the physician or nursing supervisor and must make certain that clients are informed before signing the consent.

Which of the following statements made by a nurse shows a lack of understanding regarding the Uniform Anatomical Gift Act? 1. "A client must be 21 to give consent to be an organ donor." 2. "All clients admitted to the hospital are asked about becoming an organ donor." 3. "We have a form here on the unit that must be signed to show a client's informed consent to be an organ donor." 4. "In our state, you can check the back of a client's driver's license to verify whether they are an organ donor."

ANS: 1 An individual who is at least 18 years of age has the right to make an organ donation (defined as a "donation of all or part of a human body to take effect upon or after death"). Donors need to make the gift in writing with their signature. In many states, adults sign the back of their driver's license, indicating consent to organ donation. In most states, required request laws mandate that at the time of admission to a hospital, a qualified health care provider has to ask each client older than 18 whether he or she is an organ or tissue donor

Which of the following statements made by a nurse puts the nurse at risk for assault of the client? 1. "You will be sorry if you don't agree to take this medication." 2. "You can't refuse this medication if you really want to feel better." 3. "I'll be so disappointed in you if you don't take your medication." 4. "I'll tell your son you aren't cooperating if you don't take your medication."

ANS: 1 Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary. Threatening to tell a family member may be a breech of confidentiality; the remaining options are examples of unnecessary pressuring of the client. This case is not an example of invasion of privacy

Which source of law best addresses a situation where nurse accidentally administers an incorrect dosage of morphine sulfate to the client? 1. Civil law 2. Criminal law 3. Common law 4. Administrative law

ANS: 1 Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Generally, violations of civil laws cause harm to an individual or property and damages involve payment of money. Administering an incorrect dosage of morphine sulfate would fall under civil law because it could cause harm to an individual. Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment). Common law is created by judicial decisions made in courts when individual legal cases are decided (i.e., informed consent). Administrative law is created by administrative bodies, such as state boards of nursing when they pass rules and regulations (i.e., the duty to report unethical nursing conduct)

The nurse realizes that an individual client's value system is most affected by: 1. Life experiences 2. Economic status 3. Spiritual beliefs 4. Formal education

ANS: 1 Development of values begins in childhood, shaped by experiences within the family unit, especially dramatic events during the formative years. The other options may influence the value system, but not to the same extent

When a client who is in need of a lung transplant is placed on the organ donor registry according to his current health needs, this is an example of ethical: 1. Justice 2. Fidelity 3. Beneficence 4. Nonmaleficence

ANS: 1 Health care providers agree to strive for fairness in health care. Criteria set by a national multidisciplinary committee make every effort to ensure justice by ranking client organ recipients according to need. The remaining options refer to keeping a promise, kindness, and doing no harm.

Which of the following statements made by a nurse reflects a lack of understanding regarding a DNR (do not resuscitate) order? 1. "All family members need to agree before a DNR order can be written." 2. "All terminally ill clients are ultimately required to be declared a DNR status." 3. "The DNR order on the terminally ill client in Room 45 needs reviewed today." 4. "If the client's family can't be located the physician will write the DNR order."

ANS: 1 If there is no living will or durable power of attorney appointed, members of the family will be consulted regarding a DNR order. Although not all family members need to agree, an order will usually not be written if some family members express strong opposition to the status change. DNR orders are not necessarily maintained throughout the client's stay because a client's condition may warrant a change in DNR status. To ensure client safety, the attending physician must review the DNR orders every 3 days for hospitalized clients or every 60 days for clients in residential health facilities. If no family can be located, the attending physician has the legal right to write the order. There is no legal requirement for a terminally ill client to be required to assume DNR status.

In the emergency department a client feels that she has been waiting longer than the other individuals due to the fact that she has no insurance. The ethical principle that is involved in this exact situation is: 1. Justice 2. Autonomy 3. Beneficence 4. Nonmaleficence

ANS: 1 Justice refers to treating people fairly. Allocation of resources and access to health care involves the ethical principle of justice. The client without medical insurance should not have to wait longer to receive health care than those with insurance. Autonomy refers to a person's independence. Autonomy represents an agreement to respect another's right to determine a course of action. Beneficence refers to taking positive actions to help others. Nonmaleficence refers to the avoidance of harm or hurt.

What standard of care applies to the student nurse's conduct when providing care normally performed by a registered nurse (RN)? 1. The same standard of care as an RN 2. A standard of care of an unlicensed person 3. No special standard of care because her faculty member is responsible for her conduct 4. A standard similar to but not the same as the staff nurse with whom she is assigned to work

ANS: 1 Student nurses are expected to perform as professional nurses (i.e., as an RN would in providing safe client care). Students are not working in the same capacity as an unlicensed person, and therefore are not compared to the standard of an unlicensed person. No special standard of care because her faculty member is responsible for her conduct is not a true statement. Staff nurses may serve as preceptors, but that does not excuse the student from performing at the level of an RN. If a client is harmed as a direct result of a nursing student's actions or lack of action, the liability for the incorrect action is generally shared by the student, instructor, hospital or health care facility, and university or educational institution

The nurse is showing respect for a client's right to autonomy regarding an invasive procedure by: 1. Obtaining consent for the procedure 2. Performing the procedure appropriately 3. Providing client education regarding the procedure 4. Being frank when discussing the pros and cons of the procedure

ANS: 1 The signed consent ensures that the nurse obtained the client's permission before proceeding with the procedure. The remaining options are examples of nonmaleficence, client right to be informed, and veracity.

A secondary school teacher with advanced multiple sclerosis insists on teaching from a wheelchair and being treated the same as other colleagues. The teacher is demonstrating which of the following? 1. Prizing her choice 2. Choosing from alternatives 3. Considering all consequences 4. Acting with a pattern of consistency

ANS: 1 The teacher is demonstrating prizing her choice. She cherishes her choice of being treated like everyone else despite her medical condition and publicly affirms the choice by teaching from a wheelchair and insisting she be treated the same as her colleagues. At this point, the teacher is not choosing from alternatives. She could have chosen to quit teaching, but she did not. She has already made her choice. The teacher is not demonstrating considering all consequences. She has already made her choice. At this point, the teacher is not demonstrating acting with a pattern of consistency. She is not repeating a behavior.

A nurse's use of ethical responsibility can best be seen in which of the following nursing actions? 1. Delivery of competent care 2. Formation of interpersonal relationships 3. Correct application of the nursing process 4. Evaluation of new computerized technologies

ANS: 1 The term responsibility refers to the characteristics of reliability and dependability. In professional nursing, responsibility includes a duty to perform actions well and thoughtfully. When the nurse provides competent care, the nurse is demonstrating ethical responsibility. Formation of interpersonal relationships is not an ethical responsibility. Application of the nursing process is not an ethical responsibility. Evaluation of new computerized technologies is not an ethical responsibility.

Which of the following statements is true regarding the implications of the nurse's signature as a witness for a client's consent? (Select all that apply.) 1. Client signed voluntarily. 2. The signature is authentic. 3. Client appears to be competent. 4. Client appears knowledgeable about the procedure. 5. The nurse has discussed the possible risks of the procedure. 6. The nurse has discussed possible post procedure nursing care.

ANS: 1, 2, 3, 4 The nurse's signature witnessing the consent means that the client voluntarily gave consent, that the client's signature is authentic, and that the client appears to be competent to give consent. When nurses provide consent forms for clients to sign, nurses must ask the clients if they understand the procedure for which they are giving consent. If clients deny understanding or you suspect they do not understand, notify the physician or nursing supervisor. Nursing care post procedure should be discussed but is not inferred by a nurse's signature as a witness. Discussing possible risk factors is the physician's responsibility.

Although the American Nurses Association's (ANA's) code of ethics is reviewed and revised regularly to reflect changes in nursing practice, the basic principles that remain constant are: (Select all that apply) 1. Advocacy 2. Reliability 3. Responsibility 4. Accountability 5. Confidentiality 6. Professionalism

ANS: 1, 3, 4, 5 The American Nurses Association (ANA) established the first code of nursing ethics decades ago. The ANA reviews and revises the Code regularly to reflect changes in practice. Basic principles remain constant; however, responsibility, accountability, advocacy, and confidentiality. Although admirable, the remaining options are not considered core principles of the code.

The nurse is working with the client and trying to clarify the client's values regarding his care. Which of the following statements reflects an example of the type of response a nurse should use in a values clarification situation? 1. "Your questions were pretty blunt." 2. "Tell me what you're thinking right now." 3. "I've felt that way before. I'd be upset, too." 4. "You seem concerned about your tests. Let me explain them."

ANS: 2 "Tell me what you're thinking right now" is correct. Values clarification is a process of self-discovery in which the nurse should assist the client. The goal of values clarification with a client is effective nurse-client communication. As the client becomes more willing to express problems and feelings, the nurse can better establish an individualized plan of care. The character of a nurse's response to a client can motivate the client to examine personal thoughts and actions. When the nurse makes a clarifying response, it should be brief and nonjudgmental. "Your questions were pretty blunt" is incorrect. Values clarification is a process of self-discovery in which the nurse should assist the client. The character of a nurse's response to a client can motivate the client to examine personal thoughts and actions. When the nurse makes a clarifying response, it should be brief and nonjudgmental. The client is being judgmental in this response. "I've felt that way before. I'd be upset, too" is incorrect as well. The nurse should not influence the client with his or her own values, even if they are similar. "You seem concerned about your tests. Let me explain them" is also incorrect. This statement is therapeutic in that it is reflective of a client's feeling, and offers information. However, it does not encourage the client to examine their values.

A physician asks a family nurse practitioner to prescribe a medication that the nurse practitioner knows is incompatible with the current medication regimen. If the nurse practitioner follows the physician's desire, which of the following is the most correct answer? 1. Good Samaritan laws will protect the nurse. 2. The nurse practitioner will be liable for the action. 3. This type of situation is why nurse practitioners should have malpractice insurance. 4. If the nurse practitioner has developed a good relationship with the client, there will probably not be a problem

ANS: 2 A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client. Good Samaritan laws will not protect the nurse in this situation. Good Samaritan laws are for providing care at the scene of an accident. The nurse should refuse to administer the medication when he or she knows it is wrong. Having malpractice insurance is not the answer, as it does not protect the client from harm. The nurse practitioner should refuse administering the medication. Developing a good relationship with the client is important, but will not protect the nurse from legal liability for providing incompetent care.

The belief that all life is sacred and must be preserved regardless of the quality of that life is an example of: 1. Cultural bias 2. Personal value 3. Universal truth 4. Individual preference

ANS: 2 A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. A cultural bias refers to interpreting and judging phenomena in terms particular to one's own culture while a universal truth is so overwhelmingly true that all mankind respects and acknowledges the validity of the statement. An individual preference is a personal choice

A client is told by his nurse that he has to take the medications, including an injection. The client refuses the medications, but continues to have them administered by the nurse. This action is an example of the intentional tort of: 1. Assault 2. Battery 3. Malpractice 4. Invasion of privacy

ANS: 2 Battery is any intentional touching without consent. An example of battery is a nurse who gives a medication after the client has refused. Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary. Malpractice is negligence committed by a professional such as a nurse or physician. This case is not an example of malpractice. Invasion of privacy is where the client has unwanted intrusion into his or her private affairs. This case is not an example of invasion of privacy.

At an accident scene a nurse stopped and began to provide emergency care for the victims. Her actions are best labeled ethically as: 1. Triage 2. Beneficence 3. Nonmaleficence 4. Respect for persons

ANS: 2 Beneficence refers to taking positive actions to help others, as in providing emergency care at an accident scene. Triage is the screening and classification of casualties to make optimal use of treatment resources and to maximize the survival and welfare of clients. Nonmaleficence is the avoidance of harm or hurt. Respect for persons has to do with treating people equally despite their social standing, for example.

A nurse stealing narcotics from an acute care nursing unit is guilty of a: 1. Civil offense 2. Criminal offense 3. Common law offense 4. Administrative law offense

ANS: 2 Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment). A felony is a crime of a serious nature that has a penalty of imprisonment for greater than 1 year or even death. A misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year. An example of criminal conduct for nurses is misuse of a controlled substance. Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Common law is created by judicial decisions made in courts when individual legal cases are decided (i.e., informed consent). Administrative law is created by administrative bodies, such as state boards of nursing, when they pass rules and regulations.2

The nurse is heard stating to another staff member that, "the client in Room 54 is such a whiner; you would think she was dying." This nurse is liable of: 1. Libel 2. Slander 3. Malpractice 4. Invasion of privacy

ANS: 2 Defamation of character is the publication of false statements either verbally or in writing that result in damage to a person's reputation. Slander occurs when one verbalizes the false statement. Libel is the written defamation of character, whereas invasion of privacy occurs when the client has unwanted intrusion into his or her private affairs. Malpractice is negligence committed by a professional such as a nurse or physician. Nursing malpractice results when care falls below the standard of care.

Abandoning a client would be an example of a nurse's failure to professionally display: 1. Justice 2. Fidelity 3. Beneficence 4. Nonmaleficence

ANS: 2 Fidelity refers to the agreement to keep promises. A commitment to fidelity supports the reluctance to abandon clients. The remaining options refer to fairness, kindness, and doing no harm.

Which of the following nursing actions best reflects a nurse's commitment to the ethical principle of fostering autonomy regarding an older client living in an extended care facility? 1. Providing options regarding the furniture arrangement of the client's room 2. Supporting a client's decision to adopt a DNR (do not resuscitate) status 3. Allowing sufficient time for the client to independently accomplish morning hygiene 4. Consulting the client regarding personal preferences regarding treatment options

ANS: 2 Following the ethical principle of autonomy, the nurse facilitates a client's decision- making process in order to make their own decisions regarding all aspects of life, including their care, and then supports those decisions. The most important and possibly controversial decision is that of DNR status and thus shows the greatest commitment on the nurse's part.

A nurse who is working with clients who have DNR (do not resuscitate) orders knows that these orders: 1. Are legally required for terminally ill clients 2. May be written by the physician without client consent if resuscitation is futile 3. Are maintained throughout the client's stay in either an acute care or a long-term care facility 4. Follow nationally consistent standards for implementation of client interventions

ANS: 2 If the client is unable, and there is no surrogate available to give consent, the DNR order can be written but only if the physician is reasonably medically certain that the resuscitation would be futile. A DNR order is not legally required for terminally ill patients.. DNR orders are not necessarily maintained throughout the client's stay because a client's condition may warrant a change in DNR status. The attending physician must review the DNR orders every 3 days for hospitalized clients or every 60 days for clients in residential health facilities. There is no nationally consistent standard for DNR implementation. States have their own statutes regarding DNR orders.

An unconscious client with a head injury needs surgery to live. His wife only speaks French, and the health care providers are having a difficult time explaining his condition. Which of the following is the most correct answer regarding this situation? 1. An institutional review board needs to be contacted to give their emergency advice on the situation. 2. The health care team should continue with the surgery after providing information in the best manner possible. 3. A friend of the family could act as an interpreter, but the explanation could not provide details of the client's accident, because of confidentiality laws. 4. Two licensed health care personnel should witness and sign the preoperative consent indicating they heard an explanation of the procedure given in English.

ANS: 2 In emergency situations, if it is impossible to obtain consent from the client or an authorized person, the procedure required to benefit the client or save a life may be undertaken without liability for failure to obtain consent. In such cases, the law assumes that the client would wish to be treated. In an emergency, it is not necessary to contact the institutional review board. In doing so, it would take up valuable time. A family member or acquaintance that is able to speak a client's language should not be used to interpret health information. An official interpreter must be available to explain the terms of consent (except in an emergency situation). Telephone consents usually require two witnesses. This is not the case in this situation.

A nurse is being asked to move from the eye unit to a general surgery floor where she in inexperienced in this specialty due to an influenza epidemic among the nursing staff. She is aware of her inexperience. The nurse's initial recourse is to: 1. Fill out a report noting her dissatisfaction 2. Ask to work with another general surgery nurse 3. Notify the State Board of Nursing of the problem 4. Politely refuse to move, take a leave-of-absence day, and go home

ANS: 2 Nurses who float should inform the supervisor of any lack of experience in caring for the type of clients on the nursing unit. They should also request and be given orientation to the unit. Asking to work with another general surgery nurse would be an appropriate action. A nurse can make a written protest to nursing administrators, but it should not be the nurse's initial recourse. Notifying the state board of nursing should not be the nurse's initial recourse. The nurse should first notify the supervisor and request appropriate orientation and training. If problems continue, the nurse should attempt the usual chain of command within the institution before contacting the state board of nursing. A nurse who refuses to accept an assignment may be considered insubordinate, and clients will not benefit from having less staff available

An older client is experiencing the greatest problem with the concept of autonomy when he has difficulty: 1. Expressing his need for pain medication 2. Disagreeing with his health care provider 3. Participating in discussions regarding his treatment 4. Discussing his need for assistive living arrangements

ANS: 2 Older people are usually not as familiar with the concept of autonomy as people from younger generations. As a result, older adults are sometimes uncomfortable disagreeing with doctors or nurses. They view assertiveness as a violation of trust. The remaining options reflect autonomy problems but management of personal health issues is the most important issue.

Regarding hours worked and frequency of errors, recent research has shown that nurses working more than 12.5 hours per shift and more than a 40-hour week are: 1. Reporting more physical illnesses than those working only 40 hours per week 2. Three times more likely to commit an error in nursing judgment related to client care 3. Experiencing more physical injuries than those working only 40 hours per week 4. Experiencing signs of emotional 'burn out' more frequently than those working only 40 hours per week

ANS: 2 Results showed that nurses who worked shifts lasting 12.5 hours or more had a three times greater likelihood of making an error. Overtime increased the odds of making at least one error regardless of length of original shift scheduled. The remaining options are not supported by research data.

The nurse has successfully completed a distance learning class on ECG (electrocardiogram) interpretation. This is an example of the nurse exhibiting the professional principle of: 1. Advocacy 2. Responsibility 3. Accountability 4. Confidentiality

ANS: 2 The word responsibility refers to a willingness to respect obligations and to follow through on promises. The nurse has a responsibility to remain competent to practice so that he or she is able to reliably follow through on responsibilities. The remaining options are reflective of other professional principles.

The nursing professional code of ethics is best defined as: 1. The criteria for judging nursing professionalism 2. A benchmark for professional nursing deeds and actions 3. The nursing profession's expectations of its members' behavior 4. A document that holds nurses responsible for professional behavior

ANS: 3 It is a collective statement about the group's expectations and standards of behavior. The remaining options are not accurate or complete descriptions of the nursing professional code of ethics.

The nurse recognizes that values clarification interventions are beneficial for the client when: 1. The client and nurse have different beliefs 2. The client is experiencing a values conflict 3. The nurse is unsure of a client's personal values 4. The client has chosen to reject the normal values

ANS: 2 Values clarification can help clients gain an awareness of personal priorities, identify ambiguities in values, and resolve major conflicts between values and behavior. Values clarification for nurses can help nurses strengthen their ability to advocate for a client because nurses are better able to identify personal values and accurately identify the values of the client. Values clarification is not necessarily beneficial for the client when the client and nurse have different beliefs. Values clarification for the client will not necessarily help the nurse who is unsure of the client's values. Values clarification interventions for the client will help the client, not the nurse, gain awareness. The values that an individual holds reflect cultural and social influences, relationships, and personal needs. Values vary among people and develop and change over time. Therefore it may be inappropriate to state a client has rejected "normal" values when value systems vary among people. What is considered normal to one person may not be to another.

When documenting notification of the primary health care provider concerning a client whose condition is deteriorating, the nurse must be sure to include which of the following? (Select all that apply.) 1. Client's wife at bedside. 2. Client rating pain at 3 out of 10 at 0920. 3. Client asking to have wife called to come to hospital. 4. Dr. Smith notified of client's pain rating of 8 out of 10 at 0900. 5. Client administered 2 mg morphine sulfate IV every 5 minutes for two doses. 6. Client ordered morphine sulfate 2 mg IV every 5 minutes until pain relief is

ANS: 2, 4, 5, 6 The nurse must be certain to document that the physician was notified and his or her response, nursing action in follow-up of orders, and the client's response. The remaining options are not relevant to the proper documentation of the situation.

Which of the following elements are essential among a group working towards the successful resolution of a conflict of opinion? (Select all that apply.) 1. Similar value systems 2. Presumption of good will 3. Similar cultural background 4. Client-centered decision making 5. Strict adherence to confidentiality 6. Participation of all involved parties

ANS: 2, 4, 5, 6 The resolution of conflicting opinions works best when the following elements are part of the process: the presumption of good will on the part of all participants, strict adherence to confidentiality, client-centered decision making, and the welcome participation of families and primary caregivers. The remaining options represent group characteristics that usually minimize conflict in decision making

Which of the following statements reflects application of the specific ethical principle of confidentiality? 1. "I'm concerned that funding may affect the outpatient program." 2. "I'm going to make sure that the client understands the instructions." 3. "I cannot share that information with you about the client's condition." 4. "I need to get more information about the client's personal health history."

ANS: 3 "I cannot share that information with you about the client's condition" reflects the application of the ethical principle of confidentiality. Information is not to be shared with others without specific client consent. "I'm concerned that funding may affect the outpatient program" reflects a concern regarding allocation of resources. It is not a confidentiality issue. The nurse who makes sure a client has gained understanding is being ethically responsible. "I need to get more information about the client's personal health history" reflects data gathering. Information gathered is to be used for the purpose of providing competent health care. It should not be shared with others without specific consent of the client.

Which of the following statements best illustrates the deontological ethical theory? 1. "I believe this disease was allowed by a supreme being." 2. "He has become a stronger individual through experiencing the loss of his father." 3. "Under no circumstances would it ever be right for a person to stop CPR efforts." 4. "The chemotherapy did not cure this person, but it provided a better life for him."

ANS: 3 "Under no circumstances would it ever be right for a person to stop CPR efforts" is correct. Deontology defines actions as right or wrong based on their right-making characteristics, such as fidelity to promises, truthfulness, and justice. Deontology does not look at consequences of actions to determine rightness or wrongness. Fidelity to promises and beneficence may be principles upon which this statement is based on determining wrongness. "I believe this disease was allowed by a supreme being" does not reflect the deontological ethical theory. Because it reflects a relationship between disease and a supreme being, it follows the feminist ethical theory. "He has become a stronger individual through experiencing the loss of his father" does not best illustrate the deontological ethical theory because it is citing a consequence. It follows the utilitarian ethical theory. "The chemotherapy did not cure this person, but it provided a better life for him" does not best illustrate the deontological ethical theory because it is citing a consequence. It follows the utilitarian ethical theory.

On admission to the hospital, a terminal cancer patient says he has a living will. This document functions to state the client's desire to: 1. Receive all technical assistance to prolong his life 2. Have his wife make the decisions regarding his care 3. Be allowed to die without life-prolonging techniques 4. Have a lethal injection administered to relieve his suffering

ANS: 3 A living will is an advance directive, prepared when the individual is competent and able to make decisions, regarding that person's specific instructions about end-of-life care. Living wills allow people to specify whether they would want to be intubated, treated with pressor drugs, shocked with electricity, and fed or hydrated intravenously. A living will specifies what interventions the client does not want, so that his or her life will not be prolonged. If his wife has power of attorney she would be able to make decisions regarding the client's care. Assisted suicide, such as a lethal injection, is not a function of a living will. A living will defines a client's wishes for withholding treatment that would prolong his or her life.

Which nursing observation of the patient in intensive care indicates the patient is sleeping comfortably during NREM sleep? a. Eyes closed, lying quietly, respirations 12, heart rate 60 b. Eyes closed, tossing in bed, respirations 18, heart rate 80 c. Eyes closed, mumbling to self, respirations 16, heart rate 68 d. Eyes closed, lying supine in bed, respirations 22, heart rate 66

ANS: A During NREM sleep, biological functions slow. During sleep, the heart rate decreases to 60 beats/min or less. The patient experiences decreased respirations, blood pressure, and muscle tone. Heart rates above 60 are too high and respirations of 22 are too high to indicate comfortable NREM sleep.

The nurse is having difficulty reading the prescribed dosage on a handwritten order for a pain medication. The most appropriate action to ensure the client's safety and to minimize legal issues is for the nurse to: 1. Ask another RN to confirm the order 2. Request the pharmacist to interpret the order 3. Call the health care provider to clarify the order 4. Consult a current drug book to determine the normal dosage range

ANS: 3 A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client. The nurse should clarify the order with the prescriber if unable to read the order. Although asking others to interpret the order may appear prudent, it is ultimately the nurse's responsibility if a medication error is made. Although the drug book may provide a normal range it does not aid in determining definitively what the order intended

The nurse is explaining the rationale for seeking the family's permission to apply a physical restraint to a combative client. This is an example of the nurse exhibiting the professional principle of: 1. Advocacy 2. Responsibility 3. Accountability 4. Confidentiality

ANS: 3 Accountability refers to the ability to answer for one's own actions. Nurses should ensure that their professional actions are explainable to their clients and to their employer. The remaining options are reflective of other professional principles

Which one of the following actions is an example of an unintentional tort? 1. Restraining a client who refuses care 2. Taking photos of a client's surgical wounds 3. Leaving the side rails down and the client falls and is injured 4. Talking about a client's history of sexually transmitted diseases

ANS: 3 An unintentional tort is an unintended wrongful act against another person that produces injury or harm. An example of an unintentional tort would be leaving the side rails down and the client falls and is injured. Restraining a client who refuses care would be an example of assault and battery. Taking photos of a client's surgical wounds without the client's permission is an example of invasion of privacy. Talking about a client's history of sexually transmitted diseases would fall under the category of invasion of privacy. Personal information should be kept confidential.

The nurse holds a client's hand during a painful procedure. This action shows a positive act towards the client that is referred to as: 1. Veracity 2. Fidelity 3. Beneficence 4. Nonmaleficence

ANS: 3 Beneficence refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest. The remaining options reflect truthfulness, keeping true to a promise, and doing no harm.

Which of the following statements made by a nurse reflects the best understanding of the legal safeguards of a DNR (do not resuscitate) order? 1. "All family members need to agree before a DNR order can be written." 2. "All terminally ill clients are ultimately required to be declared a DNR status." 3. "The DNR order on the terminally ill client in Room 45 needs reviewed today." 4. "If the client's family can't be located, the physician will write the DNR order."

ANS: 3 DNR orders are not necessarily maintained throughout the client's stay because a client's condition may warrant a change in DNR status. To ensure client safety, the attending physician must review the DNR orders every 3 days for hospitalized clients or every 60 days for clients in residential health facilities. If there is no living will or durable power of attorney appointed, members of the family will be consulted regarding a DNR order. Although not all family members need to agree, an order will usually not be written if some family members express strong opposition to the status change. If no family can be located, the attending physician has the legal right to write the order. There is no legal requirement for a terminally ill client to be required to assume DNR status.

The nurse is aware that an ethics committee in a health care facility serves to: 1. Interview all persons involved in a case 2. Illustrate circumstances that demonstrate malpractice 3. Serve as a resource for specific situations that may occur 4. Examine similar previous instances for comparison of outcome decisions

ANS: 3 Ethics committees serve as a resource to support the processing of ethical dilemmas. Ethics committees serve several purposes: education, policy recommendation, and case consultation or review. Although an ethics committee may gather further information, ethics committees do not interview all persons involved in a case. Rather, they offer consultation or case review. Illustrating circumstances that demonstrate malpractice is not a purpose of an ethics committee. Examining similar previous instances for comparison of outcome decisions may be part of data gathering to help process an ethical dilemma or for policy recommendation, but it is not the purpose of an ethics committee.

The legal basis for a nurse to provide emergency treatment without consent to a client incapable of informed consent is: 1. Such care is clearly a nursing responsibility 2. To fail to provide such care is nursing negligence 3. It is presumed that the client would want the emergency treatment 4. Health care providers have an obligation to provide emergency treatment

ANS: 3 In emergency situations, if it is impossible to obtain consent from the client or an authorized person, the law assumes that the client would wish to be treated. Providing appropriate nursing care is a nursing responsibility, and failure to do so is negligence.

A client has actively picketed for gun control. During a robbery of his business, he was shot in the leg. As the nurse assists him with morning care, which statement would the nurse expect him to make that coincides with his values? 1. "Firearms may have a place in our society." 2. "Individuals should arm themselves for protection." 3. "Prosecution should be the maximum for that felon." 4. "Protection is a necessary evil for the good guy of the world."

ANS: 3 Individual experience influences what we come to value. The client who experienced a gunshot during a robbery of his business may value gun control and verbalize a desire to have his attacker prosecuted for the violent crime. The client who has picketed for gun control and who was gunshot is unlikely to value firearms in our society. The individual who has actively picketed for gun control is unlikely to desire the use of guns. The individual would be more likely to believe that if there were gun control, there would be no need for guns. The individual who has actively picketed for gun control is unlikely to desire the use of guns. The individual would be more likely to believe that if there were gun control, there would be no need for guns.

Which of the following is the most important factor in a nurse deciding whether or not to carry malpractice insurance? 1. The nurse's knowledge level of Good Samaritan laws 2. The amount of malpractice insurance provided by the nurse's employer 3. The time frames and individual liability of the employer's malpractice coverage 4. The evaluation of whether the nurse works in a critical area of nursing where clients have higher morbidity and mortality rates

ANS: 3 It would be important to know the time frames of the employer's malpractice coverage. In other words, is the nurse only covered during the times he or she is working within the institution? It would be important to know the individual liability. For example, if sued, what financial responsibility would the nurse have? The nurse should be aware of Good Samaritan laws, but this would not be sufficient coverage for most nursing practice. Therefore it is not the most importance factor in determining whether to purchase private malpractice insurance. The amount of malpractice insurance provided by the employer is not the most important factor in deciding whether to carry private insurance. Generally, the employer's malpractice insurance coverage is much greater than private insurance coverage. The area of nursing in which the nurse is employed is not the most important factor in deciding whether or not to carry malpractice insurance. Lawsuits can occur anywhere

Which of the following statements made by a nursing student regarding responsibility for provided care requires immediate follow-up by the nursing instructor? 1. "I'm not held to the same standards as a licensed RN." 2. "I am required to provide the safest, appropriate care I am capable of." 3. "My clinical instructor is ultimately responsible for the care I provide." 4. "No one expects nursing students to provide care on the level as an experienced RN."

ANS: 3 Student nurses are expected to perform as professional nurses, that is, as an RN would in providing safe, appropriate client care. The clinical instructor is responsible for proper instruction, supervision, and guidance but the student is responsible for their own acts. The remaining options do reflect misconceptions, but the issue of responsibility has priority.

Which of the following statements made by a nurse shows the best understanding regarding the requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 2003? 1. "I'm always careful to close the door when taping or listening to the unit's shift report." 2. "The nursing assistants know to hand me the vital signs sheet and not just put it on the medication cart." 3. "I called the radiology department to tell them I would be faxing the client information they requested." 4. "The client's niece called to see how she slept last night, but I told her I couldn't share that with her over the phone."

ANS: 3 The Health Insurance Portability and Accountability Act (HIPAA) requires all hospitals and health care agencies to have specific policies and procedures in place to ensure that there are reasonable safeguards to protect written and verbal communications about clients. By notifying the receiver of an impending client-oriented fax, the nurse has taken a reasonable measures to ensure it is seen by only the appropriate individuals. Although the remaining options deal with safeguards, the potential for a breech in client confidentiality is not as great in those scenarios.

A nurse is ambivalent as to the need to vigorously suction the secretions of a terminal client in a comatose state. Which of the following is an appropriate statement by the nurse in regard to processing an ethical dilemma? 1. "I just feel like I should not suction this client." 2. "I need to know the legalities of the living will of this client." 3. "I cannot figure out what's right in this situation. I need to collect more data." 4. "My spiritual beliefs mandate that I continue to provide all the interventions in my scope of practice."

ANS: 3 The first step in processing an ethical dilemma is determining whether the problem is an ethical one. The nurse who cannot figure out what is right, is stating a characteristic of an ethical dilemma, which is that the problem is perplexing. The next step is to gather as much information as possible that is relevant to the case. "I just feel like I should not suction this client" is the nurse is stating the problem according to her feelings. "I need to know the legalities of the living will of this client" is the nurse who wants to know the legalities of the living will of a client is collecting some, but not all, data pertaining to the problem. "My spiritual beliefs mandate that I continue to provide all the interventions in my scope of practice" is the nurse stating her own beliefs.

Which of the following nursing statements reflects the best understanding of the importance of appropriate nursing documentation regarding risk management? 1. "If the client isn't compliant, I'm sure to put that in my notes." 2. "I'm always careful to document any changes in the client's condition." 3. "My notes are the proof that I provided the client with effective, appropriate care." 4. "When there is a lawsuit, the nursing notes are the first thing the attorney looks at."

ANS: 3 The nurse's documentation is often the evidence of care received by a client and serves as proof that the nurse acted reasonably and safely. The remaining options are not incorrect but do not identify the primary importance to the nurse.

When a nurse signs as a witness on an informed consent form, she is indicating that the client: 1. Fully understands the procedure 2. Agrees with the procedure to be done 3. Has voluntarily signed the consent form 4. Has authorized the physician to continue with the treatment

ANS: 3 The nurse's signature witnessing the consent means that the client voluntarily gave consent, that the client's signature is authentic, and that the client appears to be competent to give consent. It is the physician's responsibility to make sure the client fully understands the procedure. If the nurse suspects the client does not understand, the nurse should notify the physician. The nurse's signature does not indicate that the client agrees with the procedure, but that the client has voluntarily given consent and is competent to do so. Clients also have the right to refuse treatment, which is also signed and witnessed. The nurse's signature does not verify that the client has authorized the physician to continue with treatment. It only verifies that the consent was given voluntarily, the client is competent to give consent, and the signature is authentic.

Which of the following statements reflects a nurse's need for further instructions regarding an incident report? 1. "I hope this incident report will help determine a way to help prevent falls." 2. "Risk management will want to review the incident report on the client's fall." 3. "I put the incident report on the client's fall in his chart as soon as I was finished." 4. "I need to review the guidelines before I fill out this incident report regarding the client's fall."

ANS: 3 The report is confidential and separate from the medical record. The remaining options reflect an understanding about incident reports.

Which of the following statements related to confidentiality made by a nurse requires immediate follow-up by the nurse manager? 1. "I believe the client is eligible for both Medicare and Medicaid." 2. "The client with pneumonia has tested positive for TB (tuberculosis)." 3. "Did you know that the client in Room 45 has a daughter who has type 1 diabetes mellitus?" 4. "I arranged for the client's information to be faxed to the assistive living facility she will be transferred to."

ANS: 3 This information is private and the nurse is violating the client's right to confidentiality because the information has no bearing on the care needs of the client. The remaining options are not reflective of an ethical breech because the exchange of that information has a direct bearing on the client's care.

A client who is recently diagnosed with cancer is encouraged to consider sharing the information with her family so they can support her through the decisions she will need to make regarding her care. The nurse is using the principle of: 1. Confidentiality 2. Fidelity 3. Veracity 4. Justice

ANS: 3 Veracity in general means accuracy or conformity to truth. The nurse is encouraging the client to be truthful with the client's family. Confidentiality means to not impart private matters. Fidelity refers to the agreement to keep promises. Justice refers to fairness.

Which of the following statements made by a terminally ill client reflects the best understanding of the purpose of a living will? 1. "It will make sure my wishes are respected." 2. "My family won't be burdened with making those hard decisions." 3. "I don't want strangers making those kinds of decisions for me." 4. "I can make my wishes known while I still have the ability to express them."

ANS: 4 A living will is an advance directive, prepared when the individual is competent and able to make and communicate personal decisions, regarding specific instructions about end- of-life care. The remaining options represent motivation for implementing a living will.

A registered nurse interprets a scribbled medication order by the attending physician as 25 mg. The nurse administers 25 mg of the medication to a client, and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who would ultimately be responsible for the error? 1. Attending physician 2. Assisting resident 3. Pharmacist 4. Nurse

ANS: 4 A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client. The nurse should clarify the order with the physician if unable to read the order. The attending physician could be included in a lawsuit, but it would be the nurse who is ultimately responsible for the error. The assisting resident would not be ultimately responsible for the error. The assisting resident did not carry out an inaccurate order. The pharmacist could be included in a lawsuit, but it would be the nurse who is ultimately responsible for the error because the nurse was the individual who carried out an inaccurate order.

A nursing student that immediately informs her clinical instructor after she realizes that she has administered the wrong dose of medication to a patient is best described professionally as: 1. Confident 2. Trustworthy 3. Compliant 4. Accountable

ANS: 4 Accountability refers to the ability to answer for one's own actions. The goal is the prevention of injury to the client. The student nurse who informs her instructor of an error is being accountable for her actions and has a goal to prevent injury to the client. The student nurse would not be described professionally as confident (i.e., sure of oneself). The student is not best described as trustworthy. To be trustworthy, one is worthy of trust or confidence and reliable. In this case, the student was not reliable to administer medication correctly. This student nurse is not best described professionally as compliant. The student is not acting in accordance with wishes, commands, or requirements.

The case of a nurse accused of unethical nursing conduct will be heard by the state board of nursing. This is an example of: 1. Civil law 2. Criminal law 3. Common law 4. Administrative law

ANS: 4 Administrative law is created by administrative bodies, such as state boards of nursing when they pass rules and regulations such as unethical nursing conduct. Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment). Common law is created by judicial decisions made in courts when individual legal cases are decided.

Although a nurse may not agree, the nurse recognizes that a terminally ill client has the legal right to: 1. Seek passive euthanasia in some states 2. Sign an organ donor pledge statement 3. Refuse DNR (do not resuscitate) status 4. Refuse treatment in the form of food and water

ANS: 4 Competent clients have the right to refuse treatment. This includes life-saving hydration and nutrition. Physician-assisted suicide is legal in the state of Oregon, and it is legally a client's decision to declare a DNR status or to sign an organ donor card.

Regarding the nurse's use of the specific ethical principle of autonomy in a client situation, an example would be: 1. Learning to do a procedure safely and effectively 2. Returning to speak to a client at an agreed upon time 3. Preparing the client's room for comfort and privacy 4. Supporting a client's right to refuse a specific type of therapy

ANS: 4 Following the ethical principle of autonomy, the nurse allows a client to make his or her own decisions regarding care and then supports that decision. Learning how to perform a procedure safely and effectively is a nurse's use of ethical responsibility. Returning to speak to a client at an agreed upon time demonstrates the ethical principle of fidelity. Preparing the client's room for comfort and privacy is a nurse's use of ethical responsibility.

When a nurse considers the possible positive effect a treatment will have against the pain it may cause the client, the nurse is displaying: 1. Justice 2. Fidelity 3. Beneficence 4. Nonmaleficence

ANS: 4 Nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good but also the equal commitment to do no harm. The remaining options refer to fairness, truthfulness, and kindness.

The nurse is discussing lack of sleep with a middle-aged adult. Which area should the nurse most likely assess to determine a possible cause of the lack of sleep? a. Anxiety b. Loud teenagers c. Caring for pets d. Late night television

ANS: A During middle adulthood, the total time spent sleeping at night begins to decline. Anxiety, depression, and certain physical illnesses can affect sleep, and women can experience menopausal symptoms. Insomnia is common because of the changes and stresses associated with middle age. Teenagers, caring for pets, and late night television can influence the amount of sleep; however, these are not the most common causes of insomnia in this age group.

Which of the following statements best reflects the nurse's ethical concern for nonmaleficence regarding the client's treatment plan? 1. "The radiation therapy has not substantially decreased the client's tumor related pain." 2. "The client expressed the idea that this treatment was definitively going to cure her cancer: 3. "The client's family requested that she not be informed of the seriousness of her cardiac condition." 4. "The procedure is quite invasive, and there is little chance that it will improve the client's quality of life."

ANS: 4 Nonmaleficence is the avoidance of harm or hurt. Whether the discomforts of treatment are benefiting the client or are worse than the disease itself have to be considered. The health care professional tries to balance the risks and benefits of a plan of care while striving to do the least harm possible. The remaining options are related to veracity (truthfulness), fidelity (keeping a promise), and possibly fairness.

The client has been diagnosed with malignant bone cancer and the treatment involves chemotherapy on an outpatient basis. While treating the cancer the client unfortunately becomes very ill, experiences significant side effects from the therapy, and has a severe reduction in the quality of life. The specific ethical principle that is in question in this situation is: 1. Veracity 2. Fidelity 3. Justice 4. Nonmaleficence

ANS: 4 Nonmaleficence is the avoidance of harm or hurt. Whether the discomforts of treatment are benefiting the client or are worse than the disease itself have to be considered. The health care professional tries to balance the risks and benefits of a plan of care while striving to do the least harm possible. Veracity refers to truthfulness. This situation is not questioning truthfulness. Fidelity refers to the agreement to keep promises. This situation does not question fidelity. Justice refers to fairness. This situation is not a matter of justice.

The newly enacted Health Insurance Portability and Accountability Act (HIPAA) of 2003 requires: 1. Insurance coverage for all clients 2. Policies on how to report communicable diseases 3. Limits on information and damages awarded in court cases 4. Safeguards to protect written and verbal information about clients

ANS: 4 The Health Insurance Portability and Accountability Act (HIPAA) requires all hospitals and health agencies to have specific policies and procedures in place to ensure that there are reasonable safeguards to protect written and verbal communications about clients. HIPAA does not require insurance coverage for all clients. It limits the extent to which health plans may impose preexisting condition limitations and prohibits discrimination in health plans against individual participants and beneficiaries based on health status. HIPAA does not require policies on how to report communicable diseases. It does require safeguards to protect written and verbal information about clients. HIPAA does not require limits on information and damages awarded in court cases.

The nurse understands the implications of the Patient Self-Determination Act. This legislation requires that: 1. Clients designate a power of attorney 2. DNR orders for clients meet standard criteria 3. Organ donation is required upon death, if possible 4. Information be provided to the client regarding rights for refusal of care

ANS: 4 The Patient Self-Determination Act requires health care institutions to provide written information to clients concerning the clients' rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. The Patient Self- Determination Act does not require clients to designate a power of attorney. The Patient Self-Determination Act does not require that DNR orders meet standard criteria. The Patient Self-Determination Act does not require organ donation upon death. It is the client's decision whether he or she wants to participate in organ donation.

The Joint Commission (TJC) sets standards of care, in which an institution is required to have: 1. Limits of professional liability 2. Educational standards for nurses 3. A delineated scope of practice for health professionals 4. Written nursing policies and procedures for client care

ANS: 4 The TJC requires that accredited hospitals have written nursing policies and procedures. Standards of care help define the limits of professional liability. The TJC does not require an institution to have limits of professional liability. Nurse practice acts establish educational requirements for nurses. Nurse practice acts define the scope of nursing practice. The rules and regulations enacted by the state board of nursing define the practice of nursing more specifically. The American Nurses Association has developed standards for nursing practice that delineate the scope, function, and role of the nurse and establish clinical practice standards

Which of the following statements best reflects a nurse's understanding of the proper critical thinking process regarding the need for personal malpractice insurance? 1. "The state's Good Samaritan laws protect me outside of the hospital." 2. "I work in a very low risk area of nursing, so I don't really have a need." 3. "The hospital carries its own malpractice insurance, so I don't need extra." 4. "Lawsuits can occur years after the event, so I carry my own liability insurance."

ANS: 4 The employing institution's insurance only covers nurses while they are working within the scope of their employment. Because nurses are professionals and it is often difficult to separate their private lives from their professional skills, nurses need to consider purchasing individual professional liability insurance, even if the employing institution has coverage. It would be important to know the time frames of the employer's malpractice coverage. The nurse may be only covered during the times he or she is working within the institution. Good Samaritan laws have a narrow scope and would not cover many nursing activities. Although it is true that some areas of nursing have a higher potential for liability claims, all areas have risk. The hospital's insurance may not cover all potential expenses and may not be applicable in all liability situations.

The nurse is completing an assessment on an older-adult patient who is having difficulty falling asleep. Which condition will the nurse further assess for in this patient? a. Depression b. Mild fatigue c. Hypertension d. Hypothyroidism

ANS: A Older adults and other individuals who experience depressive mood problems experience delays in falling asleep, earlier appearance of REM sleep, frequent awakening, feelings of sleeping poorly, and daytime sleepiness. A person who is moderately fatigued usually achieves restful sleep, especially if the fatigue is the result of enjoyable work or exercise. Hypertension often causes early-morning awakening and fatigue. Alcohol speeds the onset of sleep. Hypothyroidism decreases stage 4 sleep.

The nurse is caring for a patient on the medical-surgical unit who is experiencing an exacerbation of asthma. Which intervention will be most appropriate to help this patient sleep? a. Place bed in semi-Fowler's position. b. Offer iron-rich foods for meals. c. Provide a snack before bedtime. d. Encourage the patient to read.

ANS: A Placing the patient in a semi-Fowler's position eases the work of breathing. Respiratory disease often interferes with sleep. Patients with chronic lung disease such as emphysema or asthma are short of breath and frequently cannot sleep without two or three pillows to raise their heads. Iron-rich food may help a patient with restless legs syndrome. Providing a snack and encouraging the patient to read may be good interventions for patients, but the most appropriate would be raising the head of the bed.

The nurse is preparing an older-adult patient's evening medications. Which treatment will the nurse recognize as relatively safe for difficulty sleeping in older adults? a. Ramelteon (Rozerem) b. Benzodiazepine c. Antihistamine d. Kava

ANS: A Ramelteon (Rozerem), a melatonin receptor agonist, is well tolerated and appears to be effective in improving sleep by improving the circadian rhythm and shortening time to sleep onset. It is safe for long- and short-term use particularly in older adults. The use of benzodiazepines in older adults is potentially dangerous because of the tendency of the drugs to remain active in the body for a longer time. As a result, they also cause respiratory depression, next-day sedation, amnesia, rebound insomnia, and impaired motor functioning and coordination, which leads to increased risk of falls. Caution older adults about using over-the-counter antihistamines because their long duration of action can cause confusion, constipation, and urinary retention. Kava promotes sleep in patients with anxiety; it should be used cautiously because of its potential toxic effects on the liver.

Chapter 43: Sleep Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. The nurse is caring for a young-adult patient on the medical-surgical unit. When doing midnight checks, the nurse observes the patient awake, putting a puzzle together. Which information will the nurse consider to best explain this finding? a. The patient misses family and is lonely. b. The patient was waiting to talk with the nurse. c. The patient has been kept up with the noise on the unit. d. The patient's sleep-wake cycle preference is late evening.

ANS: A Sleep involves a sequence of physiological states maintained by the central nervous system. It is associated with changes in the peripheral nervous, endocrine, cardiovascular, respiratory, and muscular systems. A disease process associated with the cranial nerves, urinary pathway, or spinal reflexes may influence a person's ability to sleep, but the best answer is the central nervous system.

The nurse is caring for a patient who has been in holding in the emergency department for 24 hours. The nurse is concerned about the patient's experiencing sleep deprivation. Which action will be best for the nurse to take? a. Expedite the process of obtaining a medical-surgical room for the patient. b. Pull the curtains shut, dim the lights, and decrease the number of visitors. c. Obtain an order for a hypnotic medication to help the patient sleep. d. Ask everyone in the unit to try to be quiet so the patient can sleep.

ANS: A The most effective treatment for sleep deprivation is elimination or correction of factors that disrupt the sleep pattern. Obtaining a private room in the medical-surgical unit for the patient will help with decreasing stimuli and promoting more rest than an individual can obtain in an emergency department even with the interventions mentioned.

The nurse is evaluating outcomes for the patient with insomnia. Which key principle will the nurse consider during this process? a. The patient is the best evaluator of sleep. b. The nurse is the best evaluator of sleep. c. Effective interventions are the best evaluators of sleep. d. Observations of the patient are the best evaluators of sleep.

ANS: A With regard to problems with sleep, the patient is the source for evaluating outcomes. The patient is the only one who knows whether sleep problems have improved and what has been successful. Interventions are not the best indicator; achievement of goals according to the patient is the best. Observations do provide needed data, but in the case of insomnia, the patient is the source for evaluating the restfulness of sleep

The nurse is completing a sleep assessment on a patient. Which tool will the nurse use to complete the assessment? a. Visual analog scale b. Cataplexy scale c. Polysomnogram d. RAS scale

ANS: A The visual analog scale is utilized for assessing sleep quality. Cataplexy, or sudden muscle weakness during intense emotions such as anger, sadness, or laughter, occurs at any time during the day; there is no cataplexy scale for sleep assessment. A polysomnogram involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep; this is used in a sleep laboratory study. Researchers believe that the ascending reticular activating system (RAS) located in the upper brainstem contains special cells that maintain alertness and wakefulness; however, there is no assessment tool called the RAS scale.

The nurse is caring for a patient who has not been able to sleep well while in the hospital, leading to a disrupted sleep-wake cycle. Which assessment findings will the nurse monitor for in this patient? (Select all that apply.) a. Changes in physiological function such as temperature b. Decreased appetite and weight loss c. Anxiety, irritability, and restlessness d. Shortness of breath and chest pain e. Nausea, vomiting, and diarrhea f. Impaired judgment

ANS: A, B, C, F The biological rhythm of sleep frequently becomes synchronized with other body functions. Changes in body temperature correlate with sleep pattern. When the sleep-wake cycle becomes disrupted, changes in physiological function such as temperature can occur. Patients can experience decreased appetite, loss of weight, anxiety, restlessness, irritability, and impaired judgment. Gastrointestinal and respiratory/cardiovascular symptoms such as shortness of breath and chest pain are not symptoms of a disrupted sleep cycle.

The patient and the nurse discuss the need for sleep. After the discussion, the patient is able to state factors that hinder sleep. Which statements indicate the patient has a good understanding of the teaching? (Select all that apply.) a. "Drinking coffee at 7 PM could interrupt my sleep." b. "Staying up late for a party can interrupt sleep patterns." c. "Exercising 2 hours before bedtime can decrease relaxation." d. "Changing the time of day that I eat dinner can disrupt sleep." e. "Worrying about work can disrupt my sleep." f. "Taking an antacid can decrease sleep."

ANS: A, B, D, E Caffeine, alcohol, and nicotine consumed late in the evening produce insomnia. Worry over personal problems or situations frequently disrupts sleep. Alterations in routines, including changing mealtimes and staying up late at night for social activities, can disrupt sleep. Exercising 2 hours before bedtime actually increases a sense of fatigue and promotes relaxation. Taking an antacid does not decrease sleep.

The nurse is caring for a patient in the intensive care unit who is having trouble sleeping. The nurse explains the purpose of sleep and its benefits. Which information will the nurse include in the teaching session? (Select all that apply.) a. NREM sleep contributes to body tissue restoration. b. During NREM sleep, biological functions increase. c. Restful sleep preserves cardiac function. d. Sleep contributes to cognitive restoration. e. REM sleep decreases cortical activity.

ANS: A, C, D Sleep contributes to physiological and psychological restoration. NREM sleep contributes to body tissue restoration. It allows the body to rest and conserve energy. This benefits the cardiac system by allowing the heart to beat fewer times each minute. During stage 4, the body releases growth hormone for renewal and repair of specialized cells such as the brain. During NREM sleep, biological functions slow. REM sleep is necessary for brain tissue restoration and cognitive restoration and is associated with a change in cerebral blood flow and increased cortical activity.

A patient has sleep deprivation. Which statement by the patient will indicate to the nurse that outcomes are being met? a. "I wake up only once a night to go to the bathroom." b. "I feel rested when I wake up in the morning." c. "I go to sleep within 30 minutes of lying down." d. "I only take a 20-minute nap during the day."

ANS: B Being able to sleep and feeling rested would indicate that outcomes are being met for sleep deprivation. Limiting a nap to 20 minutes is an intervention to promote sleep. Going to sleep within 30 minutes indicates a goal for insomnia. Waking up only once may indicate nocturia is improving but does not relate to sleep deprivation

The nurse is having a conversation with an adolescent regarding the need for sleep. The adolescent states that it is common to stay up with friends several nights a week. Which action should the nurse take next? a. Talk with the adolescent's parent about staying up with friends and the need for sleep. b. Discuss with the adolescent sleep needs and the effects of excessive daytime sleepiness. c. Refer the adolescent for counseling about alcohol abuse problems. d. Take no action for this normal occurrence.

ANS: B Discussion regarding adolescent sleep needs should first occur with the adolescent. Although it may be common for this adolescent to want to visit with friends and experience activities that go late into the night, these activities can and do impact the hours of sleep and the physical needs of the adolescent, no matter the reason for the late nights, and they do need to be addressed. The nurse will address the adolescent, not the parents. Addressing alcohol abuse problems is not the next step but may be required later. While staying up late may be a normal occurrence for this adolescent, action is required.

The nurse is beginning a sleep assessment on a patient. Which question will be most appropriate for the nurse to ask initially? a. "What is going on?" b. "How are you sleeping?" c. "Are you taking any medications?" d. "What did you have for dinner last night?"

ANS: B Sleep is a subjective experience. Only the patient is able to report whether or not it is sufficient and restful. Asking patients how they are sleeping is an introductory question. After this beginning question is asked, problems with sleep such as the nature of the problem, signs and symptoms, onset and duration of the issue, severity, predisposing factors, and the effect on the patient can be assessed. What is going on is too broad and open ended for information about sleep to be obtained specifically. Medications and food intake can be part of the detailed assessment of sleep issues.

The nurse is teaching a new mother about the sleep requirements of a neonate. Which comment by the patient indicates a correct understanding of the teaching? a. "I can't wait to get the baby home to play with the brothers and sisters." b. "I will ask my mom to come after the first week, when the baby is more alert." c. "I can get the baby on a sleeping schedule the first week while my mom is here." d. "I won't be able to nap during the day because the baby will be awake."

ANS: B The patient indicates an understanding when asking the mother to come after the first week. The neonate up to the age of 3 months averages about 16 hours of sleep a day, sleeping almost constantly during the first week. The baby will sleep rather than play. The baby will not be on a sleeping schedule the first week home. The mother will be able to nap since the baby sleeps 16 hours a day.

A community health nurse is providing an educational session at the senior center on how to promote sleep. Which practices should the nurse recommend? (Select all that apply.) a. Take a nap in the afternoon. b. Sleep where you sleep best. c. Use sedatives as a last resort. d. Watch television right before sleep. e. Decrease fluids 2 to 4 hours before sleep. f. Get up if unable to fall asleep in 15 to 30 minutes

ANS: B, C, E, F The nurse should instruct the patient to sleep where he or she sleeps best, to use sedatives as a last resort, to decrease fluid intake to cut down on bathroom trips, and, if unable to sleep in 15 to 30 minutes, to get up out of bed. Naps should be eliminated if they are not part of the individual's routine schedule, and if naps are taken, they should be limited to 20 minutes or less a day. Television can stimulate and disrupt sleep patterns.

The patient presents to the clinic with reports of irritability, being sleepy during the day, chronically not being able to fall asleep, and being tired. Which nursing diagnosis will the nurse document in the plan of care? a. Anxiety b. Fatigue c. Insomnia d. Sleep deprivation

ANS: C Insomnia is experienced when the patient has chronic difficulty falling asleep, frequent awakenings from sleep, and/or short sleep or nonrestorative sleep. It is the most common sleep-related complaint and includes symptoms such as irritability, excessive daytime sleepiness, not being able to fall asleep, and fatigue. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fatigue is an overwhelming sustained sense of exhaustion with decreased capacity for physical and mental work at a usual level. Sleep deprivation is a condition caused by dyssomnia and includes symptoms caused by illness, emotional distress, or medications.

The nurse is caring for a patient who is having trouble sleeping. Which action will the nurse take? a. Suggest snug-fitting nightwear. b. Provide a favorite beverage. c. Encourage deep breathing. d. Walk with the patient.

ANS: C Relaxation exercises such as slow, deep breathing for 1 or 2 minutes relieve tension and prepare the body for rest. Instruct patients to wear loose-fitting nightwear. Walking and drinking a favorite beverage would not necessarily encourage sleep.

An older-adult patient is visiting the clinic after a fall during the night. The nurse obtains information on what medications the patient takes. Which medication most likely contributed to the patient's fall? a. Melatonin b. L-tryptophan c. Benzodiazepine d. Iron supplement

ANS: C The most likely cause is a benzodiazepine. If older patients who were recently continent, ambulatory, and alert become incontinent or confused and/or demonstrate impaired mobility, the use of benzodiazepines needs to be considered as a possible cause. This can contribute to a fall in an older adult. Short-term use of melatonin has been found to be safe, with mild side effects of nausea, headache, and dizziness being infrequent. Iron supplements may be given to patients with restless legs syndrome. Some substances such as L-tryptophan, a natural protein found in foods such as milk, cheese, and meats, promote sleep; while it does promote sleep, it is not the most likely to cause mobility problems.

The patient has just been diagnosed with narcolepsy. The nurse teaches the patient about management of the condition. Which information from the patient will cause the nurse to intervene? a. Takes antidepressant medications b. Naps shorter than 20 minutes c. Sits in hot, stuffy rooms d. Chews gum

ANS: C The nurse will intervene about sitting in a hot, stuffy room as this will make the narcolepsy worse so this needs to be corrected. Patients with narcolepsy need to avoid factors that increase drowsiness (e.g., alcohol, heavy meals, exhausting activities, long-distance driving, and long periods of sitting in hot, stuffy rooms). Patients are treated with antidepressants, and management techniques involve scheduling naps no longer than 20 minutes and chewing gum. Additional management techniques include exercise, light high-protein meals, deep breathing, and taking vitamins.

The nurse is caring for a patient in the sleep lab. Which assessment finding indicates to the nurse that the patient is in stage 4 NREM? a. The patient awakens easily. b. The patient's eyes rapidly move. c. The patient is difficult to awaken. d. The patient's vital signs are elevated.

ANS: C The patient is difficult to arouse, vital signs are significantly lower, and this stage lasts about 15 to 30 minutes. Stage 4 NREM is the deepest stage of sleep. Lighter sleep is seen in stages 1 and 2, where the patient awakens easily. REM sleep is characterized by rapid eye movement.

A young mother has been hospitalized for an irregular heartbeat (dysrhythmia). The night nurse makes rounds and finds the patient awake. Which action by the nurse is most appropriate? a. Inform the patient that it is late and time to go to sleep. b. Ask the patient if she would like medication for sleep. c. Recommend a good movie that is on television tonight. d. Take time to sit and talk with the patient about her inability to sleep.

ANS: D A nurse on the night shift needs to take time to sit and talk with patients unable to sleep. This helps to determine the factors keeping patients awake. Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patient's inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of her children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.

The nurse is caring for an adolescent with an appendectomy who is reporting difficulty falling asleep. Which intervention will be most appropriate? a. Close the door to decrease noise from unit activities. b. Adjust temperature in the patient's room to 21° C (70° F). c. Ensure that the night-light in the patient's room is working. d. Encourage the discontinuation of a soda and chocolate nightly snack.

ANS: D Discontinuing the soda and chocolate nightly snack will be most beneficial for this patient since it has two factors that will cause difficulty falling asleep. Coffee, tea, colas, and chocolate act as stimulants, causing a person to stay awake or to awaken throughout the night. Personal preference influences the temperature of the room, as well as the lighting of the room. Noise can be a factor in the unit and can awaken the patient, but caffeine can make it difficult to fall asleep

The nurse adds a nursing diagnosis of ineffective breathing pattern to a patient's care plan. Which sleep condition caused the nurse to assign this nursing diagnosis? a. Insomnia b. Narcolepsy c. Sleep deprivation d. Obstructive sleep apnea

ANS: D Obstructive sleep apnea (OSA) occurs when the muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing airflow or stopping it for as long as 30 seconds. The person still attempts to breathe because chest and abdominal movements continue, resulting in snoring or snorting sounds. With narcolepsy, the person feels an overwhelming wave of sleepiness and falls asleep. Insomnia is characterized by chronic difficulty falling asleep. Sleep deprivation is a condition caused by dyssomnia. OSA is the only one of these conditions that results in blockage of the airway and impacts the ability to breathe.

A nurse is teaching the staff about the sleep cycle. Which sequence will the nurse include in the teaching session? a. NREM Stage 1, 2, 3, 4, REM b. NREM Stage 1, 2, 3, 4, 3, 2, 1, REM c. NREM Stage 1, 2, 3, 4, REM, 4, 3, 2 REM d. NREM Stage 1, 2, 3, 4, 3, 2, REM

ANS: D The cyclical pattern usually progresses from stage 1 through stage 4 of NREM, followed by a reversal from stages 4 to 3 to 2, ending with a period of REM sleep. The others are incorrect sequences.

A single parent is discussing the sleep needs of a preschooler with the nurse. Which information will the nurse share with the parent? a. "Most preschoolers sleep soundly all night long." b. "It is important that the 5-year-old get a nap every day." c. "On average, the preschooler needs to sleep 10 hours a night." d. "Preschoolers may have trouble settling down after a busy day."

ANS: D The preschooler usually has difficulty relaxing or settling down after long, active days. By the age of 5, naps are rare for children, except those for whom a siesta is a custom. Preschoolers frequently awaken during the night. On average, a preschooler needs about 12 hours of sleep.

The nurse is caring for a young-adult patient on the medical-surgical unit. When doing midnight checks, the nurse observes the patient awake, putting a puzzle together. Which information will the nurse consider to best explain this finding? a. The patient misses family and is lonely. b. The patient was waiting to talk with the nurse. c. The patient has been kept up with the noise on the unit. d. The patient's sleep-wake cycle preference is late evening.

ANS: D This patient is awake and alert enough to do a puzzle. The individual's sleep-wake preference is probably late evening. All persons have biological clocks that synchronize their sleep-wake cycle. This explains why some individuals fall asleep in the early evening, whereas others go to bed at midnight or early morning. Waiting to talk with the nurse, being lonely, and noise on the unit may contribute to lack of sleep, but the best explanation for the patient being awake is the biological clock