Nursing Exam 2

Three groups of QIs

- prevention Qis - inpatient Qis - patient safety Qis

ways health care is paid

- private insurance - public insurance

Workplace environments include which factors in health care delivery?

- chemical factors - psychological factors - physical factors

An accountability checklist asks questions regarding the nurse's accountability to what facts?

- client - institution - self - profession - public - agency

Right to die issues

- client self-determinination - futile treatment - withholding or withdrawing treatment - assisted death - right to refuse treatment

Institutional Measurement

- clinical pathways - describes the optimum progression through system - care can be modified to address the problem

Nurses' professional practice and ability to deliver health care is influenced by what environmental factor?

- polluted water - infectious diseases - pesticides

Energy medicine

- BEM applications to the body - radio frequency hyperthermia - radio frequency diathermy - magnets - nerve stimulators - biofields- Reiki & therapeutic touch

Which of these questions should be included in an environmental assessment?

- How is your home heated or cooled? - What hobbies do you have? - Have you been exposed to chemicals in past or present jobs? - Where do you live?

Ethics

- a branch of philosophy - provide answers to questions of human conduct that arise in life & attempts to determine what is right or good

A young woman was beaten by her boyfriend while he was drinking. She did not seek treatment for her injuries right away because she was afraid she'd get fired from her job if she took time off. Which social issues are at play in this situation?

- abuse - substance abuse - poverty

Which of these are health care delivery trends occurring today that impact the nurse's ability to deliver health care?

- access fo all to health care - providing preventive and curative services - responding to actual and future epidemics and potential health threats

Three never events

- air embolism - blood incompatibility - foreign object left behind in a surgical client

Which of the following are key principles?

- beneficence - justice - nonmaleficence - autonomy

Two HAIs

- catheter-associated urinary tract infections (CAUTIs) - Staphylococcus aureus septicemia- methicillin-resistant Staphylococcus aureus (MRSA)

Time-out

- conducted immediately before any invasive procedure - involves immediate members - all members of the team actively communicate during the time-out and agree, that the client identity, site, and procedure is correct

What are some key ethical principles?

- contextualism - beneficence - nonmaleficence - autonomy - justice

Implications for nurses in the financing and control of healthcare

- cost control - well-being of the client - effective use of healthcare resources - changing the healthcare system

Barriers to nursing research include lack of time, poor attitudes among practicing nurses, comfort with the status quo, and lack of education to properly critique research studies. Which approach can improve the utilization of nursing research on a unit?

- create an interdisciplinary team to do patient rounds - create a shared governance model - create a journal for the unit

Health care decisions

- decisions are made with multiple individuals

The Goals of Healthy People 2020

- eliminate preventable disease, disability, injury, and premature death - achieve health equity - create social and physical environments that promote good health - promote healthy development and healthy behaviors

Technological approaches to decrease the number of errors

- eliminating ambiguous abbreviations - computerized physician/provider order entry - computerized decision support systems - computerized adverse drug monitoring - barcode point of care - use of smart pumps

Community-based nursing

- emphasizes advocating for clients, promoting self-care, focusing on health promotion and disease prevention, and recognizing the importance of family, culture and the community - Public health, home health, ambulatory care, occupational health, & school nursing

An example of nurses modeling environment-friendly behaviors includes which actions?

- encouraging the hospital to use more "reusable" products - turning off lights in rooms that are not occupied - participating in recycling programs on the nursing units

Homeopathy

- exposure to extremely small quantities of substance causing an illness or related substance will stimulate a cure - basis for immunization and allergy desensitization

Reasons to delegate

- frees up RN time for more critical tasks - saves time and money - promotes a team-building atmosphere

Communication

- handoff- info about the client or resident communicated from one healthcare provider to another typically occurs at each change of shift

Biologically based practices

- herbal medicines - special diets - vitamin therapy - keep an open mind

Community environmental factors that threaten health include which of the following?

- high-tension power lines - pollution

Framework for Ethical Decision Making

- identifying and clarifying the problem - gathering data - identifying options - making a decision - acting and assessing

Which of these are considered social threats to the health care system?

- immigration/race disparities - aging population - access to information

code of ethics

- implicit standards and values for the profession - American Nurses Association Code of Ethics - International Council of Nurses Code for Nurses

Concept of Bioethics

- interdisciplinary field within health care that has evolved with modern medicine to address questions that arise as science and technology produce new ways of knowing - dilemmas for health professionals

Common law

- judicial law and common usage or custom - safe medication practice illustrates how common usage applies to nursing

Advance directives

- living wills, durable power of attorney for healthcare, and physician orders for life-sustaining treatments - patient's wishes are made - Five Wishes for End of Life Care

Balancing science and mortality

- nurses must examine life - determine own values and seek to understand values of others

Universal protocol

- pre procedure verification - making surgical site - performing time-out

Institutional policies provide guidance:

- proper actions to be taken in specific situations - identify the individuals responsible for taking action - establish specific timelines for actions

what are nursing homes for?

- provide care for those without the ability to manage ADLs - provides skilled care in nursing, physical therapy, and speech therapy is termed a skilled nursing facility (SNF) - admission to a nursing home is functional

Joint Commission

- provides accreditation for wide variety of healthcare facilities including home care, ambulatory care, and assisted living - encourages hospitals to reduce the incidence of errors

Mind-body medicine

- relaxation exercises - meditation - visualization - hypnosis - prayer - biofeedback

Personal identity

- requires to assume responsibility for patient harm - nurse cannot be relieved of liability by another professional - damages can be levied against current assets and future earnings

Six rights of medication administration prevent medication errors

- right client - right drug - right dose - right route - right time - right documentation

A nurse has requested that a CNA take out an intravenous (IV) catheter from a patient, Mr. Thomas, because he is being discharged. When the CNA walks into the room, the patient is still hooked up to a bag of normal saline (NS) running a 100mL/h. The removal of the IV is within the scope of practice, and the CNA proceeds to remove the IV. Which of the following five rights of delegation is missing?

- right direction/communication - right supervision/evaluation the nurse should have given better instruction about what to do if the IV was still running, and the nurse should have supervised the CNA in completing the task

Regulatory law

- rules and regulations established by administrative bodies within government

Factors that lead to chemically dependency

- stress - frequent shift changes - staffing shortages - injuries - pain

Events that can NOT happen

- surgery on the wrong body part - creating and sustaining a culture of safety - informed consent, life-sustaining treatment, disclosure, and care of the caregiver - matching healthcare needs with service delivery capability - facilitating information transfer and clear communication - medication management - prevention of healthcare-associated infections - condition- and site-specific practices

Which of the following are examples of values a person may hold?

- truth - money - educational attainment - peace Values provide guidance to people as they interact with each other and the environment.

Which of examples of social media posts that can be considered illegal?

- tweets about patients - hashtags using patient information - pictures of patients - post discussing patients

Scope of the Law

-includes those rules of conduct or action recognized as binding or enforced by government - "the principles and regulations established in a community by some authority and applicable to its people, whether in the form of legislation or of custom and policies recognized and enforced by judicial decision"

Research process steps

1) focus on the clinical problem area 2) perform initial literature review 3) specify the problem and define the variables 4) establish a tentative proposition/hypothesis and a second literature review

NCBSN's five rights to delegation

1) right task 2) right circumstances 3) right person 4) right direction/communications 5) right supervision/evaluation

Nursing process

1. Assessment 2. Diagnosis 3. Planning 4. Interventions 5. Evaluation

Decision making process

1. Identify and clarify the ethical problem 2. Gather factual data 3. Identify and evaluate options 4. Make a decision 5. Act and assess

factors affecting the development of hospitals

1. advances in medical science 2. development of medical technology 3. changes in medical education 4. growth of the health insurance industry 5. greater involvement of the government 6. emergence of professional nursing

Which of the following is a communication technique that Amy used with Chris during her inpatient stay?

Helping relationship- when nurses communicate with patients to assist them in attaining optimal health or to support them through difficult situations.

In this week's episode of "A Year in the Life," Jolene recommends that Amy narrow her topic of interest before doing a literature search. Why is this important?

Narrowing a subject of interest helps the researcher do a timely literature search that keeps the focus of the study on topic.

Naturopathy

Natural agents used in treating disease such as food, exercise, air, water, and sunshine

Should nurses always carry their own personal malpractice insurance?

No, because nurses need to make their own decisions regarding the extra fees that are associated with personal malpractice insurance.

Based on the talk show podcast, Maria did not think that an Institutional Review Board (IRB) was necessary for a publishable project. Which of the following best describes an IRB and its purpose?

A group that meets regularly to verify that the proposed study meets scientific standards

Which events or errors would require the nurse to complete an incident report?

A patient became agitated and bit the nurse on the hand, drawing blood.

Which type of evidence is the is the most rigorous?

A single, randomized clinical trial

A registered nurse has asked a certified nursing assistant (CNA) to discontinue a Foley catheter. Before delegating this task, the RN should have evaluated the CNA's:

Competence- the ability to complete a task

Was the hospital team legally negligent in discharging Chris the same day as a potential fall?

No. The primary care physician assessed Chris and determined that she was physically and mentally competent to go home.

Attitudes, dispositions, and passions are part of which domain of critical thinking?

Affective dimensions

Accountability is often confused with which terms?

Autonomy and authority

The ethical principle that is focused on doing only good is:

Beneficence- which is to ensure only good is done.

Which is not part of the ethical decision-making process in nursing?

Diagnose- this is apart of the nursing process but not the ethical decision-making process

Intuitionist

Each situation weighed on a case-by-case basis to determine relative goals, duties, and rights.

The nurse know that the clients are receiving substandard care due to reductions in staffing. She needs current literature, looking for serious gaps in the accepted standards of practice, and examines the effects of the new staffing practice on ethical principles. Which step in the process for ethical decision making is the nurse using?

Evaluating the ethical problem

Chris filed a negligence claim against Amy. Nursing negligence claims are usually due to which of the following?

Failure to do what is expected and doing what is not expected.

True or false: Nurses affect the global environment solely through the proper disposal of harmful materials.

False

True or false: Violence occurs in urban, rural, and suburban settings and results in trauma. In rural areas, violence is the leading cause of death in young African American men.

False- it is urban areas (not rural)

Which terms are pertinent to negligence?

Harm and breach of duty

What is the role that Big Al now plays, as a recovering addict and counselor?

He acts as a mentor and guide. He provides direction and cannot make people realize their bad choices.

Which should not appear on an accountability checklist?

Hours worked

Rights based

Individuals have basic inherent rights that should not be interfered with.

A 72-year-old patient with chronic lymphoma leukemia is comatose due to recent extensive chemotherapy. Her husband tells the nurse case manager that his wife did have a living will, but it was reversed at the other hospital, in order for her to receive chemo treatment. He states she is terminal, and therefore he does not want to see her continue to suffer. The primary care provider orders IV-fluid therapy and a blood transfusion and schedules the patient for PEG tube placement and an MRI to rule out metastatic brain tumor. The primary care provider informs the husband that though his wife is terminal, the living will no longer exists. The husband informs the nurse manager that he has medical power of attorney, and he asks the nurse for advice. The nurse manager decides to provide advice to the husband. Several of the ethical principles in the ANA Code of Ethics deal with autonomy. It is important to provide details that will allow others to make informed decisions. Which dimension of critical thinking is the nurse manager applying to the situation?

Intellectual standards- implies that both the nurse and the patient (or the patient's family) collar in recognizing the health issue, integrating the plan of care, and reflecting on whether the nursing interventions were successful.

Jolene advised Amy to complete an incident report after Amy found Chris sitting on the floor next to the bed. What did Jolene tell May to include in her report?

Only facts that Amy observed

When utilizing a nursing evidence-based research project, the acronym PICOT is recommended. What does PICOT stand for?

Patient population Intervention Comparison Outcome Time frame

The idea that "experts develop certain characteristics related to practice (confidence, competence, and maturity) that enable them to quickly make correct correct clinical judgements that seem to simultaneously spring into action" is an example of:

Patricia Benner's novice-to-expert model

A nurse working in the emergency room and identified an increasing number of patients using health care services not through primary provider but through visits to the ER. The nurse understands this trend reflects what social problem that influences health care delivery?

Poverty- poverty, substance abuse, incivility, and moral decay have led to a decline in communities.

A nurses voices concerns that her patient will not be safe in his home environment if discharged. Short-term rehabilitation is ordered for the patient. The patient's insurance company denies coverage for the services and the patient is discharged home instead. What influenced the decision-making process for the patient and nurse?

Society- not everyone has health care services available to them.

What is a personal value?

Something a person perceives as important in life

Amy is struggling with Chris's discharge; she admits to her uncle that she "just can't stop thinking about it." Which phase of the nurse-patient relationship do you think Amy is struggling with?

Termination ( Phase 4)- the nurse assesses the patient's ability to independently manage and cope with health-related issues. The patient and nurse mutually agree to end the relationship.

A nurse witnesses a health care provider calling in a Schedule II narcotic prescription for a friend. The health care provider asks the nurse not to say anything about what was witnessed. The nurse is unsure what to do. What will influence the nurse's actions?

The legislation regarding dispensing Schedule II narcotics. The nurse is legally bound by legislation related to narcotics and must alert the proper personnel as to the actions of the health are provider. Ethic permeates all areas of professional practice.

A nurse refuses to care for a pregnant woman who is terminating her pregnancy at 20 weeks due to trisomy 13, which is incompatible with life. Another nurse on the floor states that she will care for the patient, and the nurse's assignments are changed. What may have influenced the nurse's refusal to provide care?

The nurse has religious beliefs conflict with the patient's decision.

Provision 4 of the ANA Code of Ethics

The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.

Provision 5 of the ANA Code of Ethics

The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.

Provision 6 of the ANA Code of Ethics

The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

Why would a registered nurse opt to not delegate a task to an LPN or CNA?

There is a high potential for harm and quick independent thinking is needed.

A 6-month-old baby is due for immunizations. The clinic closest to the parents' home has recently closed. There is a large university hospital in an urban area an hour away from their home. However, the family doesn't have reliable access to a vehicle. Which social domain is the primary influence on this aspect of the family's health in this situation?

Transportation

A CNA is asked to walk a patient after abdominal surgery for a total of three times this shift. It is within the scope of practice for the CNA to ambulate the patient. However, the patient was not walked at all that day and, later that night, has a hard time breathing. True or false: The nurse is held accountable in this situation.

True

True or false: A registered nurse can be held accountable for tasks delegated to certified nursing assistants and licensed practical nurses.

True- they frequently delegate nursing responsibilities to practical/vocational nurses and UAP's (unlicensed assistive personnel).

Can a person learn professional values?

Yes- nurses learn professional values as part of socialization into the profession.

Chemically impaired nurses

a concern to the profession and danger to clients

Negligence

a failure to exercise that degree of care

A Quality Improvement Organization (QIO)

a group of health quality experts, clinicians, and consumers organized to improve quality of care delivered to people with Medicare

The Vision of Healthy People 2020

a society which all people live long, healthy lives

Self-evaluation

a way to protect against poor nursing care

Tort

a wrongful act

Criminal law

addresses the general welfare of the public ex. misdemeanor and felony

Many stay boards of nursing offer:

alternatives to disciplinary actions for chemically addicted nurses.

Recognizing potential problems, anticipating results, and prizing the use of reason is called:

analyticity

A nurse's ethical decision-making process has many pitfalls. An example of one of the pitfalls includes:

arguing that because everybody does something, that something must be good.

Community

based care is when the client is IN CHARGE

Moral Development

basic standards for what we consider right and wrong that are based on religious beliefs, social influences, group norms, culture, and life expectancies

Learning right and wrong: infants

begin with no concept of right or wrong - basic trust is met

The ANA states that accountability means:

being answerable to someone for something one has done.

Authority

being in a position to make decisions and influence others to act accordingly to those decisions

Fidelity

being obliged to keep commitments and promises

Amy is an RN working on a busy obstetrical unit. She attends a national perinatal conference where she attends many continuing education sessions. She shares her newfound knowledge with her coworkers when she returns. What ethical principle is Amy demonstrating?

maintenance of nursing competence.

During routine surgery, it is discovered that a patient has a terminal disease. After she awakens, she asks how everything went and if she is doing well. The nurse begins to reassure her, but then stops and instead carefully and compassionately breaks the bad news. This is and example of which part of critical thinking?

critique of judgment- The nurse chooses to reassure her first and then thought it'd be better to explain the new diagnosis when the patient has recovered from their surgery. Then the nurse changes their mind and tells the patient the whole truth because that's more ethical.

Reflexology

massage of the feet to activate points that correspond to other body parts or systems

There are great disparities in the quality of health care throughout communities in the US. These disparities exist primarily because:

more affluent communities tend to have better facilities

A 95-year-old client has been informed he has terminal brain cancer. The client states he wants to do everything possible to prolong his life because he owes it to his family. This is an example of:

deontology

Bioethics

discipline dealing with the ethical implications of biologic research and applications

Beneficence

doing or producing good

Civil law

encompasses those laws regulating private conduct between individuals

Amy mentions to Ben a quote from her nursing professor: "Even if you think no one's watching, they are." What does this quote refer to?

ethical decision making

What is the first step in the research process?

focus on the clinical problem area

Primary prevention

focuses on preventing disease

Tertiary prevention

focuses on preventing long-term disability and restoring functional capacity

Secondary prevention

focuses on screening and preventing complications

Constitutional law

greatest authority in any jurisdiction, found in the US Constitution and in state constitutions

what act resulted in the construction of many hospitals?

hospital survey and construction act of 1946

Agency for Health Care Research and Quality (AHRQ)

identified set of items for indicators of quality of care

Malpractice

identifies professional negligence

Medical and physician directives

if properly executed, provides physician with immunity from claims of negligence in the patient's death

Value

important and enduring beliefs or ideals shared by the members of a culture about what is a good or desirable and what is not that exert major influence on the behavior of an individual and serve as broad guideline in all situations

What were the pieces of supportive evidence that Shonda used to review Amy's actions?

incident report, assessments, and follow-up

Statutory law

includes all written laws and government codes

Healthy People 2020

includes overall goals, priority areas, and leading indicators to measure progress in developing healthier communities

HIPPA Protected health information

individually identifiable data about a person's health or healthcare

Confidentiality

keeping privileged information private

Learning right and wrong: school-age children

learn that good behavior is rewarded and bad behavior is punished

Veracity

obligation to tell the truth

Values conflict

occurs when we must choose between two things, both are important

Paternalism

one individual assumes the right to make decisions for another

In this week's episode of "A Year in the Life," Amy is planning to attend the nursing EBP committee. What is the issue that she wants to research?

opioid addiction and pain management

A nurse is caring for a patient newly diagnosed with Type 1 diabetes. The patient is unemployed and uninsured, and is unable to afford monthly medications. The nurse understands that many uninsured and unemployed individuals qualify for:

participation in state Medicaid insurance programs

Informed consent

physician or advanced practice nurse has duty to disclose information so patient can make choices

Which perspective is the most prevalent framework found in ethical thinking?

principalism- influences ethical thinking, incorporates duties and rights, and values rationalism.

Values clarification

process of becoming more conscious of what one values

A clinic nurse observes an increasing rate of Type 2 diabetes in her patient population. She develops and leads a daily community walking program for clinic patients. This is an example of:

promoting a healthy community environment

Which of these is not a part of a nurse's duty to a community environment?

promoting local produce and food products

community agencies

provides care including - public health agencies - home care agencies - hospice care

The ANA Code of Ethics (2001) is a document that assists nurses in their provision of care through:

providing a set of values and behaviors to use when ethical dilemmas arise.

After a nursing research project is completed, what should the nurse do next?

publish the results to increase the literature base

What type of nursing research would be best used to examine compliance with hand washing?

quantitative- provides an analytical emphasis to an issue.

Learning right and wrong: adolescent

questions existing moral values and his or her relevance to society

Proper delegation

requires a knowledge of the competencies of the people around you.

The ANA code of Ethics for Nurses is based on many common ethical principles. An example of one of those common principles is:

respect for human dignity

Supervisory liabilities

responsible for exercising good judgement

Employer liability

responsible for hiring qualified persons

In the previous situation, which of the Five Rights of Delegation was not properly met?

right supervision/evaluation

Boundary violations

situation is which the nurse moves beyond a professional relationship and becomes involved with clients and their families

End-of-life issues

some of the most common ethical and bioethical dilemmas routinely faced by nurses

Assault

something to make a person genuinely afraid that they will be touched without consent

Clinical Pathway

standardized hospitals tool to monitor outcomes

Learning right and wrong: adult

strives to make sense of the contradictions and learns to develop own set of morals and values

Client empowerment

teaching, explaining options, and supporting decision

Utility

the good of many outweighs the wants or needs of the individual

Non maleficence

the prevention of intentional harm

Delegation

the process of a nurse directing another to complete or perform nursing tasks.

Answerability

the requirement to offer answers, reasons, and explanations to certain others.

A growing trend in the delivery of health care services in the US, which impacts the role and function of nurses, is:

the use of advance practice registered nurses to provide health services

Enacted law

those laws passed by the legislative bodies

The Mission of Healthy People 2020

to improve health through strengthening policy and practice

Battery

touching a person when that individual has not consented to the action

Culture of safety

trust and mutual respect encourage healthcare providers to report errors, near misses, other adverse events without fear of retribution

Massage

uses both fixed and movable pressure

Chiropractic

uses manipulation of the body joints to restore normal function

A hospital can be held liable for a nurse's actions under which of the following?

vicarious liability- used when a hospital is held accountable for any action performed by its staff.

A nurse must disinfect a patient's commode and bedside table with bleach water. A strategy to prevent a health hazard in the nurse's environment includes:

wearing gloves when using bleach or other disinfectants

Standard of best interest

what the healthcare providers or family believes is best for that individual

Serious situations

when using the chain of command does not invoke response to voiced concerns, one might use whistleblowing

public insurance

which include medicare and medicaid

Five Considerations of Critical Thinking

- purpose of thinking - adequacy of knowledge - potential problems - helpful resources - critique of judgements

why do we have rehabilitation centers?

- they assist individuals in returning to maximum level of independence - Sister Callisto Roy's adaptation model

Sister Callisto Roy's adaptation model

1. physiologic 2. self-concept 3. role function 4. interdependence

How many provisions are included in the ANA Code of Ethics?

9 provisions

private insurance

- largest percent of coverage - provided by employer

classification of healthcare agencies

- length of stay - ownership - type of care

Intellectual Standards Domain of Critical Thinking

- moral belief systems - ethical frameworks

Affective Dimensions Domain of Critical Thinking

- attitudes - dispositions - passions

Michelle is a nurse on a hospice unit. Her patient has multiple new medication orders. Michelle compares the physician order with the order on the medication administration record. This action demonstrates what ethical principle?

Accountability and Responsibility

Taking the time to explain all treatment options to a confused patient is an example of which principle?

Autonomy- this means that they allow the patient to make his or her own decision, which is also an individual's right to self-determination.

A nurse fails to ensure that a patient has been educated on all treatment options for Stage 2 breast cancer. The nurse failed to uphold what ethical principle?

Autonomy- which means that the patient has the ability to choose treatment options. The individual has the freedom to make rational and unconstrained choices.

The nurse providing discharge instructions a patient who speaks a little English. An interpreter is not available for the nurse to use, so the nurse provides the discharge instructions using a slow rate of speech and written instruction sheet for the patient. The patients nods her head and smiles while the nurse provides the instructions and leaves shortly after that. The nurse does not feel the patient understood the instructions. What factor has influenced this ethical dilemma?

Culture- Nurses need to be aware of culturally diverse population clusters and the usual health practices of these groups to provide effective nursing care.

A man is admitted to the ER with signs of internal bleeding. He is a Jehovah's Witness and is refusing any blood type transfusion according to his beliefs. The man's condition is worsening, but he is still conscious, coherent, and perfectly responsive. What should the nurse do?

Do everything possible to help the patient while still honoring his request. Although the patient is injured, the nurse has to respect his autonomy.

True or false: If a procedure is considered unethical, but you can save your patient's life by performing it, you should proceed because your primary concern is the patient.

False- Nurses have a responsibility for ethical decision making. The primary responsibility is for the nurse caring for the patient is to respect the person as a unified being.

A man accused of murder has been admitted to the hospital to receive medical treatment for some minor stab wounds. His nurse treats him but doesn't bother taking the time to give him pain medication before attending to his wounds. True or false: This is an example of the principle of justice.

False- the principle of justice states that care should be provided to patients in fairness and impartiality, as per what is right and what is deserved.

True or false: After administering medication to a patient as requested by a doctor, your patient has a bad reaction and goes into cardiac arrest. Even if the correct medication was administered in the correct amount, you have still failed to uphold the principle of non maleficence.

False- to violate the principle of non maleficence, there must be an intent to harm.

Amy tells her patient that she will be right back with a full pitcher of water and the patient's pain medication. Amy forgets to return to the patient's room. The patient calls the nursing station 30 minutes later stating he is in severe pain. Amy failed to uphold what ethical principle?

Fidelity- which means the nurse upholds promises made to the patient.

Now assume that the patient from the previous scenario speaks only Spanish, and no one in the room can communicate with him properly. As the nurse prepares a blood transfusion, the patient raises his voice and seems to lose his mental stability. What should the nurse do?

Find someone who is able to properly communicate with the patient before proceeding.

Which of these is an example of using critical thinking when dealing with a possible genetics-related diagnosis?

Finding and analyzing the family history of the patient

Anna is caring for two patients with type 2 diabetes. She provides both patients with their anti diabetic medications, but one patient also receives detailed education about the medication. The other patient receives no education from Anna. What ethical principle did Anna fail to uphold?

Justice- which refers to treating people equally. Patients with the same medication should receive similar education.

Situational

No prescribed rules, norms, or majority-focused results that must be followed

Which framework is based on the idea of analyzing situations using general norms derived from common morality?

Principalism

A nurse refuses to give sensitive information about her patient to the patient's family member over the telephone. This is an example of what ethical principle?

Protection of confidential information.

What is the importance of the ANA Code of Ethics?

The Code of Ethics addresses specific issues in nursing, emphasizing the nurse's obligation to the client.

Provision 8 of the ANA Code of Ethics

The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.

Provision 7 of the ANA Code of Ethics

The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.

Provision 1 of the ANA Code of Ethics

The nurse practices with compassion and respect for the dignity, worth, and uniqueness of every individual, unrestricted by social or economic status, personal attributes, or the nature of health problems

Provision 3 of the ANA Code of Ethics

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

Provision 2 of the ANA Code of Ethics

The nurse's primary commitment is to the patient, whether an individual, family, group, or community.

Provision 9 of the ANA Code of Ethics

The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

True or false: Assurance of competence is the shared responsibility of the profession, individuals, and organizations. Therefore, the provisions in the ANA Code of Ethics protect the public.

True- Professional autonomy is preserved when a nurse monitors compliance with nursing standards and guidelines.

True or false: If a nurse is unable to critically reason and use clinical judgment, it may be difficult for him or her to make ethical decisions.

True- Scholars debate whether critical thinking is a general life skill. If viewed as a general life skill, critical thinking must be learned by everyone that survive in a rapidly changing world.

True or false: Critical thinking demands that nurses have solid, logical reasons for judgements and actions.

True- critical thinking does demand that nurses have solid, logical reasons for judgements and actions

Tom witnesses a coworker diverting narcotics from the medication dispensing unit. He confronts the nurse. She asks Tom not to say anything to anyone. She tells Tom that she will seek treatment. Tom is unsure what to do. What ethical principle will guide Tom in decision making?

Veracity- which implies that the nurse will be truthful in all interactions with everyone.

Which of the following best describes systems theory?

a theory addressing elements and interactions among variables in a situation and their interrelated effects.

A nurse in the emergency room is faced with having to make ethical decision regarding the patient being cared for. The nurse would be using critical-thinking skills when forming a decision if the nurse:

examined all of the consequences surrounding the decision

Justice

fairness and impartiality to provide equality of service according to individual needs and contributions

what was established in 1965?

medicare and medicaid

Teleological

outcome-focused approach that places emphasis on results and protects the interest of the majority

Autonomy

self-determination and freedom of choice

How many steps are there in the ethical decision-making framework?

seven - identifying and clarifying the problem - gathering relevant factual data - identifying and evaluating options - making a decision - acting - assessing

A nurse working at a rural hospital posted comments on her Facebook page concerning the care she provided to a community member after he experienced an alcohol-related motor vehicle accident. The contributing factor to this ethical dilemma was:

technological advances in communicating with friends and family.

In ethical issues, the primary responsibility of the nurse in caring for the client is:

to always respect the person as a unified being

Ethical decision making is influenced by what three perspectives?

- Care - Contextualism - Principalism

A new treatment for cancer has recently been developed using a combination of completely safe products commonly found in a hospital setting. While there have been only positive effects, the treatment is still not universally accepted in professional practice. But a nurse has the ability to easily-- and seemingly safe-- help a family member using this treatment. Which factors make this situation unethical?

- Funding - Society/Culture - Professionalism

Which concepts represent the meta paradigm of nursing?

- Human beings - Nursing - Environment - Health

Which actions represent steps in the ethical decision-making process for nurses?

- Identifying all facts - Identifying irrelevant facts and eliminating - Evaluating the ethical problem - Choosing and acting

4 Domains of Critical Thinking

- Intellectual Standards - Affective Dimensions - Abilities - Elements of Thought

Which of the following are ways of knowing in nursing?

- Personal - Ethical - Aesthetic - Empirical

Utilitarian

- Provide the greatest good for the greatest number of people. - Rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences - strongest approach for bioethical decision making

DRGs: Diagnostic Related Groups

- common method of reimbursement for health care services based on predetermined fixed price-per-case or diagnosis - patient assigned to a diagnostic grouping - payment to hospital is set based on this DRG - hospitals face financial incentive to reduce length of stay

medicaid

- covers disabled persons, low-income households with children, and those in nursing homes

Three approaches

- deontological - teleological - situational

Abilities Domain of Critical Thinking

- developing ethical/legal skills - accountability - reporting incompetent, unethical, or illegal practice

Deontological

- duty-focused normative approach centered on rules from which all action is derived - rooted in the assumption that humans are rational and act out of principles that are consistent and objective, and compel them to do what is right

fee-for-service payment

- fee is generated when a service is provided

prospective payment

- fixed reimbursement amount for care

medicare

- largest health insurance program in the US - entitlement program based on age or disability - part A: payment for hospitalization - part B: purchased insurance to meet physician's fees and outpatient costs

cost control in healthcare

- mechanisms for controlling costs and improving patterns of care have been instituted

there are several different approaches to finance the healthcare:

- personal payment - charitable care - insurance plans - HMOs - government programs

ambulatory care settings

- provide care on an outpatient basis - care could be simple office or performance of ambulatory surgery

what do assisted-living centers do?

- provide supportive services

what does the patient protection & affordable health care act of 2010 represent?

- provides affordable health insurance - requires U.S. citizens/legal residents to have a qualifying health insurance

Elements of Thought Domain of Critical Thinking

- purpose - issue or problem at hand - point of view - assumptions - information available - implications and concequences

Duty based

A duty to do something or to refrain from doing something.

According to the ICN Code for Nurses, which statement is true?

A registered nurse is individually responsible and accountable for maintaining professional competence