Updated! Ch.1 Aspects of Medical-Surgical Nursing, EAQ Chapter 1 Aspects of Medical-Surgical Nursing

Which is the licensed practical or vocational nurse's best protection against negligence and malpractice?

Adherence to standards of care

6 Principles of Ethics

1) Autonomy- respect individuals rights 2) Beneficence- act in pts best interest 3) Justice- fairness/equity 4) Nonmaleficence- do no harm 5) Confidentiality-protect pt privacy 6) Veracity- honesty

A nursing student observes a classmate document vital signs on a patient's record, and she remembers that she never saw the student enter the patient's room. She is friends with the student and does not want to cause trouble, but she also understands that the patient could be at risk if the vital signs are not accurate. Which situation might the student making this observation be experiencing?

An ethical dilemma

Which defines the boundaries of licensed practical or vocational nurses' practice? a. Law b. Ethics c. Values d. License

Law

5 Appropaches to conflict resolution 3 C 2 A

Accommadation- agreement reached or not; negative: differences are suppressed/resentment; when to use: you are wrong, the other person really has a better idea, the issue is more important to the other party than to you; you are outnumbered or outranked Collaboartion- finding solutions; Compromsie- mutual/compromised Avoidance- "cool off" until reasonable Competition- strong stance of defending

Which describes the licensed practical or vocational nurses working with and through others to accomplish nursing care for more patients than one individual can provide alone?

Delegation

Which is the first step to resolving an ethical dilemma?

Determine if the issue is an ethical dilemma.

While riding in the hospital elevator, a nurse hears two colleagues discussing a patient with a cardiac disorder on their unit who is also deaf. Which reason supports the nurse asking the colleagues to stop this conversation?

Discussing the patient's condition is a breach of confidentiality.

A nursing student is working as a nursing assistant on her day off and is caring for a patient who needs an intravenous dressing changed. The nursing assistant feels comfortable attempting the task even though it is not in her job description. Which action is mostappropriate for the nursing assistant?

Do not perform a task that is not in her job description.

Which action an expected communication competency of the licensed practical or vocational nurse?

Documenting and reporting to appropriate health care personnel all assessments, interventions, progress, or impediments to achieving patient outcomes

Which principle of health care ethics is concerned with fairness, equity, and appropriateness of treatment?

Justice

Which care setting correctly identifies where medical-surgical licensed practical or vocational nurses traditionally fill leadership or management position? a. Hospitals b. Long-term care c. Home health care d. Ambulatory surgery centers

Long-term care

What does NAPNES stand for?

National Association for practical Nurse Education

The nurse failed to provide a patient with medications as ordered by the provider. As a result, the patient's blood pressure dropped significantly, and the patient became dizzy and fell. Which behavior did the nurse display?

Negligence

Which identifies the act committed by a licensed practical or vocational nurse whose failure to monitor a patient results in injury? a. Tort b. Abuse c. Negligence d. Nonmaleficence

Negligence

Which nursing action identifies an intentional tort?

Placed a patient in restraints without an order threatening contact without the patient's consent restraining or medicating a patient against their wishes invasion of privacy by sharing or publishing personal patient information giving false information that can damage the patient's reputation acting in a negligent manner

A nurse has experienced a values conflict with another person. Which outcome would reflect a positive result of this conflict? a. Adopting the other person's viewpoint b. Understanding the other person's point of view c. Refusing to recognize or respect another's values d. Leaving the conflict resolution to a supervisor to solve

Understanding the other person's point of view

Which is the term for beliefs and attitudes that are important to a person and influence the choices the person makes on a daily basis?

Values

All nurses experience the process of self-discovery to help them better understand their values and patients' values. Which description identifies this process? a. Values clarification b. Values identification c. Values management d. Values reinforcement

Values clarification

A nurse is documenting in the patient's record. The nurse knows that communication and documentation with and about patients must be done in a truthful way. Which value does this describe?

Veracity

Tort

a civil wrong against a person or property Ex: threatening contact without pt consent, restraining or medicating a patient against their wishes, invasion of privacy by sharing or publishing personal pt information, giving false information that can damage the patient's reputation, and acting in a negligent manner.

Ethics

ethical questions that arise in health care, defining what actions are right and wrong and whether the motives and outcomes are good or bad usually is a grey area rather than black or white

Leadership

future oriented role, creates a vision/mission, empowers

1) Professional Behaviors

accountability caring attitude enhance knowledge and skills Ex: comply with ethical/legal frameworks

competition negative outcomes when to use

can generate bad feelings creates winner and loser may try to block actions of the winner when you need a quick decision to implement unpopular nonnegotiable actions to defend important principles

In which roles do licensed practical or licensed vocational medical-surgical nurses function? Select all that apply

caregiver care coordinator patient educator case manager counselor patient advocate consultant researcher administrator/manager staff educator expert witness

Roles of LVN

caregiver, care coordinator, patient educator, case manager, counselor, patient advocate, consultant, researcher, administrator/manager, staff educator, and expert witness

3) Assessment

collection and processing of relevant data for the purpose of pts health status. Ex: physical, emotional, cultural, family, etc

2) Communication

compassion and cultural awareness, directed towards a positive outcome and trusting relationship. Ex: relative, accurate and complete information

negative outcomes of accommodation when to use

differences are suppressed; resentment you are wrong other person has a better idea the issue is more important to the other person than you outnumbered

what is bioethics?

the study of ethical situations in biology and medicine

1. Which is the primary purpose of the Standards of Nursing Practice, as developed and published by national organizations such as the National Association for Practical Nurse Education and Service (NAPNES)?

Providing guidelines for nursing practice and nursing education

What does SBAR stand for?

Situation, background, Assessment, recommendation

What Act specifies the roles of an LVN?

State Nurse Practice Act in place to protect the public

Which identifies a civil wrong committed by the licensed practical or vocational nurse who restrained and medicated a patient without the patient's consent? a. Tort b. Negligence c. Beneficence d. Nonmaleficence

Tort

What is NAPNES?

the Standards of practice and educational competencies of graduates of Nursing Programs to better define the range of capabilities, responsibilities, rights, and relationships to other health care providers for scope and content

collaboration negative outcomes when to use

wastes time; outcome already decided to build understanding to find creative solutions to address difficult issues that affect productivity

Which is a benefit of the licensed practical or vocational nurse gaining awareness of and clarifying his or her personal values? Select all that apply.

-Better self-understanding - Enhanced understanding of patients - Ability to help patients in understanding what is important to them

A student nurse is participating in a clinical rotation at a long-term care facility and is accompanying a staff nurse on wound care rounds. The staff nurse prepares a syringe of morphine to premedicate the patient with a large, painful wound who is to undergo a dressing change. The staff nurse hands the syringe to the student nurse and directs her to administer the injection in the patient's thigh. Which should be the student's response?

"This is my first time with a needle; thank you for the opportunity, but I have not practiced this procedure, so I cannot do it."

Which is an essential knowledge component related to medical-surgical conditions expected of medical-surgical licensed practical or vocational nurses? Select all that apply.

- Pathophysiology -Nursing Interventions -Clinical manifestations -Potential Complications -Expected patient responses

Which nursing interventions are within the scope of practice for a licensed practical nurse (LPN), according to the National Council of State Boards of Nursing? Select all that apply.

- Promoting a safe and therapeutic environment for the patient - Planning nursing care episodes for individuals with stable conditions - Participating in health teaching and counseling to maintain the optimal health level of patients

Which is an essential element of effective delegation by a licensed practical or vocational nurse? Select all that apply.

-Documentation of outcomes - Monitoring of staff performance -Knowledge of education and training of staff members - Awareness of the specific condition and needs of each patient

Which component of SBAR systematic communication facilitates the exchange of important information among health care professionals? Select all that apply.

-Situation -Assessment -Background -Recommendation

Which situation is the nurse experiencing when confused by a situation at work that has one or more right answers?

Ethical dilemma

Which refers to the values relevant to the licensed practical or vocational nurse's conduct? Select all that apply

Ethics

During a clinical maternity rotation, a student nurse overhears an older staff nurse complaining about a patient admitted for delivery and her support person, who is also a woman. "I don't know what these young people think they are doing. A child needs a mother and a father, not two mommies." Which best describes what is being displayed by the staff nurse?

Ethnocentrism

Which behavior is observed in a patient who thinks his or her own culture is superior to that of others? a. Altruism b. Utilitarianism c. Ethnocentrism d. Cultural diffusion

Ethnocentrism

Which values are considered "core" values in nursing?

Fairness, beneficence, justice, and appropriateness

Four Stages of Conflict F.A.C.O

Frustration- angry to situation; may believe their goals are being blocked Conceptualization- each party formulates a view on basis; conflicts typically center on perceived differences in facts, goals, how to achieve goals, and the values on which goals are based Action- behaviors that may or may not resolve Outcomes- win or lose/positive/negative

A home care licensed practical nurse is caring for an older adult patient who lives alone in a beachfront bungalow. The patient requires more assistance than the home care agency can provide, and it has been suggested that the patient consider nursing home placement. The alert and oriented patient tells the nurse, "If you will stay with me and take care of me, I will give you my home when I die." The nurse has to graciously decline. Which portion of the National Association for Practical Nurse Education and Service (NAPNES) Code of Ethics for licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) would be violated?

Give conscientious service and charge just remuneration.

Which professional competency expected of the licensed practical or vocational nurse is demonstrated by contributing to the formulation of nursing care plans for stable patients with noncomplex conditions in consultation with the registered nurse?

Planning

Which term describes adherence to standards of care, accountability for one's actions, and the use of legal and ethical principles in nursing practice?

Professional behavior

compromise negative outcomes when to use

keeps the peace when time pressures require quick solution when each party is firmly committed to different views can produce acceptable outcomes

4) Planning

knowledge and collection of info to provide direction for individualized care and safe/accurate pathways to promote progress and positive outcomes. Ex: modify, formulate, prioritize

professional negligence is called what are the qualifications to be classified with this?

malpractice -nurse owed a duty to the patient -the nurse did not carry out that duty - the patient was injured -the injury was caused by the nurse's failure to carry out that duty

avoidance negative outcomes when to use

neither satisfied to deal with trivial issues to delay a decision until parties are calmer when one's party's demands cannot possibly be met when others could resolve the issue more readily

Clinical Judgement Model

recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes

6) Managing

serving patient outcome while supporting organizational outcomes Ex: supervise and evaluate activities of personnel

Medical Surgical Nursing settings:

specialty that requires skill and knowledge to care for adult patients with variety of conditions requiring medical or surgical management requires knowledge on conditions related to patho, manifestations, complications, tx, interventions, and expected pt responses acute care facilities home health care ambulatory care clinics outpatient services residential facilities skilled nursing facilities medical offices adult day care primary care schools correctional facilities private businesses

list the 7 steps in the resolution of an ethical dilemma.

step 1: ask the question; is this an ethical dilemma? step 2: gather information relevant to the case; pt, family,instutional, and social perspectives are important sources of relevant information step 3: clarify values; distinguish fact, opinion, and values stpe 4: verbalize the problem; simple statement of the dilemma step 5: identify possible courses of aciton step 6: negotiate a plan; requires a confidence in one's own pov step 7: evaluate the plan over time

What is SBAR?

systematic communication that facilitates the exchange of information between professionals.

Which characterizes the professional behaviors expected of a licensed practical or vocational nurse? Select all that apply.

-Adherence to standards of care - Accountability for one's actions - Use of ethical and legal principles in nursing

Which conflict resolution strategy based on situation is recommended for licensed practical or vocational nurses? Select all that apply.

-Avoidance -Competition - Compromise - Collaboration -Accommodation

The licensed practical or vocational nurse is providing care for a patient who chooses to discontinue renal dialysis knowing renal failure may cause death. Which would occur if the nurse's professional ethics differ from personal morals?

Conflict

Which information is included in the stipulations of the National Association of Practical Nurse Education and Service (NAPNES) Code of Ethics for licensed practical nurses (LPNs)/licensed vocational nurses (LVNs)? Select all that apply.

-Function within legal guidelines. - Fulfill all duties faithfully and efficiently. - Accept personal responsibility for actions.

Which ethical principles most often guide the licensed practical or vocational nurse when faced with situations that do not have simple solutions? Select all that apply.

-Justice (fairness) -Veracity (be truthful, honest) - Autonomy (respect individual rights) - Beneficence (act in the patient's best interest) - Confidentiality (protect patient privacy)

Which guideline relates to accountability and patient handoff for licensed practical or vocational nurses? Select all that apply

-Organize information before beginning. -Document any specific patient or family requests or concerns - State patient's name, age, room number, diagnosis, and condition. - Report relevant clinical information including deviations from norms.

Which values has the American Association of Critical Care Nurses identified as essential for licensed practical or vocational professional nurses? Select all that apply.

-Truth -Altruism -Justice -Freedom -Human dignity -esthetics

Essential elements of effective Delagation

-knowledge of patients condition -compliance with state policies -determination of tasks that can be safely delegated -evaluation of the patients response to the care -documentation of outcomes -monitoring of performance -compliance with institutional policies and procedures r/t delegation -knowledge of training and background of delegatee

What are the 5 rights of delegation?

1. Right task- can it be delegated 2. Right Circumstance- Should it be delegated; is the pt's condition stable 3. Right person- can this person do the task 4. Right direction/ communication- is the task being conveyed in a clear manner; the delegatee cannot make any decisions and cannot modify the activity unlesss approved by the lvn/pn 5. Right supervision- is the task being followed up on once complete.

A health care team at an acute care facility is working together to make an ethical decision. The team is in the process of gathering all information relevant to the case. Which step is the health care team in when referring to the ethical decision-making process?

2

Which ethical principle is demonstrated through the nurse's adherence to institutional standards of care?

Accountability

A nurse has received a patient from the emergency department and is assisting with the collection and processing of relevant data before appraising the patient's health status. Which activity is this considered?

Assessment

5) Caring Interventions

Assist pts in meeting their needs and identified outcomes Ex: honor dignity, emotional cultural, religious, and spiritual influences

Which ethical principle mandates the implementation of informed consent in clinical practice? a. Justice b. Autonomy c. Beneficence d. Nonmaleficence

Autonomy

Which is the best protective action of the nurse against unintentional torts during clinical practice?

Avoiding negligence and malpractice in the profession

A nurse is documenting in a patient's record. The nurse knows that which process describes how information is exchanged among individuals? a. Referral b. Documentation c. Communication d. Professional behavior

Communication

Two nurses, an unlicensed assistive personnel (UAP), and a housekeeper are at the nurse's station discussing an argument that was witnessed by one of the nurses. The nurse explains that a husband and wife were arguing over the wife's decision not to pursue further treatment for breast cancer. Which principle of ethics was violated?

Confidentiality

A nurse stops a family member from physically abusing a patient and reports this to the nursing supervisor. Which ethical principle is described?

Beneficence

effective communicator managing conflict knowledgeable and competent in all aspects of delivery of care role model participatory approach in decision making shows appreciation delegates work appropriately sets objectives and guides staff displays caring, understanding, and empathy for others motivates and empowers others proactive and flexible focuses on team development

Characteristics of an Effective Leader

Malpractice

Professional negligence Ex: failure to monitor a pt or document findings, -failure to notify other staff of changes in pt status, -failure to respond to correctly carry out orders, -failure to maintain or correctly use equipment, -failure to follow the six rights of medication administration, -failure to convey discharge instructions appropriately, -failure to ensure patient safety, especially those who are at risk for injury, -failure to follow policies and procedures, -and to properly delegate and supervise

A nurse who upholds the concept of nonmaleficence in the care of patients would adhere to which principle?

Striving to do no harm

Management

Task focused, control, day to day work

Which is a characteristic feature of an ethical problem?

The solution is profoundly relevant to several areas of human concern.

A student vocational nurse is ready to begin a clinical rotation on a medical unit. Which level of accountability is the student held to while caring for patients?

To the same standards of care as a licensed nurse