Nursing 122 Final Exam
The nurse who admits making a medication error and immediately files an incident report is demonstrating: a. accountability b. individuality c. an injustice d. values clarification.
ANS: A Accountability is an ethical duty that states that one should be answerable legally, morally, ethically, or socially for one's activities. Individuality is something that distinguishes one person or thing from others. Injustice is when a person is denied a right or entitlement. Values clarification is a tool that allows the nurse to examine personal values in terms of ethical situations.
In preparing students for professional nursing practice in the twenty-first century, where should the emphasis be placed? a. Care coordination, direct care for complex clients, and outcomes evaluation b. Chemistry, biostatistics, and computer programming c. Illness care, hospice, and ethics d. Psychomotor skills, obstetrics, and epidemiology
ANS: A Caring for complexities in practice, coordinating care, and focusing on outcomes evaluation are the tasks that reflect the direction in which nursing is heading. As supplemental courses to nursing, these are essential but they do not represent an area of emphasis for professional nursing. Illness care, hospice, and ethics are currently components in programs that are preparing students for professional nursing. Psychomotor skills, obstetrics, and epidemiology are limited in scope.
While completing a nursing degree in Virginia, a student who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nursing student values: a. cultural competence b. prejudice c. stereotyping d. ethnocentrism
ANS: A Cultural competence is the responsibility of all nurses to become knowledgeable about the values, beliefs, and health care practices of the culturally diverse groups that are dominant in the nurse's particular practice area. p.188
Nurse practice acts: a. are written and passed by legislators. b. are affected by the practice of dentists. c. reflect only the concerns of RNs. d. cannot be influenced by special interest groups.
ANS: A Just as other sections of state codes are written and passed by legislators, so is the nurse practice act of each state.
Which organization provides federal funding for research? a. National Institute of Nursing Research b. Robert Wood Johnson Foundation c. W.K. Kellogg Foundation d. Sigma Theta Tau International
ANS: A The National Institute of Nursing Research is a federal agency that provides federal funding for health care research.
The new director of nurses has instituted "walking rounds" on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, "She doesn't know how we do things here!" The nurse is demonstrating: a. appeal to emotion b. appeal to tradition c. red herring d. straw man
ANS: B An appeal to tradition is the argument that doing things a particular way is best because they've always been done that way.
A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the: a. Institute for Safe Medication Practices b. Institute of Medicine c. National Committee for Quality Assurance d. The Joint Commission
ANS: B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health. pp. 379-380
The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include inconsistent methods of cleaning the site, dressing frequently becomes wet when patient showers, IV tubing not changed every 48 hours per protocol, and inadequate handwashing of RN prior to insertion. A bar graph demonstrates the frequency in descending order with 80% of infections being attributed to inadequate handwashing. The quality tool used is a: a. cause-and-effect diagram b. run chart c. Pareto chart d. flowchart
ANS: C Pareto charts are bar graphs that show causes contributing to a problem in descending order so leading cause is easily recognized. With the cause-and-effect diagram, all causes are listed but not in frequency of occurrence Run charts show data over time. Flowcharts show steps in a process.
A nurse is interested in understanding the meaning of the human experience of surviving polio. Subject recruitment targets persons who have been diagnosed with the disease. The researcher reflects on the data and identifies common themes in order to understand the "lived experience." These characteristics are consistent with the qualitative research method known as: a. grounded theory. b. ethnography. c. phenomenology. d. case study.
ANS: C Phenomenology is a qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants.
Which type of data analysis results in the non-numerical organization of data? a. Descriptive b. Inferential c. Qualitative d. Quantitative
ANS: C Qualitative data analysis results in the organization of words or phrases, not numbers. Interviews are reviewed and are transcribed line by line in an effort to group common conceptual meanings.
Institutional review boards determine whether research studies involving human subjects will: a. be published. b. add to the body of nursing knowledge. c. cause harm. d. receive funding.
ANS: C The institutional review board (also called the human subjects committee) examines research proposals to ensure that the ethical rights of those individuals participating in the research study are protected. This board makes sure that persons who participate in research are assured that their right to privacy, confidentiality, fair treatment, and freedom from harm is protected.
A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what is the first day of the week?
ANS: C The patient must be able to name the day of the week rather than use answer yes or no. "Is today Wednesday?" can be answered yes or no, which is not representative of open communication.
Although the media portrayed nursing in a negative light in MAS*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of: a. nurses who can be promiscuous and still help doctors. b. the fact that caring is not as important as the desire to serve one's country. c. the ability of nurses to cope with the dreadfulness of war by using humor. d. the contributions of male military nurses.
ANS: C The sitcom MAS*H did show humor as a coping mechanism for nurses in a war setting. MAS*H's portrayal of promiscuous nurses has no merit because nurses assist physicians. The sitcom addressed both factors as part of the nurse's role in the military. D: No male nurses were portrayed in the sitcom.
What is the purpose of the Nurse Reinvestment Act of 2002? a. Provides disability insurance to RNs who contract a life-threatening illness while on duty b. Funds public service announcements that promote unlicensed caregivers as an alternative to professional nurses c. Focuses on nurse retention and safety enhancement grants d. Provides pediatric nursing training grants
ANS: C This act funded $20 million to provide nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This act does not provide disability insurance to RNs. These funds do not promote unlicensed caregivers as an alternative to professional nurses. This act provides for geriatric training grants, not pediatric training grants.
A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill? a. Contact the elected representative's office by phone to request support for the bill. b. Support a health advocate to run for election as state representative. c. Tell all students about the bill. d. Explain the rationale for the bill to the school board.
ANS: A
Select the best example of an upstream cause of heart disease: a. Not being able to afford to move out of a heavily polluted neighborhood. b. Smoking 1 pack of cigarettes a day. c. Having a family history of high blood pressure d. Eating a diet high in fried food.
ANS: A
Which of the following might lead a patient to have a harder time managing their diabetes? a. All of these might make it harder to manage diabetes. b. A job that does not provide health insurance c. Lack of access to a health provider who speaks their language. d. Living in a neighborhood with limited access to fresh fruits and vegetables
ANS: A
You and your friend have a Bio-Chemistry exam and your friend is sure she is going to fail it because she has been too ill to study recently. Your friend asks you to help because you have mastered the material. You sit close enough so she can look at your exam if she chooses to, but you do not go out of your way to let her see it. Is your action considered academic dishonesty? a. Yes, this is academic dishonesty because you are helping another student cheat b. No, because you are just trying to help your friend out; if he had more time to study he could have done this on his own. Plus it's not really hurting anyone. c. All of the responses are correct. d. No, you are not being dishonest since you turned in your own work. It is up to your friend to decide if he wants to cheat or not. You are not responsible.
ANS: A
With the crisis in health care and the nursing shortage, why is the image of nursing still important? a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship. b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice. c. Nurses must present a unified image if they hope to ever move nursing to a profession. d. The dynamic state of today's health care requires nurses to move from a caring image to one of technologic competence.
ANS: A A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient. Nursing has a unique body of knowledge. Nursing is a profession. Unification will enhance the professional goals for nursing. Caring will always be part of the nursing image and nurses have already moved into the technologic realm.
The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph? a. Time plot b. Pareto chart c. Flowchart d. Cause-and-effect diagram
ANS: A A run plot or time plot graphs data in time order to identify any changes that occur over time. A Pareto chart is used in quality improvement to display data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few. A flowchart provides pictures of the sequence of steps in a process. A cause-and-effect diagram lists potential causes, arranged by categories to show their potential impact on a problem, and is not arranged by time.
An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect
ANS: A An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue.
During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy? a. An older person with Alzheimer's disease is denied the right to ambulate in the hallway. b. A mentally competent adult refuses medical treatment for the autoimmune disease, lupus erythematosus, stating that this condition reflects the will of a higher power. c. A visitor fell during visiting hours but refused to be examined by the physician on call. d. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to the procedure.
ANS: A Autonomy is defined as personal freedom, the right to make choices. Allowing a mentally competent adult to refuse medical treatment is an example of autonomy. A mentally competent adult refusing anesthetic prior to a procedure demonstrates autonomy.
A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college sophomores. The researcher was applying the principles of: a. beneficence b. human dignity c. justice d. human rights
ANS: A Beneficence is a term that is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good. Human dignity is the inherent worth and uniqueness of a person. Justice involves upholding moral and legal principles. Human rights are the basic rights of each individual.
The Affordable Care Act of 2011: a. would provide health care benefits to millions who were previously uninsurable or unable to afford insurance. b. caps the amount that hospitals and physicians can charge for procedures. c. requires that by 2020 all newly licensed nurses have a bachelor's degree at minimum. d. subsidizes private insurance companies, thereby reducing health care costs for individuals who have chronic or catastrophic illness such as cancer.
ANS: A It is anticipated that the ACA (2011) will make insurance coverage possible for millions who have previously not had insurance or had been denied insurance. REF: pp. 18-19
A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his/her own values as they relate to this issue. The nurse must: a. know his/her own values and how these values relate to beliefs and the philosophy of nursing b. rid the impurities in his/her value system c. ignore his/her own values d. realize that values do not change
ANS: A Nurses must make a deliberate effort to recognize their own values and must learn to consider and respect the values of others. Health care decisions are seldom made independently of other people. Decisions are made with the client, the family, other nurses, and other health care providers. There is no need to get rid of impurities in the value system; everyone's system is unique, and there really are no impurities. The nurse cannot ignore her own values; these are what shape the nurse's ethics and morals. Values can change as a person matures and passes through different life experiences. Values also are often influenced by those around us, especially authority figures.
According to the Quality Chasm report: a. health care providers should be proactive rather than reactive to patient needs b. common needs rather than individual preferences should be the priority c. medical information should be confined to the primary care provider d. specialized providers or case managers should control health care decisions
ANS: A Quality is based on predicting patient needs rather than reacting to needs. Care that is based on individual needs and preferences predicts satisfaction with care. Providers and the patient should have access to information so they can make well-informed decisions. The patient, not the providers/managers, should have control over health care decision making.
In attempting to decide which services should be offered to a community, the public health nurse decides to implement hypertension screening and treatment because most of the residents are hypertensive. This decision is based on the principle of: a. veracity b. values c. utilitarianism d. autonomy
ANS: C Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. On the basis of this principle, an attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the situation. Veracity is defined as the moral and ethical requirement to always tell the truth in personal communication. Although the public health nurse did not lie, she did not use the concept of veracity to decide which health care issue to address with this group. Values account for our moral decisions and actions. The nurse based the decision on the needs of the group, not on her personal values. Autonomy means respect for people. The nurse did not base her decision for this group on her respect for them, but on what the needs of the majority were.
Michael Glen, RN, BSN, graduated from nursing school 6 months ago and has been working as a staff nurse at a busy outpatient urgent care center since that time. He is finally feeling more confident in his role and realizes that he is making a difference in the quality of nursing care provided at the center because of his focus on patient education. However, Michael still has to ask the other nurses for assistance with performing some procedures that are not routinely performed in the center, which is somewhat uncomfortable for him because he has heard comments from other staff nurses belittling his baccalaureate nursing education. One day, when he asks one of the more experienced, associate degree nurses to help with a procedure he has not performed before, she responds, "Don't they teach you anything in nursing school or are you just lazy?" a. This case study is an example of a defensive or sarcastic response to the associate degree nurse's sarcasm and anger. b. Michael should avoid eye contact and defer to the more experienced nurse c. This case study is an example of positive mentoring d. This case study is an example of lateral bullying tactics
ANS: D
A patient was admitted to the outpatient surgery unit for a urinary stent placement. The patient was cheerfully greeted, paperwork was promptly completed by the admission clerk, an intravenous (IV) line was quickly inserted, and preoperative medications were administered in a timely manner. The procedure was completed as planned with no complications. The patient rated the experience as poor because when discharged, the hospital transporter refused to place the patient's bag in the trunk of the car and stated, "It is not my job to pack your personal items." Which aspect of Joiner's triangle was applied? a. Quality b. Scientific approach c. Administrative support d. Economics
ANS: A The customer defines quality from his or her perspective, and the entire stay is tainted by this single bad experience. The scientific approach is the way in which changes are made to achieve quality; decisions are based on sound, valid data, and those who manage the processes have a clear understanding of the nature of variation in processes. Administrative support is important for any quality improvement initiative to be successful, but it is not one of the legs of Joiner's triangle. Financial influences did not affect the consumer's perception of quality in this case.
Regardless of the term used to describe quality health care, the focus of quality is: a. what the consumer needs and wants b. economical care c. having the greatest technologic advancement d. services equally distributed among populations
ANS: A The customer determines quality on the basis of his or her unique perception of quality care. Quality health care can be inexpensive, but if it does not meet the criteria established by the consumer, then it is not quality health care. Although technologic advancements may indeed facilitate superior diagnostics, unless the patient perceives that the technology was an indicator of quality or that it improved quality, then it is not the focus. The perception of quality is unique among individuals.
You witness the two students during the Bio-Chemistry exam in Case Study #2 sitting close together. You are sitting in the row right behind them and have a clear view of them. You suspect they are cheating, and in fact, see one of the students looking at the computer screen of the other student during the exam. According to the UM SON Student Code of Academic and Professional Conduct: pp. 62-70, which of the following statements is correct? a. You should approach them, telling them to stop, and stating that the next time you will tell the faculty. b. Since you only suspect cheating, you should say or do nothing. c. You should stay focused on your own examination, keep your eyes on your own computer less you are accused of cheating, and not get involved. d. Since you can receive an honor code violation for aiding and abetting the misconduct of the two other students, you are required to report the incident to the appropriate authority.
ANS: D
A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "Can you tell me about your exercise practices?"
ANS: D "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances. p. 334
Today's demographics of the RN population indicate that: a. nurses entering the workforce do so within 2 years of completing high school. b. more white nurses enter and obtain graduate degrees than any other ethnic group. c. the highest level of nursing education for most RNs is an associate degree. d. the majority of nurses practice in hospitals.
ANS: D 56% of nurses practice in hospitals. The youngest professionals, those with a BSN, enter at age 26. More African-Americans are entering graduate school. The highest level of nursing education is the baccalaureate degree.
An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a(n): a. Pareto chart b. control chart c. top-down flowchart d. deployment chart
ANS: D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. The Pareto chart displays data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few. A control chart distinguishes between common and special cause variations and is basically a run chart with added statistical control limits. The top-down flowchart simply lists the main steps and substeps of a process in a linear fashion and does not detail the departments or people needed.
When assessing an ethical issue, the nurse must first: a. ask, "What is the issue?" b. identify all possible alternatives. c. select the best option from a list of alternatives. d. justify the choice of action or inaction.
ANS: A The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort that is required to understand an issue fully before moving forward in the assessment procedure. It is the second step in the situation assessment procedure. A set of alternatives cannot be established until an assessment has been completed. Selecting the best option is actually the third step in the situation assessment procedure. Options cannot be selected until an assessment has been done to define the issue. Justifying the action or inaction is the final step in the situational assessment procedure. No justification can be made until the assessment and action phases have been completed.
A priority action for the nurse who works with culturally diverse clients is completion of a: a. cultural self-assessment b. continuing education course on how to speak Spanish c. sign language course d. cultural client assessment
ANS: A The first step to becoming a culturally sensitive and competent health care provider is to conduct a cultural self-assessment. Through identification of health-related attitudes, values, beliefs, and practices, the nurse can better understand the cultural aspects of health care from the client's perspective. p. 191
A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Primary b. Modular c. Functional d. Team
ANS: A The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present. P. 372
Students are assigned to write to their state leaders about an issue affecting their community. One student writes about the need among rural community for greater access to acute care services. Which of the following pieces of legislation should the student use as a reference? a. Hill-Burton Act b. Social Security Act c. U.S. Civil Service Act d. Sheppard-Towner Act
ANS: A The purpose of the Hill-Burton Act was to provide funding to construct hospitals and to help states in plan for other health care facilities in accordance with the needs of communities. REF: p. 13
A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a: a. deployment flowchart b. top-down flowchart c. Pareto chart d. control plot
ANS: B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step in the process; this is not involved in this scenario. The Pareto chart is used in quality improvement to indicate that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few. A control plot is a run chart that has a center-line and added statistical control limits; it helps reveal specific types of change within a process, rather than providing a sequencing of steps.
Potential nursing students are concerned about choosing a profession with job security and ask, "Because more people are choosing nursing, will I have a job in a few years?" The nurse answers, on the basis of the U.S. Bureau of Labor Statistics prediction, that by 2020, a. positions that have historically required RNs will be filled by foreign nurses. b. the total number of RNs will not meet the demand for the workforce number required. c. the need for hospital nurses will dramatically decrease. d. hospitals will finally achieve the required RN workforce.
ANS: B According to the U.S. Bureau of Labor Statistics, the nursing profession is predicted to have only 64% of the RN workforce required to meet demands. The number of foreign nurses arriving in the United States is not sufficient to cure the shortage, and a large number of these nurses are unsuccessful on the NCLEX-RN®, resulting in an inability of foreign RNs to practice. More than half of all nurses practice in hospitals, and it has not been indicated that this will change. Even by 2020, it is projected that the United States will achieve only 64% of the needed nursing workforce.
A nurse gives Dilantin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "Everyone just pushes the medicine slowly. No one checks for compatibility. There isn't even a compatibility chart on the unit." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Appeal to emotion d. Appeal to tradition
ANS: B An appeal to common practice occurs when the argument is made that something is okay because most people do it.
A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of: a. accountability. b. autonomy. c. nonmaleficence. d. veracity.
ANS: B Autonomy is the principle of respect for the individual person. Within the concept of autonomy, people are free to form their own judgments and perform whatever actions they choose. They are self-determining agents who are entitled to decide their own destiny. Accountability is inherent in the nurse's ethical obligation to uphold the highest standards of practice and care, assume full personal and professional responsibility for every action, and commit to maintaining quality in the skill and knowledge base of the profession. Nonmaleficence is a principle that implies a duty not to inflict harm. In ethical terms, nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. Veracity means telling the truth as a moral and ethical requirement.
During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring.
ANS: B Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together.
A client asks the nurse, "Can you explain Medicare, an amendment to the Social Security Act?" The nurse responds that Medicare: a. led to many hospital closings, along with a decrease in acute care hospital-based nursing care. b. ensured that individuals ages 65 and older and those with end-stage renal disease or permanent disabilities had health care insurance. c. provided preventive care for women, infants, and children. d. provided medical insurance to those younger adults or children who were not eligible for private insurance because of catastrophic illnesses such as cancer.
ANS: B The Medicare program provides hospital insurance, Part A, and medical insurance, Part B, to all people ages 65 and older who are eligible to receive Social Security benefits; people with total, permanent disabilities; and people with end-stage renal disease. p. 14
The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse: a. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines. b. is at risk for HIPAA violations. c. is demonstrating the logical fallacy of slippery slope. d. has properly followed policy and protected the patient by not using her name.
ANS: B The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before. p. 344
Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is a: a. Pareto chart b. control chart c. deployment chart d. top-down flowchart
ANS: B The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. p. 380
A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad, how can you get cancer without smoking?" Which statement by the nurse represents empathy? a. "Research is identifying many risk factors for cancer besides smoking." b. "I understand how you could feel angry about the diagnosis." c. "He is still a good husband." d. "Why do you think he got cancer?"
ANS: B The nurse is placing herself in the wife's position and sharing her emotions.
A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, "I want to have this baby and give it up for adoption;" however, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves the ethical principle of: a. deontology b. veracity c. autonomy d. beneficence
ANS: B Veracity is telling the truth in personal communication as a moral and ethical requirement. Deontology is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Autonomy is the principle of respect for the individual person. All persons have unconditional intrinsic value. People are self-determining agents who are entitled to decide their own destiny. Beneficence means promoting goodness, kindness, and charity.
An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother's hand moves when she is talking to her. The daughter asks the nurse, "Is mother responding to my voice?" The nurse, attempting to console the daughter, knows the movement was involuntary but states, "It does appear she did." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology
ANS: B Veracity is the principle of telling the truth in a given situation. Autonomy is the principle of respect for the individual person; this concept states that humans have incalculable worth or moral dignity. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Giving the daughter false reassurance is not a good consequence. Deontologic theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Persons are to be treated as ends in themselves and never as means to the ends of others.
In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging
ANS: B Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.
A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea
ANS: B With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.
Select the best description of the difference between a health disparity and a health care disparity: a. When looking at heart attack incidence, difference between population groups is a health care disparity while difference in quality of treatment for heart attack is a health disparity. b. Differences in health behaviors and preferences for treatment are responsible for most health care disparities. c. A health disparity is a difference in health whereby a group with less social status has poorer health outcomes, while a health care disparity means a group has poorer quality of care or less access to health care. d. A health disparity is any difference in health outcomes between two groups, while a health care disparity is a difference that the health system care about.
ANS: C
A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating the ethical principle of: a. veracity b. beneficence c. nonmaleficence d. autonomy
ANS: C Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The nurse is definitely violating this principle through her actions. Veracity is telling the truth in personal communication. Beneficence is promoting goodness, kindness, and charity. Autonomy is the principle of respect for the individual person. This concept maintains that all persons have unconditional intrinsic value.
Ethics applied to nursing can best be defined as: a. doing what is best for the client. b. making good decisions about care. c. care based on what should be done in keeping with the values of the client. d. rules for providing competent care that is based on scientific principles.
ANS: C Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her relationships with clients, clients' family members, other health care providers, policy makers, and society as a whole. A nurse must make an attempt to understand what values are inherent in the situation. "Doing what is best for the client" is not a definition of ethics. "Making good decisions about care" is not a definition of ethics. "Rules for providing competent care that is based on scientific principles." is not a definition of ethics.
A nurse is part of the policy committee for a hospital. The committee is provided with statistics indicating that patients participating in a satisfaction survey felt they lacked sufficient information about new drugs started while hospitalized and continued after discharge. In addition, charts noted high recidivism rates. The committee recommended that a formalized patient education plan be instituted to reconcile all medications and provide patient information about new medications. The committee is using which component of the Institute of Medicine (IOM) 2011 message? a. Nurses should achieve higher levels of education to be effective members of an interdisciplinary team. b. Pay for nurses should be consistent with that of physicians since the committee is interdisciplinary. c. Nurses should have a minimum of a master's degree to sit on policy committees that affect an entire facility. d. Policy is based on data, which provides the groundwork for decision making.
ANS: D The IOM report initiatives include effective workforce planning and policymaking based on better data collection and improved infrastructure. REF: p. 16
What does the Spirit of Nursing statue honor? a. Florence Nightingale's accomplishments in public health b. Edith Cavell's attempt to help the victims of the Tuskegee experiment seek treatment c. Clara Maas, who found the cure for yellow fever during WWII d. All military nurses for their bravery and compassion
ANS: D The statue the Spirit of Nursing was created to honor all military nurses. The statue does not seek to honor Florence Nightingale. Nurse Rivers was the nurse who attempted to help the victims of the Tuskegee experiment. The statue does not honor Clara Maas, and Clara Maas did not find the cure for yellow fever.
Which component of an e-mail would be effective? a. Subject: A short concise subject line: Meeting b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5:00 PM in the first floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582
ANS: D This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication.
A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier's head is an artistic representation of nurses who served in which war? a. World War I b. World War II c. Spanish-American War d. Vietnam War
ANS: D This statue represents the caring provided by nurses during the Vietnam War. There is no statue that represents nursing during World War I. There is no statue that represents nursing during World War II. There is no statue that represents nursing during the Spanish-American War.
The use of research to guide nursing practice is called: a. analysis b. generalizability c. dissemination d. utilization
ANS: D Utilization of research guides nursing practice. Clinical agencies need to make a commitment to implementing research findings and then developing policies and procedures to guide the implementation process.
During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation? a. Failure to take time to put on shoes due to urgency b. Unsteady gait due to narcotic administration c. Poor lighting that led to decreased vision d. Improper construction that caused the leak and towel placement
ANS: D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project. Urinary urgency is not an uncommon or unpredictable variation. Safety measures should be instituted when a narcotic is administered, especially to older adult patients whose ability to metabolize and eliminate the drug may be altered. Lighting was available, but it was not used.
A nursing student asks, "I wonder if the reason that the nursing shortage is so severe is that registered nurses are unhappy with their jobs." To research the answer, the National Survey of Registered Nurses was reviewed and found: a. registered nurses were the least satisfied with their job of all health care providers. b. nursing faculty are aging or leaving academia due to increased work demands and generational difference from students. c. registered nurses change employers every year to prevent burnout and to keep the nursing shortage from increasing. d. practicing registered nurses are satisfied with their job and most remain with same employer they worked for the previous year.
ANS: D According to the latest National Sample Survey of Registered Nurses (NSSR), 79.8% of practicing RNs were satisfied with their job and 88.4% were with the same employer as they had been in the preceding year (U.S. Department of Health and Human Services, 2010). Among all RNs, nursing faculty are the most satisfied (86.6%).
A group of nurses is presenting the importance of quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that: a. being insured has little effect on a person's longevity and the quality of care received b. lobbyists for the drug companies are able to gain permission for the use of new drugs within 1 year of their discovery c. although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS) d. medication-related errors place a tremendous financial burden on the U.S. health care system
ANS: D Medication-related errors for hospitalized patients cost roughly $2 billion annually. Uninsured Americans exhibit consistently worse clinical outcomes than the insured, and they are at increased risk for dying prematurely. The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years. Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents.
A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Aggressive b. Passive c. Assertive d. Passive-aggressive
ANS: D Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering. p. 341
The physician who insists on providing treatment in spite of the client's wishes because he "knows best" is reflecting: a. autonomy b. beneficence c. justice d. paternalism
ANS: D Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client and believes that his or her actions are justified because of a commitment to act in the best interest of the client. Paternalism is a reflection of the "father knows best" way of thinking. Autonomy is the principle of respect for the individual person. Beneficence means promoting goodness, kindness, and charity. Justice states that like cases should be treated alike and equals ought to be treated equally.
A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of a(n): a. interpretation b. context c. precipitating event d. preconceived idea
ANS: D Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message.
Which statement about qualitative research is correct? a. Qualitative research requires less time than quantitative research because complex statistical analysis is not necessary. b. To be statistically significant, qualitative studies must consist of large, randomly selected sample sizes. c. Because qualitative studies deal with human concepts such as suffering and quality of life, results can be generalized. d. Interviews are the primary means of collecting data that enable the researcher to describe unclear phenomena.
ANS: D Qualitative research involves ambiguous concepts. Analysis of interviews with participants who are experiencing the phenomena enables the researcher to describe unclear phenomena.
A prospective nursing student who researches universities that offer a baccalaureate degree in nursing would want to ensure that the program is accredited by the: a. American Nurses Association. b. Commission on Collegiate Nursing Education. c. National Institutes of Health. d. National Nursing Council.
ANS: B The Commission on Collegiate Nursing Education (CCNE) is the agency that exclusively accredits baccalaureate and graduate-degree nursing programs. REF: p. 4, Box 1-1
A nurse interested in life satisfaction among patients receiving hemodialysis reviews databases and identifies relevant studies which are then statistically analyzed providing generalization through multiple studies. The nurse researcher is using which type of research? a. Quasi-experimental b. Secondary analysis c. Meta-analysis d. Survey
ANS: C Meta-analysis uses the analysis of several research studies to validate smaller studies, allowing generalization.
A nurse researcher who is seeking funding for a study should identify: a. board members of funding agencies. b. priorities of funding agencies. c. budgets of funding agencies. d. accreditation of funding agencies.
ANS: B
A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the "meet the candidate" session at the town hall meeting. This is an important time for the nurse to: a. be spontaneous and not deliver a rehearsed speech. b. learn what the key issues are in the candidate's platform. c. address the person as "candidate" rather than using a first name that implies a working relationship. d. educate the public about the nurse's political platform.
ANS: B
Allostatic load may be increased by repeated exposure to: a. BPA containing plastic b. Traumatic events c. Cigarette smoke d. Air pollution
ANS: B
Preface to the Code of Ethics for Nurses with Interpretive Statements states: • the Code of Ethics for Nurses with Interpretive Statements (the Code) establishes the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making. Which of the following statements about the Code is true: a. It may be not be revised or amended. b. It is foundational to nursing theory, practice, and praxis in its expression of the values, virtues, and obligations that shape, guide, and inform nursing as a profession. c. The Code was established to honor Florence Nightingale. d. The Code is negotiable depending upon the patient population and clinical setting.
ANS: B
Which is the best example of a health disparity? a. African-Americans have higher rates of sickle cell disease than Asian-American. b. Infant mortality rates are higher for babies born to women with less than a high school education. c. In 16th century England gout was more common among the wealthy than among the poor. d. Rates of leg fractures are higher for skiers than for non-skiers.
ANS: B
Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to as a(n): a. benchmark b. critical pathway c. algorithm d. case management
ANS: B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. A benchmark is a process used in quality improvement to evaluate different aspects of a process in relation to best practices, with the goal of improving performance. An algorithm represents a decision path that a practitioner might take for a particular condition. Case management is a type of health care delivery that matches the most appropriate services to the patient's care needs in the most efficient, effective manner, often with the use of a critical pathway or a clinical guideline.
A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is known as: a. straw man b. red herring c. slippery slope d. confusing cause and effect
ANS: B A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.
A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n): a. standardization of care b. root cause analysis c. process variation d. analysis of a deployment flowchart
ANS: B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. p. 380
A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a: a. root cause b. sentinel event c. variation in performance d. causal factor
ANS: B A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. p. 380
Three illegal immigrants with no health insurance or money sustained life-threatening injuries during an automobile accident. Two of these individuals had head trauma and lacerated internal organs. The decision was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The third individual received only minor injuries, which were treated in the emergency department. The care of the two critical clients was based on the ethical principle of: a. utilitarianism b. deontology c. autonomy d. veracity
ANS: B Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontologic theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Autonomy is the principle of respect for the individual person. People are free to form their own judgments and perform whatever actions they choose. Veracity is defined as telling the truth in personal communication as a moral and ethical requirement.
A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance
ANS: B Filtration is the unconscious exclusion of extraneous stimuli in communication.
A qualitative researcher reviews data collected with a grief support group to develop a theory of how widows and widowers mourn. The researcher is using which qualitative research design? a. Phenomenology b. Grounded theory c. Case study d. Hypothesis generation
ANS: B Grounded theory is a qualitative research approach that describes a social process and has theory generation as its main purpose.
Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020? a. Positions that historically required registered nurses will be filled by unlicensed personnel. b. The job growth rate for RNs will surpass job growth in all other occupations. c. The need for hospital nurses will dramatically decrease. d. Hospitals will finally achieve the required RN workforce.
ANS: B In 2020 the United States is projected to have only 64% of the registered nursing workforce required to meet the demand for RNs. Unlicensed personnel will not be filling positions for nurses because this group does not have the education needed to provide such care. The need for hospital nurses will dramatically increase, not decrease. Hospitals will not have enough nurses as stated per statistics.
During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a. assertive communication b. active listening c. empathy d. passive communication
ANS: B In active listening, a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.
The research hypothesis is that aromatherapy reduces stress more effectively than does acupuncture. The researcher does not identify a control group. This study would be a(n) _________ design. a. experimental b. quasi-experimental c. survey d. meta-analysis
ANS: B In quasi-experimental studies a control group, randomization, or the manipulation of one or more variables is missing.
What effect did the movie One Flew Over the Cuckoo's Nest have on health care? a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care. b. The public and the nursing profession were made aware of the right of vulnerable populations. c. Nurses were seen as advocates for individuals who cannot advocate for themselves. d. Funding for nursing traineeships was eliminated.
ANS: B One Flew Over the Cuckoo's Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected. The context for the care of patients with mental disability did not change as a One Flew Over the Cuckoo's Nest portrayed nurses as the enforcers of the system. Funding for nursing traineeships was not eliminated. Rather, the Nurse Training Act was established in 1964.
The primary purpose of licensure for RNs is to: a. prevent others from using the title nurse. b. protect the public. c. demonstrate a specialized body of knowledge. d. enhance recognition for the profession.
ANS: B Protecting the public is one of the essential purposes of the state board of nursing, which regulates licensure.
Charles Dickens' character Sairy Gamp: a. portrayed nurses as trained professional individuals who put others before themselves. b. chose nursing because she had no other avenue for employment. c. was a prostitute who took advantage of sick old men. d. characterized nurses as being at the forefront of technology and autonomy.
ANS: B Sairy Gamp endured nursing because of the lack of other opportunities. Sairy Gamp did not portray a professional image of nursing, but that of an untrained caregiver who profited from the sick and dying. Sairy Gamp was a nurse who used her position to take advantage of her patients. Dicken's portrayal of a nurse does not suggest that the nurse is at the forefront of technology and autonomy.
A public health nurse is interested in determining which educational programs are needed in the aggregates served. The researcher personally interviews individuals who are walking on the streets in the community. This type of research design is: a. quasi-experimental. b. survey. c. case study. d. ethnography.
ANS: B Survey is a nonexperimental research design that focuses on obtaining information regarding the status quo of some situation, often through direct questioning of participants.
William is a 24 year old nursing student who has cheated from the time he entered the nursing program. Each semester brings new challenges, and his grades continue to skim the passing point. He finds new ways to cheat and to cover up his lack of nursing knowledge. He is just getting by. He is unable to assemble grammatically correct sentences, organize a research paper, or follow the dreaded APA format as taught or described in his manual. In his junior and senior years he experiences difficulty in integrating nursing theory, practice, and praxis. His faculty is perplexed about allowing him to pass his senior semester and thus not graduate. The faculty sites The Quality and Safety Education for Nurses (QSEN), which establishes the knowledge, skills, and attitudes (KSAs) for professional nurses & The American Association of Colleges of Nursing (AACN), which sets the national standards for America's baccalaureate-and higher-degree nursing education to build her case for William's failure. Which of the following statements concerning Williams's progression is correct? [Case Study adapted from: Ganske, K.M., (September 30, 2010) "Moral Distress in Academia" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 6.] a. He is will be fine once he gets past the challenges of nursing school and QSEN or AACN standards have no significance in the academic decisions of the faculty to provide William with a degree. b. His faculty should have caught him in his freshman year and expelled him from nursing school. c. His dishonesty threatens patient safety and he should not progress. d. He is immature but once he has the responsibility for patient care he will grow up.
ANS: C
A nurse studied a community to determine if there were clients who would benefit from a hospice program if one were developed. This type of research is: a. a survey b. quasi-experimental. c. a needs assessment method. d. a pilot study.
ANS: C A needs assessment method is a study in which the researcher collects data for the purpose of estimating the needs of a group; commonly used to prioritize the needs of an organization or community.
A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain. The nurse injects saline into the client's IV line and takes the morphine for herself. The nurse is violating which principle of ethics? a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas
ANS: C Beneficence is providing benefit to others by promoting their good. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the client's pain medication and substituting saline, the nurse did harm, not good for this client. Autonomy is the principle of respect for the individual person; the nurse does not respect someone that he or she is inflicting harm upon. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Because the client's pain medication was taken from him, the consequences were all bad. Dilemmas are not included as a principle of ethics.
A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication b. filtration c. blocking d. false assurance
ANS: C Blocking occurs when the nurse responds with noncommittal or generalized answers.
Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War? a. Florence Nightingale b. Margaret Hoolihan c. Clara Maas d. Sairy Gamp
ANS: C Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever. Florence Nightingale is the founder of professional nursing. Margaret Hoolihan is a character on a TV show, not an actual nurse. Sairy Gamp is a character in a Charles Dickens novel.
An older adult is unable to reach the phone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "You are just too late for that. Where were you when he needed you?" b. "Did you ever consider purchasing a cell phone for your dad to prevent this from happening?" c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."
ANS: C Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person.
A physician complains to administration that the nurse working last evening is unethical, based on observing the nurse educate the patient about a new medication ordered. The physician demanded the nurse be reprimanded and reminded that only physicians have the educational background to teach patients about new medications. Which comment and action by the administrator would be most effective in changing nurse-physician relationships in this instance? a. Contact the patient's family and ask, "Do you prefer that all teaching related to medications be performed by the physician rather than the nurse" to determine what action to take. b. Inform the nurse, "You will be suspended for 3 days for going beyond your job description," and enforce the 3-day suspension because the physician did not write the order to "teach the patient about the new medication" c. After investigating the situation, thank the physician while also providing information that patient education related to medication is within the scope of practice of registered nurses. Share the physician's concern and administrator's response with the nurse so both parties are aware of the resolution of the concerns. d. Advise the physician that only nurses can teach patients about medications; the physician's role is to only prescribe. No action will be taken against the nurse.
ANS: C Investigating the situation to provide evidence is the first step. Once the facts are known, action can be taken. In this instance, including the ethics committee would help ensure an unbiased decision.
Nurses can combat the nursing shortage by: a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce. b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination. c. working more hours with a higher nurse/patient ratio. d. advocating for funds to pay for nursing education and a safer work environment.
ANS: D Advocating for funds to pay for nursing education and a safer work environment is a positive strategy as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise. Unions are not the answer to the nursing shortage. This approach would make access to health care more difficult, and the nursing shortage would only increase because efforts to attract nurses from younger generations would be reduced by the fact that funding for exposure to nursing would most likely decrease. Lowering standards would increase the chance for errors, cause patient care standards to become lower, and harm the image of nursing. As the acuity level of patients increases, the nurse/patient ratio should be lowered. Facts reveal that lower nurse/patient ratios reduce errors and decrease mortality rates.
A client and her husband used in vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives; she asks that the sperm be destroyed because her husband's faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband's beliefs. The nurse realizes that: a. the client is in the second step of ethical decision making and that the client's value system is influencing her choices of alternative actions. b. a logical line of reasoning has led to validation of the decision to destroy the husband's sperm. c. the client has not been able to navigate the complicated issues inherent in this situation. d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband.
ANS: D After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase the person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings of the justification, and will anticipate objections to the justification. The second step of ethical decision making is identification of hidden issues. Validation of the decision considers many factors and requires analysis of all possible alternatives. No situational decision can be made unless an individual begins with the first step of actually identifying and stating the actual issue.
Which statement accurately describes communication? a. The components of communication are mutually exclusive b. Communication is linear c. Communication involves only the sender and the receiver; everything else is superficial d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback
ANS: D Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.
A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, "What are core competencies?" The nursing instructor replies, "Core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students." b. critical thinking exercises aimed to improve reading and math skills." c. educational opportunities that provide remediation when student is unable to perform psychomotor skills correctly." d. those skills necessary for safe, competent nursing practice."
ANS: D Core competencies are those skills and elements that are fundamental and essential for safe, competent practice. PP. 39-40
In differentiating between early efforts of quality assurance and present-day quality improvement efforts, which statement is correct? Quality assurance: a. had a broad focus b. promoted problem solving by all members of the health care team c. was preventive in nature d. tended to occur as a reaction to a specific problem
ANS: D Early efforts focused on identified problems and were reactive rather than proactive. Quality assurance focused on specific incidents rather than on broad system improvements. With quality assurance, only a few people such as auditors focused on problems, and administration only later recognized the importance of proactive initiatives involving all members of the health care team. Early efforts of quality assurance focused on identified problems rather than on avoiding future problems.
A registered nurse is on break and checking e-mails. One e-mail contains a picture of a celebrity who is a patient in the hospital, and on the same floor, where the nurse works. Included with the photo is a message, "check out my Facebook," which contains additional photographs of the patient. The nurse immediately deletes the picture to prevent having to report the "friend" to supervisors. Based on the action of the nurse who received the message, which statement is correct? a. The nurse is not at risk for having his or her license suspended since removing the photos made them temporary and invisible to all others. b. Because the nurse did not send the message and immediately deleted the photo, there is no risk for discipline. c. Because the patient is on the same floor as the one on which the nurse works, the information can be ethically and legally shared. d. Failing to report receiving the message demonstrates poor ethical and legal role-modeling as well as placing the nurse at risk for discipline.
ANS: D Failing to report the image can result in discipline.
