Chapter 3: Critical Thinking, Ethical Decision Making, and the Nursing Process

The nurse moves a confused, disruptive patient to a private room at the end of the hall so that other patients can rest, even though the confused patient becomes more agitated. The nurse's intervention is consistent with what moral theory?

"Consequentialism," by which good consequences for the greatest number are maximized Explanation: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." The choice of action is clear under this theory, because the action that maximizes good over bad is the correct one. The theory poses difficulty when one must judge intrinsic values and determine whose good is the greatest. In addition, it is important to ask whether good consequences can justify any amoral actions that might be used to achieve them.

A client about to undergo gastric bypass surgery calls the nurse into the room. The client whispers to the nurse a concern that friends will learn about the upcoming surgery and pleads with the nurse to keep the surgery a secret. What response by the nurse is best?

"I am not at liberty to discuss your case with anyone except those directly involved in your care unless you authorize me to do so." Explanation: According to the Health Insurance Portability and Accountability Act (HIPAA) (U.S. Department of Health and Human Services [USDHHS], 2003), efforts must be made to protect each client's private information, whether it is transmitted by verbal, written, or electronic means of communication. Unless authorized by the client, the nurse is not allowed to discuss the client's case with anyone not directly involved in the client's care.

The physician asks the nurse not to disclose a client's diagnosis of end-stage cancer with the client until the client's family can be available to provide support. During the nurse's shift, the client asks the nurse, "What is wrong with me? Everyone is treating me like I am dying." Which of the following replies by the nurse allows the nurse to maintain integrity while providing care for the patient?

"You feel like people are treating you like you are dying?" Explanation: By using the therapeutic communication technique of restating, the nurse demonstrates listening and validates the client's concerns, allowing the nurse to maintain integrity. Calling the chaplain defers care of the client to the clergy. Telling clients they are fine does not provide accurate information to them. Lying to the patient jeopardizes the nurse's integrity and ability to develop a trusting relationship with the client. Although information provided at the client's request protects the client's autonomy, it does not provide respect for others in this situation. Disclosure of sensitive information without compassion and caring may increase the impact and distress related to a poor diagnosis.

The nurse is caring for a group of clients. What priority nursing intervention illustrates planned nursing care prioritized according to Maslow's hierarchy of needs?

Administer pain medication to a client before transportation to physical therapy for crutch-walking exercises. Explanation: Assigning priorities to nursing diagnoses and collaborative problems is a joint effort by the nurse and the client or family members. Any disagreement about priorities is resolved in a way that is mutually acceptable. Consideration must be given to the urgency of the problems, with the most critical problems receiving the highest priority. Maslow's hierarchy of needs provides one framework for prioritizing problems, with importance being given first to physical needs like pain medication needs; once those basic needs are met, higher-level needs like client participation in care or taking advantage of an empty shower area can be addressed. The disruption of a family visit is not necessary unless the client is unstable.

The client has become confused and attempts to climb out of bed. What interventions will the nurse provide prior to applying restraints?

Arrange a schedule for staff to sit with the client. Explanation: The nurse should arrange a schedule for the staff to sit with the client. Calling for sedation is not the first step with caring for a client with confusion. The chair with a sheet and the side rails are restraints. The use of restraints (including physical and pharmacologic measures) is another issue with ethical overtones because of the limits on a person's autonomy when restraints are used. It is important to weigh carefully the risks of limiting autonomy and increasing the risks of injury by using restraints against the risks of injury if not using restraints, which have been documented as resulting in physical harm and death. The ANA advocates that restraints only be used when no other viable option is available. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) have designated standards for the use of restraints

A client has been diagnosed with cardiac dysfunction and admitted to a health care center. The nurse notices that the client's ankles and feet are swollen. Using critical thinking skills, which nursing intervention does the nurse know to perform next?

Assess client for dependent edema Explanation: Initial assessments of swollen ankles and feet are symptoms of dependent edema. Hence, the priority assessment method adopted by the nurse should be oriented toward gathering as much relevant information as possible related to edema. Measuring the client's weight, organizing activities to provide frequent rest periods, and assessing oxygen saturation level are also nursing interventions to be used under appropriate circumstances.

While caring for a client with a deep vein thrombosis of the leg, the nurse monitors for collaborative problems. Which action will the nurse implement while treating collaborative problems for this client?

Assess the respiratory status every 4 hours. Explanation: Collaborative problems are physiologic complications for which nurses monitor. By assessing the client's respiratory status, the nurse is monitoring for the complication of a pulmonary embolism.

The nurse is administering a medication to a client for the treatment of his constipation. The client states that he prefers not to take the medication today. The nurse respects the client's right and informs him if he needs it later, just let the nurse know. What professional value is the nurse displaying?

Autonomy Explanation: Autonomy refers to a client's right to self-determination or the freedom to make choices without opposition. Nonmaleficence is the duty to do no harm to the client. If a nurse fails to check an order for an unusually high dose of insulin and administers it, he or she has violated the principle of nonmaleficence. Beneficence is the duty to do good for the clients assigned to the nurse's care. The nurse has a duty to remove wrist restraints whenever possible (removing a harm) and to help the client regain independence (promoting and doing good). Fidelity is the duty to maintain commitments of professional obligations and responsibilities.

The use of patient restraints limits which ethical principle?

Autonomy Explanation: It is important to weigh carefully the risk of limiting a client's autonomy and increasing the risk of injury by using restraints against the risk of not using restraints. Beneficence refers to an act of goodness, justice in nursing often refers to bioethics and means giving to others what is due, finally trust is building a relationship based on reliability and truths. The patient's autonomy is limited with the use of restraints.

The nurse obtains a client's oral temperature reading of 36.8°C. How should the nurse proceed?

Document the client's temperature result as obtained. Explanation: The normal oral temperature can vary from 36.6°C to 37.3°C. There is a normal variation of 1 or 2 degrees in body temperature throughout the day.

Which of the following is a cognitive or mental activity that nurses use in critical thinking?

Drawing on past clinical experiences and knowledge to explain what is happening Explanation: Intellectual skills used in critical thinking include drawing on past clinical experiences and knowledge to explain what is happening, priority setting with timely decision making, and determining client-specific outcomes. Bias is not used to achieve goals.

A client has designated her daughter as a person to make healthcare decisions for the client if he is not able to do so. What type of advance directive is this considered?

Durable power of attorney (DPOA) for healthcare Explanation: A client may designate another person to be the DPOA for healthcare or healthcare proxy. This person has the authority to make healthcare decisions for the client if he or she is no longer competent or able to make these decisions. A general power of attorney does not give that designated person the ability to make healthcare decision. In DNR order, the client wishes to have no resuscitative action taken if he or she experiences a cardiac or respiratory arrest. A living will is a document that states a client's wishes regarding healthcare if he or she is terminally ill.

Which source of information helps the nurse formulate nursing diagnoses for a specific client?

Essential assessment data Explanation: In the diagnostic phase of the nursing process, the client's nursing problems are defined through analysis of client data. Establishing a plan comes after collecting and analyzing data, evaluating a plan is the last step of the nursing process, and assigning a positive value to each consequence is not done.

Which term is defined as a formal systematic study of moral beliefs and values as they relate to well-being?

Ethics Explanation: Ethics is the formal, systematic approach used to understand, analyze, and evaluate moral principles and values. Veracity is the obligation to tell the truth and not to lie or deceive others. Fidelity is keeping a promise. Moral uncertainty occurs when a person cannot accurately define what the moral situation is or what moral principles apply but has a strong feeling that something is not right.

Healthcare providers use a problem-solving approach for ethical dilemmas. Which is the last step of the ethical decision-making model?

Evaluate the decision in terms of effects and results. Explanation: Evaluating the decision is the very important last step. Making the decision and following through on it are important, but they are not the last step. Surveying other healthcare professionals is not part of the ethical decision-making model. Detailed documentation is important in regard to many professional duties, but it is not the last step of the ethical decision-making model.

A client is to be discharged from an acute care facility after treatment for pneumonia. The nurse notes that the client's lungs are clear and denies shortness of breath. The nurse's actions reflect which step of the nursing process?

Evaluation Explanation: Evaluation, the final step of the nursing process, allows the nurse to determine the client's response to the nursing interventions and the extent to which the objectives have been achieved. The other answers are incorrect because they are not the correct phase of the nursing process

A client reports postoperative pain near the incision site on his abdomen. He describes the pain as constantly burning and rates it at an 8/10 using the pain scale. The nurse administers morphine sulfate 2 mg IVP as ordered. Ten minutes later the nurse documents that the client now rates his pain at a 3/10 using the pain scale. The nurse's documentation is an example of which part of the nursing process?

Evaluation Explanation: Evaluation, the final step of the nursing process, allows the nurse to determine the client's response to the nursing interventions and the extent to which the objectives have been achieved. The other answers are incorrect because they are not the correct phase of the nursing process.

What statement does the nurse determine is a medical diagnosis rather than a nursing diagnosis?

Fever of unknown origin Explanation: It is important to remember that nursing diagnoses are not medical diagnoses; they are not medical treatments prescribed by the physician, and they are not diagnostic studies. Rather, they are succinct statements in terms of specific patient problems that guide nurses in the development of the plan of nursing care. Fever of unknown origin is a medical diagnosis. The rest are nursing diagnoses.

The nurse is assigned to a group of clients on the medical floor. A visitor tells the nurse that their neighbor is a client at the hospital and doesn't know what is wrong. The nurse checks the client's EMR (electronic medical record) and proceeds to inform the visitor about the client's diagnosis. What type of violation has the nurse committed?

HIPAA violation Explanation: The client has the right to request restrictions and confidential communications concerning protected health information, which is an overview of the major client protections provided by HIPAA. Although a violation of trust and hospital policy, it is first and foremost a violation of HIPAA.

Which type of nursing diagnosis has a goal to increase well-being and enhance specific health behaviors?

Health promotion Explanation: Health promotion nursing diagnoses look for ways to enhance health. Risk nursing diagnoses identify potential problems and use the stem risk for, as in Risk for Impaired Skin Integrity related to inactivity. Syndrome diagnoses are used when the diagnosis is associated with a cluster of other diagnoses. Problem-focused nursing diagnoses identify existing problems.

Which element is involved in the planning phase of the nursing process?

Identify measurable outcomes Explanation: The planning step of the nursing process involves identifying measurable outcomes, selecting nursing interventions, and documenting the planning steps. The implementation step involves carrying out nursing orders. The diagnosis step involves identifying collaborative problems. Completing a health history is done in the assessment step.

The nurse and patient establish a goal to stand at the bedside for 5 minutes prior to the end of her shift at 2300. Earlier that day the patient had a total knee replacement. This is an example of which type of goal?

Immediate goal Explanation: The patient and family are included in establishing goals for the nursing actions. Immediate goals are those that can be attained within a short period. Intermediate and long-term goals require a longer time to be achieved and usually involve preventing complications and other health problems and promoting self-care and rehabilitation.

Which communication technique is helpful in health teaching about relevant aspects of a client's well-being and self-care?

Informing Explanation: Informing is helpful in health teaching or client education about relevant aspects of the client's well-being and self-care. Silence involves periods of no verbal communication among participants for therapeutic reasons. Reflection validates the nurse's understanding of what the client is saying and signifies empathy, interest, and respect for the patient. Humor promotes insight by bringing repressed material to consciousness, resolving paradoxes, tempering aggression, and revealing new options.

While reviewing the chart of a client who was recently admitted, the nurse will use the nursing process to set up a plan of care. Order the activities the nurse will do in the most likely sequence from 1 to 5. Use all options.

Inquire about the reason for the admission. Choose the nursing diagnosis of Acute Pain. Confer with the client about the desire for pain control. Administer the prescribed 4 mg of IV push morphine. Re-assess the pain level. Explanation: The nursing process is a deliberate problem-solving approach for meeting client health care and nursing needs. The common steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation. The nurse will obtain the health history by inquiring about the chief complaint, identify a nursing diagnosis, assist the client to plan a goal, provide treatment, and re-assess the problem.

A client with HIV is visiting the health care center for a regular checkup. The client's symptoms indicate multiorgan infections, and the client reports extreme weakness and feeling depressed most of the time, as friends and colleagues have distanced themselves from the client. Which are the primary areas of concern for the nurse attending the client? Select all that apply.

Instruct the patient to take frequent rest periods. Refer patient to seek psychosocial counseling. Provide patient education related to multiorgan infections. Explanation: Independent HIV nursing management involves managing the client's psychosocial and educational needs. Diagnosis of opportunistic infections and medication prescription based on viral load are areas of interdependent concerns in disease management.

Which of the following is a true statement about critical thinking in nursing?

It involves purposeful, outcome-directed thinking. Explanation: In nursing, critical thinking involves purposeful, outcome-directed thinking. Critical thinking makes judgments based on evidence rather than conjecture. Providing a foundation for evaluation and quality improvement and showing trends and patterns in client status are functions served by documentation.

The nurse understands that one of the characteristics of critical thinking is flexibility. What can the nurse do to achieve this characteristic?

Modify priorities and adapt to change. Explanation: In order to demonstrate flexibility, the nurse must be able to modify previous priorities as well as adapt to change. Listening to new ideas and other viewpoints is an example of being open minded. Accepting that answers may not come easily is an example of perseverance, and being able to foresee probable outcomes is an example of the ability to weigh advantages and disadvantages before making decisions.

Based on the nurse's knowledge of the increased risk for bleeding in a client undergoing chemotherapy or radiation, which of the following interventions does the nurse need to include in the client's plan of care? Select all that apply.

Monitoring the platelet count Monitoring for signs of abnormal bleeding Instructing the client to use a soft toothbrush Instructing the client to use an electric razor Explanation: Utilizing critical thinking skills, the nurse knows to implement individualized interventions to reduce the client's risk of bleeding. Hence, the nurse must frequently assess platelet counts, monitor for signs of abnormal bleeding, and instruct the client and family about ways to minimize bleeding, such as using a soft toothbrush and/or an electric razor. Medications that may interfere with clotting, such as aspirin, should be avoided, and blood draws and injections should be kept to a minimum.

The nurse is to administer a potassium supplement to the client. The nurse does not check the potassium level prior to administering the medication and later finds that the potassium level was at a critical high. What principle has this nurse violated?

Nonmaleficence Explanation: Nonmaleficence is the duty to do no harm to the client. For instance, if a nurse fails to check an order for an unusually high dose of insulin and administers it, he or she has violated the principle of nonmaleficence. Beneficence is the duty to do good for the clients assigned to the nurse's care. The nurse has a duty to remove wrist restraints whenever possible (removing a harm) and to help the client regain independence (promoting and doing good). Fidelity is the duty to maintain commitments of professional obligations and responsibilities. Autonomy refers to a client's right to self-determination or the freedom to make choices without opposition.

Which set of nursing actions demonstrates that the nurse understands the nursing process?

Obtaining vital signs and pain scale rating, documenting the nursing diagnosis as acute pain, administering analgesic, and evaluating comfort level Explanation: Steps of the nursing process, in order, are assessment, diagnosis, planning, implementation, and evaluation (ADPIE). Assessment is the systematic collection of data to determine the client's health status and any actual or potential health problems. Nursing diagnoses are actual or potential health problems that can be managed by independent nursing interventions. Planning is the development of goals and outcomes. Implementation is the actualization of the plan of care through nursing interventions. Evaluation is the determination of the client's responses to the nursing interventions and the extent to which the outcomes have been achieved. The other answers are incorrect, though important nursing interventions and tasks. The question is asking about the steps of the nursing process (ADPIE). Answer B: Assessing for allergies, administering analgesic, obtaining baseline vital signs, and documenting the nursing diagnosis as acute pain does not include the evaluation of (ADPIE). Answer C: Reviewing the health record, documenting client goals, identifying the etiology of the nursing problem, and evaluating treatment outcomes, misses the first two steps: assessment and diagnosis. Answer D: Prioritizing client goals, documenting all health records precisely, conducting the health history, and documenting the nursing diagnosis- assessing is the first step of the nursing process, prioritizing client goals is based on the assessment process.

The RN develops an outcome standard of "client will ambulate with an assistive device 60 feet with assistance twice a day" for a client who had a hip replacement. What part of the nursing process is involved with this outcome statement?

Planning Explanation: Establishing the outcomes and actions will help the client achieve the overall goals of care. Assessment is the careful observation and evaluation of a client's health status by the collection of data. Implementation is putting the plan into action, and evaluation is determining the client's responses to the care provided.

Which situation would require the nurse to use critical thinking and decision-making skills in providing genetics-related nursing care?

Providing fertility counseling to a young family with a 2-year-old child with cystic fibrosis Explanation: Cystic fibrosis is an autosomal recessive genetic disorder. Parents of a child diagnosed with cystic fibrosis have a 50% chance of having another child with cystic fibrosis. Once the nurse assesses the family history, it is appropriate nursing action to for the nurse to make a referral for genetic testing or counseling. Although ADHD may have a genetic component, there is no genetics-related issue in this situation. Lead poisoning is not a genetic disorder. There is no indication that any of the children in the blended family have a genetics-related problem.

Which therapeutic communication technique may occur during the planning stage, when the client is presented with alternative ideas for consideration relative to problem solving?

Suggesting Explanation: Suggesting is the presentation of alternative ideas for the client's consideration relative to problem solving. Clarification is asking the client to explain what he or she means or attempting to help verbalize the client's vague ideas or unclear thoughts to enhance the nurse's understanding. Focusing includes questions or statements to help the client develop or expand an idea.

The nurse has developed a plan of care for a client who is having a surgical procedure and is at risk for the development of pneumonia. The nurse devises the outcome statement to read: "The client will have clear lungs by the third postoperative day. " On the third postoperative day, the client has left lower lobe crackles and infiltrates on the chest x-ray. What conclusion does the nurse reach for this client?

The outcome is not achieved, and the plan requires critical reevaluation and revision. Explanation: The client has not achieved the outcome and in fact has potentially developed pneumonia. The plan will require critical- reevaluation, and new outcomes will be required to assist with resolving the potential pneumonia. The other evaluation criteria are not correct for this particular client's condition.

A nurse chooses a quiet, private area to conduct an end-of-shift report to the oncoming nurse. Following this procedure is necessary because of what ethical problem in nursing?

The right of confidentiality is essential to protect each client's private information. Explanation: Confidentiality is essential to protect the rights of clients. The Health Insurance Portability and Accountability Act (HIPPA) is federal legislation to protect client privacy. Violation of this act could result in criminal or civil litigation. Logging off the computer ensures no one readily has access to client information.

A client has been admitted to the hospital with a large sacral pressure ulcer. The physician orders the wound care protocol to be performed twice a day. What would be a statement on the plan of care that would address the implementation phase of the nursing process for this client?

Turn the client every 2 hours. Explanation: Turning the client every 2 hours is implementing care to allow the pressure ulcer to heal and prevent another formation of a wound. Option A is the assessment phase of the nursing process. Option B is the planning phase of the nursing process, and option C is the evaluation phase of the nursing process.

When an ethical decision is made based on the reasoning of the "greatest good for the greatest number," what theory is the nurse following?

Utilitarian theory Explanation: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." Another theory in ethics is the deontological or formalist theory, which argues that ethical standards or principles exist independently of the ends or consequences

A hospital board of directors decides to close a pediatric burn treatment center (BTC) that annually admits 50 patients and to open a treatment center for terminally ill AIDS patients (with an expected annual admission of 200). This decision means that the nearest BTC for children is now 300 miles away. What example of ethical reasoning is this decision consistent with?

Utilitarianism Explanation: One classic theory in ethics is teleologic theory or consequentialism, which focuses on the ends or consequences of actions. The best-known form of this theory, utilitarianism, is based on the concept of "the greatest good for the greatest number." Another theory in ethics is the deontological or formalist theory, which argues that ethical standards or principles exist independently of the ends or consequences. Beneficence is the obligation or duty to do good and the active promotion of benevolent acts (e.g., goodness, kindness, charity).

The nurse is preparing to serve on the hospital's ethics committee. What are ethical dilemmas in the nurse's clinical practice that can show direct conflict with the principle of veracity? Select all that apply.

administering placebos for pain relief keeping a client's medical diagnosis from the client revealing a diagnosis to people other than the client with the diagnosis Explanation: Veracity is telling the truth. The ethical dilemmas in clinical practice that can directly conflict with the principle of veracity are administering placebos (nonactive substances used for treatment), not revealing a diagnosis to a client, and revealing a diagnosis to people other than the client with the diagnosis. All involve the issue of trust, which is an essential element in the nurse-client relationship. Speaking with any health care professional that is directly involved with the care of the client is acceptable. Teaching a client about self-care is not a violation of veracity.

A client has been a resident of a long-term care facility for several years. The client's condition has deteriorated to the point that the client is now unable to eat. The physician has recommended surgical implantation of a feeding tube. The client's family has a legal document outlining the client's wishes in regard to measures such as this. What is this document?

advance directive Explanation: An advance directive provides the means for clients to communicate their wishes regarding life-sustaining treatment and other medical care, so that their significant others will know what decisions the clients desire. The two types of advance directives are the living will and durable power of attorney for healthcare. Informed consent is voluntary permission granted by a client or the client's healthcare proxy for a treatment, procedure, or surgery to be performed. A form is used to obtain this consent. A durable power of attorney is a legal document that appoints a person to act as an agent for another person. A DPOA for healthcare appoints a person to make medical decisions for a client who is incapacitated and unable to make decisions for himself or herself. Do-not-resuscitate (DNR) orders involve a written medical order for end-of-life instructions. If a DNR order is written, the client wishes to have no resuscitative action taken if he or she experiences a cardiac arrest.

The nurse is attending a client with chronic renal failure. The client is experiencing a loss of appetite and reports feeling like everyday situations have become more stressful. The client reports feeling disappointed and frustrated with the condition, and says the family is not getting any help. What is the most important nursing intervention that the nurse needs to carry out at this point?

coordinate with resources for client support Explanation: Promotion of psychological comfort is one of the most important aspects of the care of a client with chronic renal failure. Coordination of resources for client support is an appropriate nursing intervention in this situation. Scheduling a family meeting is a start, but more resources for the client may be needed. Nutritional counseling and administration of immunosuppressant drugs are medical management tasks.

A nurse in a hospice facility cares for clients with terminal illnesses and witnesses a great deal of pain and emotional distress. Which factor that affects healthcare ethics determines how the nurse must respond when a client asks for help in ending his or her suffering?

legislative and judicial decisions Explanation: Society's struggles with ethical issues result in legislative and judicial decisions that affect ethical decisions. Nurse practice acts prohibit nurses from assisting clients to die. The other options are factors that do not affect the nurse's ethical position.

Which type of nursing diagnosis identifies an existing condition that the client is experiencing?

problem-focused Explanation: The problem-focused diagnosis identifies an existing problem such as Urinary Retention or Anxiety. The health promotion diagnosis is a judgment of a client's motivation and behavior to increase well-being. The risk diagnosis identifies potential problems for which the client is at risk. The syndrome diagnosis describes specific diagnoses that occur as a group.

The nurse is caring for a client who has been intubated and on a mechanical ventilator and has been restrained with soft wrist restraints. The client no longer requires the restraints, so the nurse removes them. What type of ethical decision making does the nurse display?

Beneficence Explanation: Beneficence is the duty to do good for the clients assigned to the nurse's care. The nurse has a duty to remove wrist restraints whenever possible (removing a harm) and to help the client regain independence (promoting and doing good). Fidelity is the duty to maintain commitments of professional obligations and responsibilities. Autonomy refers to a client's right to self-determination or the freedom to make choices without opposition. Nonmaleficence is the duty to do no harm to the client.

Which ethical principle refers to the duty to do good?

Beneficence Explanation: Beneficence is the duty to do good to benefit others and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict and to prevent and remove harm; it is more binding than beneficence.

Which of the following is the highest level of human need according to Maslow (1968)?

Self-actualization Explanation: The highest level need is self-actualization. The first level of need is physiological needs. Love and belonging are third-level needs. Esteem and self-esteem are fourth-level needs.

The nurse is prioritizing the care of a client who has diagnoses of uncontrolled diabetes and may have the left foot amputated related to a nonhealing ulcer. What need would the nurse place at the lowest level while prioritizing this client's care?

Self-actualization needs Explanation: Self-actualization needs are the fifth and last level. Physiologic needs are the first level, safety and security needs are the second level, and love and belonging needs are the third level.

In which situation is the nurse demonstrating the ethical principle of beneficence?

Volunteering to provide vaccinations at a local health center Explanation: Beneficence is the duty to do good to benefit others and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict harm as well as to prevent and remove harm; it is more binding than beneficence.

An advanced directive in which one person identifies another person to make health care decisions on his or her behalf is known as

a durable power of attorney for health care. Explanation: A durable power of attorney for health care is a type of advance directive in which one person identifies another person to make health care decisions on his or her behalf. Living wills are limited to situations in which the client's medical condition is deemed terminal. A DNR order is an order to have no resuscitative action taken if the client experiences cardiac arrest. Hospice is a type of palliative care for clients with terminal diagnoses.

A client has just returned to the unit following abdominal surgery and is in significant pain. According to the nursing process, how frequently will the nurse perform assessments on this client?

as often as needed Explanation: Assessment is an important, recurring nursing activity that continues as long as a need for healthcare exists. During assessment, the nurse methodically obtains data about the client's health, illness, and change in condition.

How is assessment defined as part of the nursing process?

careful observation and evaluation of a client's health status Explanation: During assessment, the nurse methodically obtains data about the client's health and illness. He or she collects information to determine abnormal function and risk factors that contribute to health problems as well as client strengths. The other options define nursing diagnosis, planning, and implementation.

Several days this week, a nurse takes time after work to read to a visually impaired client who has no family close by. This behavior demonstrates that ethical values:

concern the treatment of others. Explanation: Ethical values are rules or principles a person uses to make decisions about right and wrong. These values are consistent, they take priority over other values, they concern the treatment of others (as shown by this nurse taking personal time to show kindness to her client), and they are well thought out.

The physician has ordered cimetidine for a client with gastric ulcers, and the nurse administers the first dose. The nurse's actions are noted in the medical record. This notation is an example of which aspect of implementing the plan of care?

documentation Explanation: An important element of implementation is documentation. By law, nurses must document all nursing actions, observations, and client responses in a permanent record.

Which type of nursing diagnosis identifies potential problems that may arise due to the client's disease, condition, or situation?

risk Explanation: Risk nursing diagnoses identify potential problems and use the stem "risk for" as in Risk for Impaired Skin Integrity related to inactivity. The actual diagnosis identifies an existing problem such as Urinary Retention or Anxiety. The health promotion diagnosis is a judgment of a client's motivation and behavior to increase well-being. The syndrome diagnosis describes specific diagnoses that occur as a group.

A nurse using critical thinking interprets data and determines appropriate interventions. What factor will affect the nurse's ability to employ critical thinking with data interpretation?

the nurse's personal biases Explanation: Nurses using critical thinking will consider the possibility of personal bias when interpreting data. The other options such as the nurse's gender and the client's admission date and diagnosis are not appropriate considerations with using critical thinking.

A longterm care facility's newest client refuses to attend group activities or social events offered by the facility. Which level of Maslow's hierarchy do social events address?

third: love and belonging needs Explanation: Group activities and social events address love and belonging needs, which is the third level of Maslow's hierarchy.

A client presents to the acute care facility with several signs and symptoms. How will the nurse determine and prioritize the client's healthcare needs?

using a systematic method to plan and implement care to reach desired outcomes Explanation: Clients present with multiple healthcare needs that the caregiver must approach in an organized, systematic manner to provide efficient and effective care. The nursing process for making clinical decisions grew from problem-solving techniques and the scientific process

A nurse saw a coworker steal drugs from a locked cabinet. The supervisor notices the missing drugs and has a good idea who is responsible for the theft. The supervisor asks if the nurse saw anything out of the ordinary. Which professional value reflects a nurse's duty to tell the truth?

veracity Explanation: Veracity is the nurse's duty to tell the truth in all professional situations. Autonomy refers to a client's right to self-determination. Beneficence is the duty to do good for the clients assigned to the nurse's care. Nonmaleficence is the duty to do no harm to the client.

Which of the following is a true statement about critical thinking according to Alfaro-LeFevre (2010)?

It is guided by professional standards and codes of ethics. Explanation: Critical thinking is guided by professional standards and codes of ethics. It is based on principles of the nursing process and scientific methods. Critical thinking makes judgments based on evidence rather than conjecture. It considers client, family, and community needs.

Which critical thinking skill involves identification of client problems indicated by data?

Analysis Explanation: Analysis is used to identify client problems indicated by data. Interpretation is used to determine the significance of data that are gathered. Inference is used by the nurse to draw conclusions. Explanation is the justification of actions or interventions used to address client problems and to help a client move toward desired outcomes.

Which of the following is a true statement about a living will?

It states the client's wishes regarding healthcare if terminally ill. Explanation: A living will states the client's wishes regarding healthcare if terminally ill. It does not specify information regarding nontreatment only, it is not a legal consent, and it is not a type of financial agreement.

The nurse is preparing a client for a colonoscopy at the hospital. Who does the nurse understand is responsible for obtaining the informed consent from this client?

The health care provider Explanation: The health care provider obtains the informed consent and must inform the client of the description of the procedure, potential benefits, material risk involved, acceptable alternatives available, expected outcome, and consequences if the procedure is not done.

The nurse is developing a client's care plan. What activity best exemplifies the assessment phase of the nursing process?

determines the client has a pulse rate of 88 bpm Explanation: The assessment phase of the nursing process includes a health history and physical examination. The pulse rate is obtained during a physical assessment. The remaining options are not data obtained during the assessment phase, but steps in the implementation phase of the nursing process.

The nurse is developing a care plan. At which step of the nursing process will the nurse order the primary interventions to achieve a goal?

planning Explanation: Nurses will add interventions during the planning stage of the nursing process. Assessment data are gathered through the health history and the physical assessment. Evaluation, the final step of the nursing process, allows the nurse to determine the patient's response to the nursing interventions and the extent to which the objectives have been achieved. Collaborative problems pertain to potential problems or complications that are medical in origin and require collaborative interventions with the health care provider and other members of the health care team.