Ethical, Legal and Practice Standards Practice Questions
A competent, hospitalized patient diagnosed with multiple chronic medical problems is being discharged home by the RN. Which of the following is the priority education for the RN to teach the patient? 1. Completing a Physician's orders for life-sustaining treatment (POLST) form 2. Discontinuing advanced directives, as they are not legal outside of medical care facilities 3. Modifying the durable power of attorney for health care for home setting 4. Nullifying the living will as the illness progresses
1. Completing a Physician's orders for life-sustaining treatment (POLST) form *1) Physician's orders for life-sustaining treatment (POLST) forms provide emergency services medical orders, which are transferrable across settings. 2) Advance directives can remain in effect. 3) Changes in setting do not require a change in durable power of attorney for health care. 4) A patient can nullify a living will, but this is not the priority at this time.
When caring for a terminally ill patient a family member says, "I need your help to hasten my mother's death so that she is no longer suffering." What should the nurse do based on the position of the American Nurses Association in relation to assisted suicide? 1. Not participate in active euthanasia 2. Participate based on personal values and beliefs 3. Participate when the patient is experiencing severe pain 4. Not participate unless two practitioners are consulted and the patient has had counseling
1. Not participate in active euthanasia Nursing actions must comply with the law, and the law states that euthanasia is legally wrong. Euthanasia can lead to criminal charges of homicide or civil lawsuits for providing an unacceptable standard of care.
A nurse suspects that a treatment ordered by a physician will harm her patient; what would be the proper action for the nurse to take? 1. Refuse to carry out orders and report the situation to her nurse supervisor 2. Carry out the orders, then immediately report to her nurse supervisor 3. Inform the patient and allow her to choose whether or not to accept treatment 4. Report the physician to hospital's human resources department
1. Refuse to carry out orders and report the situation to her nurse supervisor Even though it is the physician's orders that the nurse is following, the responsibility of any nursing actions will be the responsibility of the nurse. The proper action would be to avoid doing anything that would harm a patient and report to the nurse supervisor.
Which of the following is the best example of an issue reflecting medical ethics? 1. The MD and the patient's family decide to stop tube feedings for the patient 2. A patient with a history of drug abuse has not been receiving adequate pain relief because the lowest dose of the PRN narcotic is being given. 3. The physical therapist is refusing to work with a patient who is overweight because she believes she will be injured. 4. A patient with a history of ETOH abuse and drug abuse will receive a liver transplant.
1. The MD and the patient's family decide to stop tube feedings for the patient
Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? 1 Consult a professional ethicist to ensure that the steps of the process occur in full. 2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 3 Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. 4 List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion.
2 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.
Which of the following explain how health care reform is an ethical issue? (Select all that apply.) 1 Access to care is an issue of beneficence, a fundamental principal in health care ethics. 2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.
2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.
The client who requires a co-signature for a valid consent for surgery is a: 1. 15-year-old mother whose infant requires exploratory surgery 2. 40-year-old resident in a home for developmentally disabled adults 3. 90-year-old adult who wants more information about the risks of surgery 4. 50-year-old unconscious trauma victim who needs insertion of a chest tube
2. 40-year-old resident in a home for developmentally disabled adults 1. A mother may legally make medical decisions for her children even if the mother is younger than 18 years of age. 2. CORRECT: A client living in a protected environment such as a home for developmentally disabled adults may not have the mental capacity to make medical decisions and requires the signature of a court-appointed legal representative. This person could be a parent, sibling, relative, or unrelated individual. 3. Older adults can make decisions for themselves as long as they understand the risks and benefits of the surgery and are not receiving medication that may interfere with cognitive ability. 4. The insertion of a chest tube to inflate a lung is an emergency intervention to facilitate respiration and oxygenation. This emergency procedure is implemented to sustain life and does not require a signed consent if the client is incapacitated.
A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status post knee replacement. What would be the best explanation why their care plans may be different from each other? 1. Patients may have different insurers, or one may qualify for Medicare 2. Individual patients are seen as unique and dynamic, with individual needs 3. Nursing care may be coordinated by members of two different health disciplines 4. Patients are viewed as dissimilar according to their attitude toward surgery
2. Individual patients are seen as unique and dynamic, with individual needs Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences in insurance coverage and attitude may be relevant, but these should not fundamentally explain the differences in their nursing care. Nursing care should be planned by nurses, not by members of other disciplines.
An elderly client tells her nurse that she fell the night before and was unable to get up because her caretaker had left due to a family emergency. Which response by the nurse is most appropriate? 1. Nothing. This issue is outside the scope of the nurse's duty to her client. 2. Report suspicions of elder abuse to the proper authorities. 3. Provide the client with information about how to recognize elder abuse. 4. Speak with client's caretaker about her responsibilities to her client.
2. Report suspicions of elder abuse to the proper authorities. Nurses are mandated reporters and are required by law to report suspected abuse, neglect or exploitation. Neglect is the absence of care necessary to maintain the health and safety of a vulnerable individual such as a child or elder. In this case, the client was a victim of neglect because her caretaker left her alone and without care and the client suffered an injury as a result.
The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy
3 Nonmaleficence
Which of the following would be considered a violation of the ANA Code of Ethics for Nurses (2005) for end of life issues? 1. A nurse honoring competent and informed client's decision to withhold food and fluids. 2. A nurse withholding food and fluids because it is determined to be harmful by the physician. 3. A nurse withholding life sustaining treatment because she knows the client is about to die. 4. A nurse keeping clients families informed that they can reevaluate life sustaining decisions.
3. A nurse withholding life sustaining treatment because she knows the client is about to die.
When attempting to administer a 10:00 PM sleeping medication, the nurse assesses that the patient appears to be asleep. What should the nurse do? 1. Withhold the drug 2. Notify the practitioner 3. Awaken the patient to administer the drug 4. Administer it later if the patient awakens during the night
3. Awaken the patient to administer the drug 1. This is a violation of the practitioner's order. Drug administration is a dependent nursing function. 2. This is unnecessary. 3. CORRECT: Administering a medication is a dependent function of the nurse. The prescription should be followed as written if the prescription is reasonable and prudent. This medication was not a PRN medication but rather a standing order. 4. The drug should be administered as prescribed not at a later time.
The nurse is caring for a client with stage 4 pancreatic cancer. The patient is alert and oriented times 3 and tells the nurse that he would like to be a DNR/DNI and would like to transition to comfort cares. The patient's family is upset by this and tells the nurse that the patient is depressed and doesn't know what he's saying . What should the nurse do? 1. The nurse should tell the family that she's not getting involved in this family dilemma and will send in the patient's social worker to deal with this matter. 2. The nurse should encourage the client to reconsider his decisions 3. The nurse should honor the patient's decisions 4. The nurse should consult with palliative care and service to have a care conference with the patient to persuade him into changing his mind about stopping treatment
3. The nurse should honor the patient's decisions
A practitioner asks the nurse to witness an informed consent. Which patient does the nurse identify is unable to give an informed consent for surgery? 1. 16-year-old boy who is married 2. 35-year-old woman who is depressed 3. 50-year-old woman who does not speak English 4. 65-year-old man who has received a narcotic for pain
4. 65-year-old man who has received a narcotic for pain 1. Legally, individuals younger than 18 years old can provide informed consent if they are married, pregnant, parents, members of the military, or emancipated. 2. A depressed person is capable of making health-care decisions until proven to be mentally incompetent. 3. This person can provide informed consent after interventions ensure that the person understands the facts and risks concerning the treatment. 4. CORRECT: Narcotics depress the central nervous system, including decision-making abilities. This person is considered functionally incompetent.
When considering legal issues the word contract is to liable as standard is to: 1. Rights 2. Negligence 3. Malpractice 4. Accountability
4. Accountability 1. Although patients have a right to receive care that meets appropriate standards, the word right does not have the same relationship to the word standard as the relationship between the words contract and liable. 2. The words standards and negligence do not have the same relationship as contract and liable. Negligence involves an act of commissioner omission that a reasonably prudent person would not do. 3. The words standards and malpractice do not have the same relationship as contract and liable. Malpractice is negligence by a professional person. 4. CORRECT: Liable means a person is responsible(accountable) for fulfilling a contract that is enforceable by law. Accountable means a person is responsible (liable)for meeting standards, which are expectations established for making judgments or comparisons.
You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional RN's to guide care decisions. A non-nursing colleague asks about this code, which of the following statements best define this code? 1. Improves self-health care 2. Protects patient's confidentiality 3. Ensures identical care to all patients 4. Defines the principles of right and wrong to provide patient care.
4. Defines the principles of right and wrong to provide patient care.
The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Which principle is the priority in a discussion about ethics? 1 Accountability because you as the nurse are accountable for the well-being of this patient 2 Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant 3 Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant 4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources
4. Justice The first and greatest question in this situation is how to determine the just distribution of resources Accountability, respect for autonomy, and ethics of care are not necessarily incorrect answers, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice.
Which factor is unique to malpractice when comparing negligence and malpractice? 1. The action did not meet standards of care 2. The inappropriate care is an act of commission 3. There is harm to the patient as a result of the care 4. There is a contractual relationship between the nurse and patient
4. There is a contractual relationship between the nurse and patient 1. There is a violation of standards of care with both negligence and malpractice. 2. Negligence and malpractice both involve acts of either commission or omission. 3. The patient must have sustained injury, damage, or harm with both negligence and malpractice. 4. CORRECT: Only malpractice is misconduct performed in professional practice, where there is a contractual relationship between the patient and nurse, which results in harm to the patient.
Mr. Z. is a motorcycle enthusiast and daredevil. Nevertheless, he is concerned about advance care planning and always keeps a copy of his Directive to Physicians (Living Will) right with him. This document states in no uncertain terms that he never wants to be intubated. One evening he has an accident and is brought to the closest ED. His living will and his wishes thereof are noted in his medical record. Mr. Z. has a possible closed head injury and his LOC and respiratory status start to deteriorate. If he is not intubated he will become severely compromised or even die. What should happen? A) He should be intubated B) He should not be intubated
A) He should be intubated AD doesn't apply because it isn't irreversible or terminal
Mr. G is a 52-year-old man admitted to the hospital with a severe bilateral stroke. He is unresponsive, unable to communicate, and tests show that he has severe anoxic brain injury. His physician recommends either doing a tracheotomy or shifting the goals of care to palliation (comfort care only; no aggressive therapies). Mr. G has no legal guardian and no Medical Power of Attorney. According to Texas law, who is his legal surrogate to make this decision? A) His adult daughter who lives out of state. B) His ex-wife who visits daily. C) His girlfriend. D) His clergyman.
A) His adult daughter who lives out of state.
Suppose there is no medical power of attorney. Who makes decisions for Mr. A, assuming he lacks capacity? A) His wife B) His three daughters C) A friend
A) His wife
An 80-year-old is admitted to the hospital with a massive intracranial bleed. He has been placed on the ventilator because of the respiratory failure associated with intracranial herniation. When you try to remove the ventilator, there are no respirations. The patient makes no purposeful movements. There is no pupilary reaction when you shine a light in his eyes. Corneal reflexes are absent. The medical team has conducted all appropriate tests and concluded that the patient suffered irreversible cessation of entire brain function. Which of the following is the most appropriate action regarding this patient? A) Remove the ventilator B) Make the patient DNR C) Get a court order authorizing you to remove the ventilator D) Invoke the futility policy
A) Remove the ventilator
An unconscious man is brought to the ED for a MVA hemorrhaging profusely, hypotensive and stuporous. You have never met the patient before and no one at your institution knows him. He is wearing a T-shirt that says, "Kiss me, I'm a Jehovah's Witness." What should you do about the blood transfusion? A. Give the blood. B. Wait for him to awaken enough to sign consent. C. Wait for the family. D. Seek a court order. E. Giveintravenousfluidsalone.
A. Give the blood.
A patient's daughter is speaking to the nurse caring for her father. The daughter has presented the nurse with a document identifying her as the spokesperson for the patient when he is no longer capable of speaking for himself. Which of the following best characterizes the daughter's legal relationship with her ailing father? A. Health care proxy B. Legal Samaritan C. Guardian ad litem D. Attorney
A. Health care proxy The health care proxy is a surrogate decision maker chosen by the patient and documented in a legal form dated and signed by the patient and notarized by an impartial notary (in many states). Formally this document is known as a durable power of attorney for health care. There is no such characterization known as a legal Samaritan. A guardian ad litem is a person chosen by a court of law with written documentation describing the guardian status. A guardian ad litem is not limited to health care decisions. An attorney may or may not be a health care proxy. A health care proxy does not have to be an attorney.
At the hospital where you work, you care for a child admitted frequently for management of cystic fibrosis. The child's family has initiated a Cystic Fibrosis Support Group page on Facebook, and they invite you to "friend" their page. Which of the following justifications would you use to explain your decision to accept or not accept the invitation? (Select all that apply.) A. Nurse-patient boundaries may be violated, harming possibility for therapeutic relationship. B. By accepting you could share nursing information online about the patient as a way to educate the support group. C. Postings can easily spread to a wider audience with the potential for HIPAA violations. D. The law prohibits your use of social networking with patients.
A. Nurse-patient boundaries may be violated, harming possibility for therapeutic relationship. C. Postings can easily spread to a wider audience with the potential for HIPAA violations. Participation in online social media such as Facebook entails hazards, such as nurse-patient boundaries being violated or postings being viewed by a much wider audience with potential for HIPAA violations. These justify declining an invitation to "friend" a patient's support group online. Laws do not yet exist prohibiting nurse-patient social networking, although most health care facilities have established policies that guide participation in social media. The hazards involved in a nurse's participation in social media may not be obvious. Hazards include the interruption of relationships of trust and therefore therapeutic relationships. Postings can be shared with others outside the privacy limits established by the original user. Images and information posted innocently may violate privacy when an unintended audience views the page.
One of the elements of professional negligence is the failure to act according to the standard of care or breach of duty. Standard of care may best be defined as which of the following? (Select all that apply.) A. Nursing competence as defined by the State Nurse Practice Act B. Giving nursing care in the most expedient and timely way possible C. The degree of nursing judgment and skill given by a reasonably prudent nurse under similar circumstances D. Providing health services according to community expectations and ordinances
A. Nursing competence as defined by the State Nurse Practice Act C. The degree of nursing judgment and skill given by a reasonably prudent nurse under similar circumstances D. Providing health services according to community expectations and ordinances Duty under any standard of care is the degree of nursing judgment and skill given by a reasonably prudent professional in the same or similar circumstance. A standard of care is defined by the State Board of Nursing Practice Act and current community standards. Expedient care, although timely, may not necessarily meet the standard of care.
Professional medical ethics is based on the concept of the physician as fiduciary of the patient. Having a fiduciary responsibility to patients means that you must: A. Protect and promote the health-related interests of your patients B. Ensure that your patients receive the best medical care available C. Make decisions on behalf of incapacitated patients to maximize their well-being. D. Ensure equal access to healthcare for all of your patients E. Ensure a just distribution of healthcare resources, such that everyone receives medical care commensurate with their medical need
A. Protect and promote the health-related interests of your patients
Which of the following is ethical. Select all that apply A. Respect a patient's advance directive of DNR even though the family disagrees. B. Helping a terminal patient administer lethal medication in Oregon. C. Refusing to assist in an abortion due to religious or moral principles. D. Suggest a new medicine to a patient because your friend told you it was effective.
A. Respect a patient's advance directive of DNR even though the family disagrees. B. Helping a terminal patient administer lethal medication in Oregon. C. Refusing to assist in an abortion due to religious or moral principles. For A, since the patient completed an advanced directive, the nurse is ethically responsible for voicing that decision. B is correct because euthanasia is legal in certain states, including Oregon. C is correct because conscience clauses allow nurses to refuse assisting with an abortion if it violates moral principles. D could be true if the 'friend' was someone credible, but more research should be done before suggesting a medicine to a patient since nurses are supposed to maximize the client's well-being.
A 34 yo woman who is 33 5/7 weeks pregnant presents with with chest pain and has an abnormal and worrisome EKG. She is accompanied by her husband. She has received prenatal care and there have been no complications to date with her pregnancy. What is the most appropriate course of action to take next? A. Treat the woman based on standard guidelines, and take to cardiac cath lab B. Delay treatment of woman until she receives steroids for lung maturity of her fetus C. Suggest emergency C-sxn to husband D. Perform OB ultrasound to assess age of fetus
A. Treat the woman based on standard guidelines, and take to cardiac cath lab This is the most appropriate course of action. Although there are two patients (by fetal viability) treatment is based on autonomy and beneficence towards the woman. Her abdomen can be shielded. You would avoid use of statins as these are Category X for pregnancy.
Ethics in nursing practice includes an embrace of accountability or the ability to justify your actions. Even though your practice is defined in part by orders written by health care providers and policies enforced by administrators, you remain ethically accountable for your actions. Which of the following actions illustrates accountability? (Select all that apply.) A. Your patient receives a surgical procedure that is new to your facility. You ask your manager to provide an in-service about the procedure. B. A health care provider writes orders for pain-management medication even though the patient has been free of pain for 3 days. Out of respect for the health care provider's legal responsibilities, you administer the medications. C. During annual budget preparation at your facility, you advocate for annual pay increases for you and your peers. D. Your patient confides in you that she has recently lost her job and is anxious about her medical bills, including her ability to pay for medications after discharge. Health care coverage is not your area of expertise, but you know that the social worker might be able to help. You initiate a consultation request.
A. Your patient receives a surgical procedure that is new to your facility. You ask your manager to provide an in-service about the procedure. D. Your patient confides in you that she has recently lost her job and is anxious about her medical bills, including her ability to pay for medications after discharge. Health care coverage is not your area of expertise, but you know that the social worker might be able to help. You initiate a consultation request. Taking accountability for actions involves acting independently and taking initiative to remain competent and in taking initiative to act in the patient's best interest. Declining to question a health care provider's orders represents a lack of personal accountability. Asking for a pay raise is more about advocacy than accountability.
A client who insists on leaving the hospital against medical advice (AMA) after being properly advised signs the necessary form. In order to avoid legal consequences regarding the client's decision, the nurse should: A. objectively document all the details of the situation thoroughly but concisely in the client's medical record. B. notify the nursing supervisor of the client's decision and that all reasonable efforts were made to dissuade the client from leaving. C. have a member of the security staff escort the client off the facility's property and into their private vehicle or public transportation D. with the client's permission notify a contact person that the client is leaving the hospital against medical advice.
A. objectively document all the details of the situation thoroughly but concisely in the client's medical record. Almost all health care facilities have an AMA form that patients are asked to sign when they decide to refuse or discontinue ordered therapy or intend to leave the facility. The value of the document in countering a claim of negligence should the patient or family later sue will depend in great part on the quality of the nurse's charting. Although the other options may be correct procedures, they are not directed towards protecting the nurse legally.
A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells him she will put a diaper on him if he does not use the urinal more carefully next time. Which of the following torts is the AP committing? A: Assault B: Battery C: False imprisonment D: Invasion of privacy
A: Assault A: CORRECT: By threatening the client, the AP is committing assault. Her threats could make the client become fearful and apprehensive. B: INCORRECT: Battery is actual physical contact without the client's consent. Because the AP has only verbally threatened the client, battery has not occurred. C: INCORRECT: Unless the AP restrains the client, there is no false imprisonment involved. D: INCORRECT: Invasion of privacy most often involves disclosing information about a client to an unauthorized individual.
A patient is scheduled to have surgery, and informed consent is to be obtained. Place these steps in the order in which they should performed. 1. The patient is willing to sign the consent voluntarily 2. The patient signs the consent in the presence of the nurse 3. The nurse determines that the patient is alert and competent to give consent 4. The practitioner informs the patient of the risks and benefits of the procedure
Answer: 4, 3, 1, 2 4. It is the responsibility of the practitioner to provide all the information necessary to make a knowledgeable decision. Patients have a legal right to have adequate and accurate information to make informed decisions. 3. Patients must be competent to sign a consent form. The patient must be alert, competent, and in touch with reality. Confused, sedated, unconscious, or minor patients may not give consent. Minor patients who are married, parents, emancipated, or serving in the United States military can provide a legal consent. 1. Patients must give their consent voluntarily and without coercion. 2. The health-care provider witnessing the signing of the consent must ensure that the signature is genuine.
You are caring for a 14 year-old girl at a Planned Parenthood clinic in Texas whose mother requests to come into the examining room with her daughter. Of the following three, what is the most ethically appropriate response to the mother? A) So long as the daughter does not strongly object, allow the mother's presence since the daughter is legally incompetent to make decisions for herself. B) Explain to the mother that you are legally and ethically prohibited from having the mother in the room since it would violate the daughter's confidentiality. C) Assess the risks and the benefits of the mother's presence and upon determining whether you will permit the mother's involvement make a note in the chart indicating your decision and assessment.
B) Explain to the mother that you are legally and ethically prohibited from having the mother in the room since it would violate the daughter's confidentiality. Title X and Medicaid family planning services are confidential as a matter of federal law so the mother should not be in the room privy to confidential information. A is incorrect because (1) assuming the exam involves evaluation for STDs the daughter can actually legally consent for herself and also (2) the daughter will not likely express her objections to her mother's presence in front of her even if she does mind. C is incorrect because we are dealing with a federally funded clinic and so confidentiality is a matter of federal law, not physician discretion as would be the case in a non-federally funded practice
According to the Office of Human Research Protections (OHRP), the research use of biological specimens constitutes research involving human subjects. A) True B) False
B) False Research using biospecimens that are not identifiable have been and will continue to be outside the scope of the Common Rule. Therefore, IRB review and consent are not required for this research to proceed (although investigators may voluntarily obtain both)
Mr. A is a 72-year-patient with COPD; he also has severe dementia. Mr. A's wife is 68 years old and in good mental and physical health. He has three grown daughters. His friend states he is the medical power of attorney. Who makes decisions? A) His wife B) His medical power of attorney C) His three daughters D) He does
B) His medical power of attorney
You hear that someone in your medical school class was in a serious car accident and was admitted to the hospital where you are doing your clinical rotation. You are concerned and worried. Can you look in the electronic medical record to figure out who it is and whether they are ok? A) Yes B) No
B) No
You are on consulted on a case involving a mildly depressed 22-year-old man who is blind and dependent on his girlfriend of two years for much of his medical care. The man has been in and out of the hospital for the last six months. He recently tested positive for HIV. He admits having unprotected sex with his girlfriend but insists that she not be told his HIV status. He is afraid that if she were to find out that he is HIV+, she will leave him. Can you tell the girlfriend? A) Yes B) No
B) No In Texas, physicians are permitted but not required to inform spouses ONLY
You are on your OB/GYN rotation and have been having a difficult time learning how to do the internal pelvic exam. While scrubbing in for an elective tubal ligation under general anesthesia your intern suggests that this would be a good opportunity to get some extra practice doing a pelvic exam while the patient is under anesthesia because they will be very relaxed and it will be easier to identify the ovaries. Which of the following is the best course of action? A) Say "That's unethical, they told us in our ethics class that there was an ACOG policy against that" B) Say "That's a good idea, can you help me ask the next patient for permission while she's in pre-op" C) Ask your attending if its okay for you to do the exam D) Politely decline and bring the issue to the attention of the course director.
B) Say "That's a good idea, can you help me ask the next patient for permission while she's in pre-op" Based on the process of informed consent and exhibits the best example of professionalism
You are assigned to take care of a patient who just had an abortion, but your beliefs are against abortions. It is best if you: A) Tell the charge nurse why you cannot take care of the patient. B) Take care of the patient because you are in a professional role. C) Ask another nurse is he/she could cover your shift with the patient. D) Forget about your own beliefs and assist the patient with her needs.
B) Take care of the patient because you are in a professional role. According to the ANA code of ethics for Nurses, the nurse's primary commitment is to the patient. In addition, the International Council of Nurses Code of Ethics mentions that the nurse's primary professional responsibility is to people requiring nursing care. A nurse does not necessarily have to forget about his/her own beliefs, but rather just put them aside and not let them conflict with their professional role. A nurse's responsibility is to give the best quality care and be non-judgmental towards patient's decisions.
Ethics of care suggests that you resolve an ethical dilemma by attention to relationships. As Madeleine Leininger described it, caring is the "central and unifying domain for the body of knowledge and practices in nursing." How does it differ from other approaches to ethical dilemmas? (Select all that apply.) A. Ethics of care applies exclusively to nursing practice. B. Ethics of care pays special attention to the stories of the people involved in an ethical issue. C. Ethics of care uses logic and intellectual analysis based on universal philosophical principles. D. Ethics of care depends less on universal principles than other approaches to analyze ethical dilemmas. E. Stories about relationships can be distracting when trying to resolve an ethical dilemma.
B. Ethics of care pays special attention to the stories of the people involved in an ethical issue. C. Ethics of care uses logic and intellectual analysis based on universal philosophical principles. Ethics of care focuses on relationships, logic, and narrative as a way to understand the source of ethical dilemma and the resolution of dilemmas. It is not exclusive to nursing but applies to all areas of health care. It specifically depends more on storytelling and examination of relationships than on an analysis of universal principles.
Which of the following is NOT true of a 3rd party payer system in the US? A. Medicare is the single largest payer in the United States. B. Every citizen who cannot get insurance through their job is eligible for government insurance. C. Insurance covers some, but not all, medical costs. D. Paying for medical services with 3rd parties has been a driver for higher costs.
B. Every citizen who cannot get insurance through their job is eligible for government insurance.
Which of the following is NOT a main goal of ethics committees? A. Ensuring systems contribute to and do not interfere with ethical practices B. Hiring staff who are active members of ethical associations C. Encouraging an ethical environment at every level D. Promoting patients' rights and shared decision making
B. Hiring staff who are active members of ethical associations
Which of the following choices best defines the idea of personal standards of what is right and wrong? A. ethics B. morality C. fidelity D. veracity
B. Morality Morality is defined as "private and personal standards of what is right and wrong in conduct, character, and attitude." They define ethics as "the rules or principles that govern right conduct", fidelity as being "faithful to agreements and promises" and veracity as telling the truth.
The public's right to expect to receive treatment that meets the standards of nursing care is protected by: A. state law. B. federal law. C. reporting law. D. common law.
B. federal law. Federal laws have a major effect on nursing practice, mandating a minimal standard of care in all health care settings that receive federal funds. Nursing practice is governed by state laws that delineate the conduct of licensed nurses and define behaviors of all health care professionals in promoting public health and welfare. Some states have enacted statutes that mandate nurses to report unsafe, illegal, or unethical practices of nursing colleagues or physicians. Common law is created through cases heard and decided in federal and state appellate courts. Throughout the years, judge-made law regarding nursing practice has accumulated in the form of written opinions.
An adult client who is competent tells the nurse that he is thinking about leaving the hospital against medical advice. The nurse believes that this is not in the client's best interest, so she administers a PRN sedative medication the client has not requested along with his usual medication. Which of the following types of tort has the nurse committed? A: Assault B: False imprisonment C: Negligence D: Breach of confidentiality
B: False imprisonment A: INCORRECT: Assault is an action that threatens harmful contact without the client's consent. The nurse has made no threats in this situation. B: CORRECT: The nurse gave the medication as a chemical restraint to keep the client from leaving the facility against medical advice. C: INCORRECT: Negligence is a breach of duty that results in harm to the client. It is unlikely that medication that the nurse administered without his consent actually harmed the client. D: INCORRECT: The nurse has not disclosed any protected health information, so there is no breach of confidentiality involved in this situation.
Which of the following most accurately describes the primary role of an institutional review board (IRB)? A) Protect the institution from liability B) Protect the physician from liability C) Ensure the ethical and humane treatment of human subjects in experimentation D) Ensure the study is scientifically accurate E) Ensure that the study is financially feasible for the institutions
C) Ensure the ethical and humane treatment of human subjects in experimentation
An 85-year-old man is admitted to the hospital with a severe bilateral stroke. He is unresponsive, unable to communicate, and tests show that he has severe anoxic brain injury. He is dependent on endotracheal intubation and mechanical ventilation. The attending physician believes that continuing aggressive treatment would not benefit the patient and would therefore be medically inappropriate. He has tried on several occasions to discuss this with the patient's daughter (the patient's only family member), but she insists that aggressive treatment continue. The attending physician has asked the hospital ethics committee to review the case in accordance with the Texas Advance Directives Act, Section 166.046. If the ethics committee agrees that continuing aggressive treatment would be medically inappropriate, what should the attending do? A) Discontinue the inappropriate interventions immediately. B) Seek a second opinion from another attending physician. C) Give the daughter 10 days to try to transfer the patient or come to grips with her father's death with support from the health care team and then discontinue the inappropriate interventions D) Seek legal counsel prior to discontinuing inappropriate treatments. E) Give the daughter 48 hours to try to transfer the patient.
C) Give the daughter 10 days to try to transfer the patient or come to grips with her father's death with support from the health care team and then discontinue the inappropriate interventions
Under what circumstances is it ethically justifiable to withhold information from an adolescent? A) If disclosing the information would likely result in the adolescent declining treatment. B) If disclosing the information would likely result in the adolescent declining a treatment that is life-sustaining C) If disclosing the information would likely result in severe and immediate harm to self or others D) It is never ethically justifiable to withhold information from an adolescent
C) If disclosing the information would likely result in severe and immediate harm to self or others It is ethically justifiable if disclosure would result in severe and immediate harm to self or others (think back to the informed consent lecture, although of course note that the therapeutic privilege should only be invoked in rare circumstances such as risk of suicide). This is the only circumstance in which withholding information would be justified. Pediatric patients have an ethical right to be involved in decision-making to a degree that is developmentally appropriate (assent) and to be told the truth (non-decisional right). This is true even if the treatment is life-sustaining (think of the case of Blake that we just discussed), and so A and B are false.
You are working at the desk in your hospital when another employee of the hospital asks for information about a patient who was admitted last night with a pulmonary embolus secondary to cancer. You know the details of the case. The person requesting the information states that he is a close friend and co-worker of your patient. He shows you proper identification proving he really is a co-worker of your patient who also works in the hospital. Which of the following is the most appropriate response to this request? A) Give him the information on the patient. B) Give him the information only if he is a relative of the patient. C) Inform him that you are not at liberty to give details regarding the patient without the patient's permission. D) Have him sign a release or consent form before revealing the information.
C) Inform him that you are not at liberty to give details regarding the patient without the patient's permission.
The following are key components of decision making capacity A) Understanding, Affect, Judgment, Conclusion B) Reasoning, Understanding, Clarity, Insight C) Understanding, Appreciation, Reasoning, Communication D) Reasoning, Understanding, Insight, Communication
C) Understanding, Appreciation, Reasoning, Communication
A nurse is instructing a group of students about how to know and what to expect when ethical dilemmas arise. Which of the following situations should the students identify as an ethical dilemma? A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment. B. A nurse overhears another nurse telling an older adult client that if he doesn't stay in the bed, she will have to apply restraints. C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill. D. A client who is terminally ill hesitates to name her spouse on her durable power of attorney form.
C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill. A. INCORRECT: Delivering client care while showing signs of a substance use disorder is a legal issue, not an ethical dilemma. B. INCORRECT: A nurse who threatens to restrain a client has committed assault. This is a legal issue, not an ethical dilemma. C. CORRECT: Making the decision about initiating enteral tube feedings is an example of an ethical dilemma. A review of scientific data cannot resolve the issue, and it is not easy to resolve. The decision will have a profound effect on the situation and on the client. D. INCORRECT: The selection of a person to make healthcare decisions on a client's behalf is a legal decision, not an ethical dilemma.
When considering costs of medical care while making a treatment decision: A. Costs to 3rd party payer are most important because they're paying for care B. The newest choice is usually best C. Costs should be balanced with health gains for all choices D. The actual cost of medical care are easy to find
C. Costs should be balanced with health gains for all choices
A nurse is caring for a client who is pregnant and unsure about whether or not she should have an abortion. The nurse begins to question herself by asking "Can I accept this?" and "What would I do in this situation?" What is the nurse doing in this situation? A. Gaining awareness of her professional values B. Questioning her professional beliefs C. Gaining awareness of her personal values D. Questioning her personal beliefs
C. Gaining awareness of her personal values Reflecting on values about life, death, happiness and illness is important in dealing with ethical problems. One way for nurses to gain awareness of their personal values is by asking themselves to consider their own attitudes about issues such as abortion by asking questions such as "Can I live with this?" "Can I accept this?" and "What would I want done in this scenario?" By asking herself these questions, the nurse is attempting to gain awareness of her personal values.
Which of the following is true about the ethical appeals? A. When properly understood, they cannot conflict with each other. B. In cases in which they conflict, "above all, do no harm" has lexical priority. C. In cases in which they conflict, the most we can do is to make considered judgments. D. In cases in which they conflict, we need to balance the moral appeals.
C. In cases in which they conflict, the most we can do is to make considered judgments.
Which of the following unauthorized disclosures of confidential patient information is permitted under federal law? A. Mr. M was recently in a car accident and is suing the owner of the car that hit him. The defendant's insurance company's lawyer contacts Dr. P and asks her to fax over Mr. M's medical record, which she does. B. Ms. H finds out that her 14-year old daughter recently visited a federally-funded family planning clinic at the local hospital. Ms. H contacts Dr. Y, who works at the family planning clinic, and asks to see her daughter's medical record. Dr. Y faxes a copy of the medical record to Ms. H. C. Ms. S is a 75-year old old widowed woman who has recently been admitted to the hospital. She is disoriented and confused and is unable to make decisions about her medical care. She has no Medical Power of Attorney or Directive to Physicians. Dr. T locates Ms. S's only child, an estranged daughter, and explains Ms. S's diagnosis, prognosis, and treatment options to her. D. Mr. U admits to Dr. A that he is distraught because his wife has left him, that he wants his wife dead, and that he has even thought of how he is going to kill her. Dr. A, concerned for the safety of the wife, contacts her and informs her of the threats that her husband has made. E. None of the above.
C. Ms. S is a 75-year old old widowed woman who has recently been admitted to the hospital. She is disoriented and confused and is unable to make decisions about her medical care. She has no Medical Power of Attorney or Directive to Physicians. Dr. T locates Ms. S's only child, an estranged daughter, and explains Ms. S's diagnosis, prognosis, and treatment options to her.
You are caring for a patient who will undergo a bone marrow aspiration, a difficult and painful procedure necessary to monitor the progress of recuperation after bone marrow transplantation. You are eager to minimize pain for this patient. You review the medical record for previous successful pain-management plans. You discuss the procedure with the patient. You advocate for the patient when the health care provider arrives to prepare for the procedure. Which ethical principle best describes the reasons for your actions? A. Beneficence B. Accountability C. Nonmaleficence D. Respect for autonomy
C. Nonmaleficence Although all these principles are important and valuable for nursing practice, the principle of nonmaleficence best describes efforts to minimize pain, particularly when at least some pain is unavoidable. The term is Latin and translates literally as "non" indicating "not" and "maleficence" indicating "harmful act."
You are working in an intensive care unit on the night shift. You have been caring for the same patient for three nights in a row. The patient's mother sleeps at the patient's bedside. Over time the mother has come to trust you, as evidenced by her long conversations with you while her child sleeps. Earlier in the week, in the presence of health care providers during morning rounds, she consented to an experimental surgical intervention for her child. But in conversation with you, she shares her doubts and confusions about the intervention. In the morning you ask the health care provider to consider an ethical consultation. What is the value of this nurse participating in discussions about ethical dilemmas? (Select all that apply.) A. Most state laws require that ethics committees include a nurse representative. B. The principal of beneficence promotes kindness in nurses. C. Nurses provide unique insight about patients that can be critical to the resolution of ethical dilemmas. D. Nurses can help articulate a patient's point of view based on specific nursing knowledge. E. Health care providers generally do not participate in ethical discourse.
C. Nurses provide unique insight about patients that can be critical to the resolution of ethical dilemmas. D. Nurses can help articulate a patient's point of view based on specific nursing knowledge. Nurses assess patients in ways that are unique to nursing. Furthermore they often find opportunity for communication with patients that differs in quantity and quality from other health care providers. As a result, nurses obtain information that other professionals may not notice or appreciate
A health care provider has written an order for a patient to receive a medication every 6 hours for 7 days. You note that the patient has indicated that she is allergic to this medication (rash, shortness of breath). Which of the following should you do first? A. Contact the health care provider. B. Contact the pharmacist. C. Place a "hold" note on the medication administration record (MAR). D. Contact the nursing supervisor.
C. Place a "hold" note on the medication administration record (MAR). You must stop any possible administration of the medication that will cause an allergic response in the patient. Placing a hold order on the MAR stops anyone from inadvertently administering the medication. You should then contact the pharmacy and the health care provider. The nursing supervisor should be contacted if the health care provider does not act to rescind the order.
"Quality" in the delivery of health care services means: A. Providing patient care on the basis of the healthcare organization's mission and values. B. Providing patient care according to what insurance companies authorize. C. Progressively and responsibly minimizing variations in the processes of patient care. D. Providing comparative cost-effective patient care. E. Providing the lowest cost intervention in each clinical encounter.
C. Progressively and responsibly minimizing variations in the processes of patient care.
Ms. C is a 70-year-old woman who has advanced lung cancer with widespread metastases. She is currently dependent on mechanical ventilation and requires artificial nutrition and hydration. She is unable to participate in decision-making. She has developed a life-threatening infection. Identify all life-sustaining treatments in this scenario. A) Ventilation B) Artificial nutrition and hydration C) Antibiotics D) All of the above
D) All of the above
Ms. C is a 70-year-old woman who has advanced lung cancer with widespread metastases. She is currently dependent on mechanical ventilation and requires artificial nutrition and hydration. She is unable to participate in decision-making. She has developed a life-threatening infection. Which treatments can her surrogate withhold/withdraw? A) Ventilation B) Artificial nutrition and hydration C) Antibiotics D) All of the above
D) All of the above
You are the sub-I on inpatient team and are admitting a patient overnight from the emergency room for pneumonia. While taking your history the patient tells you that they have an allergy to penicillin and "I'm not sure what happens if I take it, it was when I was a kid". While reviewing the chart you notice that the patient has received ceftriaxone a beta-lactam antibiotic in the same class as penicillin while in the emergency department. You see that an allergy alert was overridden by the intern who placed the order. What do you do? A) Monitor the patient closely overnight for signs of an allergic reaction, if none develops don't say anything. B) Inform the patient that an error occurred and you will be monitoring them closely C) Monitor the patient closely for signs of an allergic reaction. Anonymously report the incident as a "near miss" through the hospitals electronic quality improvement system. D) Ask the EC attending "I noticed that you gave the patient ceftriaxone, when I was talking to them they told me they have an allergy to penicillin from when they were a kid, do I need to be worried about that?"
D) Ask the EC attending "I noticed that you gave the patient ceftriaxone, when I was talking to them they told me they have an allergy to penicillin from when they were a kid, do I need to be worried about that?" Acknowledges an error in a non-judgmental way. It also implies that the patient should be told, and allows either the resident or attending to take responsibility for this. It is most appropriate for either the attending, or the resident to tell the patient.
What is the correct course of action to help an elderly male patient, who is terminally ill of cancer and in a high intensity of pain, would like be euthanized? A) Participate if the laws in your state allow for assisted suicide B) Participate only if your religion/morals beliefs agree with this practice C) Obtain consent from the patient (or the person with the power of attorney) before assisting D) Do nothing as euthanasia is a violation of the Code for Nurses
D) Do nothing as euthanasia is a violation of the Code for Nurses While euthanasia and assisted suicide is has been upheld by the Supreme Court in the state of Oregon, the American Nurses Association's position that active euthanasia and assisted suicide are in violation of the Code for Nurses.
Mr. A is a 72 year patient with COPD; he also has some degree of dementia that manifests occasionally, usually in the evening. Mr. A's wife is 68 years old and in good mental and physical health. He has three grown daughters. He has a friend who is his medical power of attorney. Who makes decisions for him? A) His wife B) His medical power of attorney C) His three daughters D) He does
D) He does Treatment specific. Capacity for simple decisions not complex
You are seeing patients in clinic when two men in dark suits and dark glasses come in and show you badges marking them as members of a federal law enforcement agency. The identification is legitimate. These "men in black" inform you that they are making a "minor investigation" of one of your patients. They ask to look at the patient's chart for a few minutes, saying, "You wouldn't want to interfere with a federal investigation, would you?" What should you do? A) Give them the chart. B) Give them the chart but watch what they do with it. C) Ask them to sign a release for the chart so you are absolved of responsibility. D) Tell them you cannot show them the chart unless there is a signed release from the patient. E) Tell them you can give copies but not the original record. F) Don't give them the chart but read the relevant information to them.
D) Tell them you cannot show them the chart unless there is a signed release from the patient.
You are discussing the care of an elderly woman with her family. Although she is awake and alert, the patient is very ill and physically fragile. You are awaiting the results of a biopsy for what will likely be cancer, which has already metastasized through the body. The family asks that you inform them first about the results of the biopsy. They are very loving and caring and are constantly surrounding the patient. They do not want to depress the patient further, and because there will be no hope for a cure they see no reason to ruin her remaining life with this information. What should you tell them? A) You will honor their wishes. B) You agree with their wishes and you ask them to give you the written request. C) You ask them to involve the hospital ethics committee. D) You tell them you are obligated to inform the patient of the findings. E) Explain to them that decision can only be made by the health care proxy.
D) You tell them you are obligated to inform the patient of the findings.
In allocating scarce resources, the appeal to justice requires us to: A. Give every patient that to which s/he is entitled B. Allocate the resources to those who can pay for them C. Allocate the resources to those who would benefit the most from them D. Allocate the resources in a fair manner
D. Allocate the resources in a fair manner
A patient who is terminally ill and has stage IV breast cancer decides she no longer wants to proceed with her treatment and is contemplating on the idea of euthanasia. The patient turns to her advocate and says "Please be honest. What would you do in my situation?" How should the nurse handle this scenario? A. Be honest and answer the question from the nurse's personal view B. Tell the patient there are other alternatives to euthanasia C. Ignore the question and change the topic because it is unethical D. Ask the patient "Are you considering other courses of action?"
D. Ask the patient "Are you considering other courses of action?" It is the advocate's job to explore the client's value through discussion. The patient is unsure about what she should do and her conflicting values might be detrimental to her health. Therefore, the advocate should use value clarification as an intervention. However, the advocate should never impose her personal value, even if the patient asks for it since the nurse's decision would not be relevant to the patient's situation. Instead the advocate should redirect the question back to the client by asking questions such as "Are you considering other courses of action?"
The main policy goal of the Patient Protection and Affordable Care Act is to A. Recruit new voters for candidates of the Democratic Party. B. Improve the quality of healthcare in the United States. C. Reduce spending for healthcare in the United States below current levels. D. Increase the number of citizens with a source of payment for healthcare. E. Use the insurance mandate to prevent the "free rider" problem.
D. Increase the number of citizens with a source of payment for healthcare.
According to annual assessments performed by the Federal Government, certain groups of people in the United States have poor or no access to health care. You decide to write an editorial to your local newspaper expressing your opinion about this situation. Which ethical principle would you incorporate into your editorial? A. Accountability because as the nurse you are accountable for the well-being of all patient groups B. Respect for autonomy because autonomy is violated if care is not accessible C. Ethics of care because the caring action would be to provide resource access for all D. Justice since this concept addresses questions about the fair distribution of health care resources
D. Justice since this concept addresses questions about the fair distribution of health care resources Accountability, respect for autonomy, and ethics of care are valuable and could be incorporated into a discussion about access, but the fundamental principle that shapes thinking about access to care is the principle of justice.
Given a situation in which your patient is not capable of making a treatment decision for a non-life sustaining treatment, in which order should a surrogate decision maker be sought: A. Medical Power of Attorney, Spouse, Parent, Majority of Adult Children, Adult Child with "waiver and consent" of the other Adult Children, Clergy or Designated Friend B. Medical Power of Attorney, Adult Child with "waiver and consent" of the other Adult Children, Spouse, Majority of Adult Children, Parent, Clergy or Designated Friend C. Medical Power of Attorney, Spouse, Parent, Adult Child with "waiver and consent" of the other Adult Children, Majority of Adult Children, Clergy or Designated Friend D. Medical Power of Attorney, Spouse, Adult Child with "waiver and consent" of the other Adult Children, Majority of Adult Children, Parent, Clergy or Designated Friend
D. Medical Power of Attorney, Spouse, Adult Child with "waiver and consent" of the other Adult Children, Majority of Adult Children, Parent, Clergy or Designated Friend
Physicians should be financially incentivized to provide: A. Patient care based on the current scientific literature. B. Patient care based on how the physician was trained during residency. C. Patient care that meets the local community standard. D. Patient care based on deliberative clinical judgment. E. Patient care that will be lowest cost to payer.
D. Patient care based on deliberative clinical judgment.
A patient is discussing her surgery with her surgeon. The physician leaves and asks you to have the patient sign the consent form in a few hours. Which statement made by the patient indicates that informed consent has likely been achieved? A. The patient states that the doctor has told her there is nothing more they can do and she is going home. B. The patient states that she has not spoken with her surgeon at all today. C. The patient states that her surgeon has told her that she doesn't need surgery. D. The patient states that she is having surgery on her leg in the morning and that she will have some pain and bleeding for a few days.
D. The patient states that she is having surgery on her leg in the morning and that she will have some pain and bleeding for a few days. By stating that she is having surgery in the morning and that she understands some pain and bleeding will occur, the patient reflects a reasonable understanding about the plan for her surgery and the likely outcomes. Stating the doctor has nothing more to do so she is being released, stating that her surgeon indicated surgery is not necessary, and stating that she hasn't spoken to her surgeon all day indicate that the patient may be in denial and needs further explanation, instruction, and support before undergoing surgery.
A 58 year old man is out of town on business in New York. He has a myocardial infarction and deteriorates despite thrombolytics and angioplasty. He is intubated and is disoriented and unable to understand his condition. He needs a coronary bypass. His wife is the health-care proxy but she is in another city. You would like her consent in order to perform the surgery because she is the designated surrogate. Which of the following is true in this case? A) She must come to the hospital to sign consent in person. B) The wife must designate a local guardian until her arrival. C) You must repeat the angioplasty instead. D) Telephone consent is only valid for minor procedures. E) Take consent for the bypass over the phone and have a second person witness the telephone consent.
E) Take consent for the bypass over the phone and have a second person witness the telephone consent. The wife is the designated surrogate decision maker. She can exercise substituted judgment without being present. Documentation of consent is always important, hence the witness.
Which of the following best expresses the ethical content of the appeal to the special obligations of healthcare professionals? A. Healthcare professionals should fulfill their legal obligations to patients. B. Healthcare professionals should respect the rights of patients. C. Healthcare professionals should responsibly manage organizational resources. D. Healthcare professionals should be honest in all communications with patients. E. Healthcare professionals should fulfill their fiduciary responsibilities to patients.
E. Healthcare professionals should fulfill their fiduciary responsibilities to patients. Fiduciary - Someone that has been trusted to act for and in the best interest of another person
The current organization and delivery of healthcare in the US reflects the fundamental American value of: A. Getting value for money. B. Securing the blessings of liberty to ourselves and our posterity. C. Distrust of government at all levels. D. Trust in employers to provide adequate health insurance. E. Suspicion about concentrations of power.
E. Suspicion about concentrations of power.
Which of the following is important to health? A. A safe place to live. B. Economic security. C. Appropriate medical care when ill. D. Inexpensive medications. E. Graduating from high school F. All of the above
F. All of the above
Patients can refuse mechanical ventilation but not artificial nutrition and hydration. True or False
False Explanation: Patients can refuse any and all treatment, so can surrogates based on what pt would want
For surrogate decision making, surrogates first make decisions in accordance with the patient's best interest. True or False
False Explanation: Substituted judgment standard first (make decisions on behalf of what pt would want); then comes best interest standard
A patient must be in a terminal or irreversible condition and lack decision-making capacity in order for a medical power of attorney (MPOA) to be applicable. True or False
False Explanation: This is true for living wills but not for MPOAs. For the MPOA to be applicable, the patient must lack decision making capacity but he/or she does not need to be in a terminal or irreversible condition
A hospital develops a policy for controlled donation after cardiac death (DCD). The hospital policy specifies important details of the DCD process including the following: (a) potential DCD donors are patients with non-recoverable and irreversible neurological injuries resulting in ventilator dependence; (b) the patient or surrogate decision maker must have made the decision to withdraw the ventilator and other life-sustaining therapies independently and prior to the decision to donate; (c) donation takes place after irreversible cessation of circulatory and respiratory functions according to standards of practice; and (d) for DCD donors, the declaration of cardiopulmonary death will be determined by a physician on the transplant team. True or False: This policy is ethically appropriate.
False No member of the transplant team or organ procurement organization(OPO) staff may participate in the guidance or administration of comfort care measures or the declaration of death.
Ms. C is a 70-year-old woman who has advanced lung cancer with widespread metastases. She is currently dependent on mechanical ventilation and requires artificial nutrition and hydration. She is unable to participate in decision making. She has developed a life-threatening infection. True or False: If antibiotics are initiated, they cannot be withdrawn.
False Surrogates CAN request withdrawing any life sustaining treatment (why do abx count as life-sustaining? She didn't count this as one earlier. Can refuse any and all tx. May or may not be life-sustaining.)
The United States system allows for financial incentives to be provided to encourage donation. True or False
False We have an opt-in, altruistic model here in the United States and, judging by the position statement from UNOS, that likely isn't going to change soon
The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principle, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you obscured or deleted all patient identifiers?
No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work
Ms. C is a 70-year-old woman who has advanced lung cancer with widespread metastases. She is currently dependent on mechanical ventilation and requires artificial nutrition and hydration. She is unable to participate in decision making. She has developed a life-threatening infection. True or False: Surrogates can request that antibiotics be withheld on the basis of patient wishes.
True
An example of the nurse's moral obligation according to the ANA Code of Ethics is: a) Withholding food and fluids to a dying patient if it is determined to be more harmful to administer them then to withhold them. b) Ensuring that the family members of the patient are aware of the advance directive and agree to the terms. c) Assisting with an abortion even if it is against the nurse's beliefs. d) Assisting a terminal patient's request to end his life by participating in active euthanasia.
a) Withholding food and fluids to a dying patient if it is determined to be more harmful to administer them then to withhold them. According to the ANA Code of Ethics for Nurses (2005), this position is supported through the nurse's role as a client advocate and through the moral principle of autonomy. Rationale for incorrect answers: b) the family members do not have to agree to the advance directives if they are already in place by the patient. c) Most states have conscience clauses, which enables a nurse to have the choice of not assisting with abortions if it is against their beliefs. d) While assisted suicide is legal is some states, the ANA's position on euthanasia is that both active euthanasia and assisted suicide are in violation of the Code for Nurses.
A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with: a. negligence. b. assault. c. defamation of character. d. tort.
a. negligence. Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent allegations of nursing negligence include failure to ensure client safety, improper treatment, failure to monitor the client and report significant findings, medication errors, and failure to follow the agency's policies and procedures.
Which of the following situations are appropriate for lawsuits that fall under the doctrine of res ipsa loquitur? a. A patient is delivered a wrong diagnosis because the nurse couldn't work the ultrasound machine properly. b. A patient develops an infection after surgery in response to a piece of gauze that was left inside him. c. A patient is given the wrong medication after the nurse mixes up two similar looking vials. d. A patient is subjected to prolonged smoke inhalation because the nurse couldn't locate the fire extinguisher.
b. A patient develops an infection after surgery in response to a piece of gauze that was left inside him.. This doctrine encompasses the cases that cannot be traced back to a specific nurse or doctor. In this case, it cannot be determined which health care provider left the gauze in the patient.
A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? a. Fidelity b. Beneficence c. Nonmaleficence c. Respect for autonomy
b. Beneficence The immunization is a clear effort to provide benefit. Beneficence refers to doing good. Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding healthcare plans.
The ANA Code of Ethics makes provisions for all the the following EXCEPT: a. Right to self-determination b. Right to die c. Respect for human dignity d. Primacy of the patient's interests
b. Right to die
A terminally ill patient is suffering from uncontrollable pain. The patient asks the doctor to provide her with a lethal dose of pills to end her misery. This is an example of what of end of life ethical issue? a. active euthanasia b. assisted suicide c. passive euthanasia d. termination
b. assisted suicide Assisted suicide gives the patient the means to take their own life if they request it.
A fully alert and competent 82-year-old client has end-stage kidney disease. The client says, "I'm ready to die," and refuses dialysis. The family urges the nurse to set up dialysis. What is the nurse's moral responsibility? a. request a nephrologist come speak with the family. b. honor the client's decision c. make arrangements for dialysis due to lack of written documentation stating the patient's wishes d. try to convince the client to change his mind
b. honor the client's decision Nurses must honor patients' autonomy, even when their own choices may not seem to be in their best interest.
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. has properly followed policy and protected the patient by not using her name. d. is demonstrating the logical fallacy of slippery slope.
b. is at risk for HIPAA violations. 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.
Which of the following actions best demonstrates a nurse understands the concept of values clarification? a) A nurse persuades the client to make a decision the nurse feels is in her/his own best interest. b) A nurse understands and adheres to the stated values of the institution she/he works for. c) A nurse respects the client's decision even though she/he does not agree with it. d) A nurse understands and adheres to the essential nursing values as set out by the AACN.
c) A nurse respects the client's decision even though she/he does not agree with it. Values clarification is a process nurses undertake to better understand and become aware of her/his own values. The goal is to avoid unintentionally or unconsciously imposing the values of the nurse on the client.
Patient is fighting end-stage of ovarian cancer. In the patient's advance directives, it specifically states to withhold special attempts to revive. This is an example of which end-of-life issue? a) Active euthanasia b) Assisted suicide c) Passive euthanasia d) General suicide
c) Passive euthanasia Passive euthanasia is commonly referred to as WWLST, withdrawing or withholding life-sustaining therapy that involves the withdrawal of extraordinary means of life support and allowing patient to die of the underlying medical condition. Active euthanasia involves actions to bring client's death directly (with or without client's consent). Assisted suicide is providing client with resources to kill themselves under his/her request.
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.
c. care based on what should be done in keeping with the values of the client. 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, policymakers, and society as a whole. A nurse must make an attempt to understand what values are inherent in the situation.
Which of the following would NOT be considered a case of nursing malpractice? a. the client cannot be revived due to nurse's inability to operate new equipment b. the client complains of abdominal pain and the nurse does not note it in the chart. The client's appendix ruptures. c. the nurse leaves a baby unattended on a bath table and the baby falls and is injured. d. the nurse unintentionally gives the patient a double dose of vicodin.
d. the nurse unintentionally gives the patient a double dose of vicodin. To prove a case of malpractice, 6 elements must be present: duty, breach of duty, foreseeability, causation, harm/injury, damages. In all of the above cases EXCEPT the last, there was injury to the patient. Although medication errors can be serious and result in death, the aforementioned did not explicitly state harm and would not fall under the definition of malpractice.
