unit 3, RNRS 116- M.44 Ethics & Exemplars (Pearson)

The nurse is concerned about the risk involved when implementing healthcare provider prescriptions for a newly admitted client. Which strategies should the nurse consider to reduce this risk? Select all that apply. A) Question any order written for a postoperative client. B) Question any order a client questions. C) Question any order if the client's condition changes. D) Question any verbal order. E) Question any order that is incomplete.

BCE

A patient is soon to be pronounced brain dead, and the family has been approached about organ donation. When the family returns the next day, the son mentions reading about organ donation on the internet and learning that hospitals charge the families of donors for the organ donation. The son announces that the family has decided to refuse organ donation. Which course of action by the nurse is most ethical? Informing the family that this information is completely untrue and that the family must be careful of what they see on the internet Providing the family with information from the organ procurement agency and asking that a representative of the agency speak with the family Documenting the family's decision that organ donation will be refused Trying to talk the family into reconsidering because so many donor organs are needed

Providing the family with information from the organ procurement agency and asking that a representative of the agency speak with the family

The nurse is caring for an older patient whose adult son is their healthcare proxy. The son is refusing to allow the mother to receive opioid medication for postoperative pain and to ambulate or engage in deep-breathing exercises because of pain. Which action by the nurse demonstrates ethical consideration for this patient? Asking a pain management specialist to speak to the son Requesting orders for the patient to receive non-narcotic and alternative treatments for pain Keeping the son's wishes confidential by logging out of the medical record after documenting them Understanding state law that the patient's son can refuse treatment

Requesting orders for the patient to receive non-narcotic and alternative treatments for pain

A patient with advanced metastatic cancer is receiving frequent doses of pain medications and is unresponsive. The family agrees that life-sustaining measures be withdrawn. Pain medications are administered and the patient dies the next day. Which observation of the family indicates that the nursing interventions were successful and the family members are satisfied that the best decision was made? The family is talking easily about funeral arrangements and is being supported by a clergy member. The family is visibly grief-stricken and refusing to leave the room. The family asks the nurse whether they did the right thing. The family has become quiet and withdrawn and is having difficulty choosing a funeral home.

The family is talking easily about funeral arrangements and is being supported by a clergy member

A woman who is 6 months pregnant is involved in a motor vehicle crash and sustains massive head injuries. The patient is kept alive on a ventilator until the baby can be delivered 2 months later. Which factor describes the ethical dilemma posed by this situation? The mother's right to patient autonomy versus the fetus's survival Lack of family decision making in this process The mother's obvious desire for the baby to be born verses the baby's being born early Whether it was ethical to keep the mother alive using medical technology

The mother's right to patient autonomy versus the fetus's survival

a,b,d ( Rationale The medications that increase the risk of making a pediatric medication error are those produced in adult​ concentrations, those needing a small dosage for an​ infant, and those calculated based on a​ child's weight. The risk is not as great for tablets needing to be crushed or liquids measured with an eye dropper dispenser.)

The pediatric oncology nurse is assigned to give medications to several children. For which medications would the nurse face an increased risk of making a medication​ error? ​(Select all that​ apply.) a Medication produced in adult concentrations b Medication calculated based on​ child's weight c Medication measured with an eye dropper dispenser d Medication needed in small dosage for an infant e Medication in the form of a tablet to be crushed

Which action can aid the nurse in making ethical decisions in patient care? Reviewing and revising policies as needed Using evidence-based nursing protocols Taking the most conservative course of action Basing decisions on what most colleagues believe

Using evidence-based nursing protocols

d

What does the legal term​ "discovery" mean? a Process of putting a witness on the stand to testify b Process of finding out the individual to blame for the unfortunate event c Process of filing of a civil lawsuit to recover punitive damages d Process of obtaining information before a trial

d

Which nursing activity is a common cause of pediatric medical​ errors? a Communication with children b Monitoring adverse events c Administration of drugs in suspension d Mathematical calculation

c (Rationale A just culture environment considers healthcare errors the likely result of system​ failures, not natural individual mistakes. A just culture environment believes that an atmosphere of punishment can impede error prevention activities. A just culture environment will not tolerate employee gross misconduct. Just culture employees consider themselves stakeholders.)

A nurse is returning to work as an intensive care staff nurse after an absence of several years and is taking a continuing education course on just culture. What statement by the nurse shows the need for further education on this​ topic? ​a "Just culture employees consider themselves​ stakeholders." ​b "An atmosphere of punishment can impede error prevention​ activities." ​c "Healthcare errors are the likely result of natural individual​ mistakes." ​d "A just culture environment will not tolerate employee gross​ misconduct."

The nurse is caring for an 66-year-old older woman who has identified her next-door neighbor as her advocate and support person. Which is the appropriate action by the nurse under The Joint Commission's Speak Up Campaign guidelines? Respecting the patient's wishes and allowing the neighbor to serve as the patient's advocate Informing the neighbor that the patient is likely confused and thinks she is a family member Informing the patient that the support person or advocate must be a relative Documenting that no next of kin is available

Respecting the patient's wishes and allowing the neighbor to serve as the patient's advocate

The nurse taking a certification class becomes aware that a colleague enrolled in the same class is practicing academic dishonesty. The nurse is trying to decide what to do about the situation. Which is the first step that the nurse should take in making an ethical decision? Making a decision and sticking to it Asking another trusted student what to do Waiting until there is more evidence Identifying a range of actions with potential outcomes

Identifying a range of actions with potential outcomes

b,d,e (Rationale Some forms of job discrimination include not rehiring a nurse into a former​ position, reducing a​ nurse's salary, and decreasing a​ nurse's scheduled hours. Assigning a new graduate nurse to the night shift and putting a nurse on the weekend coverage schedule are not forms of job discrimination.)

Several nurses attend an educational lecture by an official from the Occupational Safety and Health Administration​ (OSHA) and are reminded about the Whistleblower Protection Program. They hear about the various forms that job discrimination could​ take, which is prohibited by law. What are some forms of job​ discrimination? ​(Select all that​ apply.) a Putting a nurse on the weekend coverage schedule b Reducing the salary that a nurse is paid c Assigning a new graduate nurse to the night shift d Decreasing scheduled hours that a nurse works e Not rehiring a nurse into a former position

A highly skilled bariatric surgeon performs about one surgery per month at the facility, and the hospital is required to carry expensive insurance to cover bariatric procedures. The hospital decides to discontinue the service as a cost-saving measure. Which consequent-based theory is applied in this situation? Responsibility Utilitarianism Principles-based theory Relationship-based theory

Utilitarianism

A nurse is caring for an older adult client with terminal cancer. The client's family wants to continue treatment, but the client would like to discontinue treatment and go home. The nurse agrees to be present while the client tells the family. Which principle is the nurse supporting? A) Beneficence for the client B) Autonomy for the client C) Nonmaleficence for the client D) Justice for the client

Answer: B Explanation: A) Autonomy refers to the right to make one's own decisions. The nurse is supporting this principle by supporting the client in his decision. Nonmaleficence is the duty to "do no harm." Justice is often referred to as fairness. Beneficence means "doing good."

A child is taught early in life that it is wrong to take things from others. This process carries over to behavior later in life. Which process does this exemplify? Cultural relativism Moral development Utilitarianism Responsibilities

Moral development

A medication error occurred and the nurse is preparing to complete an incident report. Which information is required to thoroughly complete this report? Select all that apply. A) Name of client involved in the incident B) Location where incident report is completed C) Date and time of the incident D) Medication involved in the incident E) Number of hours the nurse was at work before the incident occurred

ACD

The nursing instructor is evaluating the success of training provided to staff nurses on ways to reduce the incidence of pediatric medication errors. Which observations indicate that training has been effective? Select all that apply. A) Staff nurses are double-checking medication calculations. B) Staff nurses are refusing to dilute medications. C) Staff nurses are using liquid preparations. D) Staff nurses are asking the pharmacy to prepare the exact doses. E) Staff nurses are asking each other to validate placement of decimal points.

ACE

The nurse is caring for a patient who has no brain activity and no hope of recovery. Three family members agree to withdraw care while one family member refuses this course of action stating, "I saw a woman on TV who was declared brain dead but who woke up a year later." Which indication of unclear values applies in this situation? Numerous or repeated instances of the same behavior Inconsistent communication or behavior Ignoring a healthcare professional's advice Confusion or uncertainty about which course of action to take

Confusion or uncertainty about which course of action to take

An older adult patient is increasingly unable to care for himself. The patient has had several falls and his children are worried about his ability to live alone safely. Which is the most frequently encountered patient rights issue related to older adult patients? Deciding whether or not to have a do-not-resuscitate (DNR) order Designating of a power of attorney for healthcare Deciding on long-term care in nursing homes or skilled nursing facilities Getting providers to listen and take their complaints seriously

Deciding on long-term care in nursing homes or skilled nursing facilities

The nurse is interviewing a patient who has a persistent cough. The patient reports doing online research and using essential oils to treat the cough. Which ethical dilemma does this pose for the nurse? Deciding whether the patient should be told that the treatment is not effective Deciding whether to contact the manufacturer of the essential oils Deciding whether to continue the interview, because the patient is already self-treating Deciding whether to document that the patient is using essential oils to treat the cough

Deciding whether the patient should be told that the treatment is not effective

The nurse is performing care interventions for patients who lack moral development or have been exposed to corrupt environments. Which is an important self-care consideration for the nurse? Refraining from speaking to these patient unless necessary because they pose a safety risk Taking the opportunity to discuss their own moral code with patients in an effort to foster moral development Ensuring personal safety by taking such measures as getting between a patient and the door Instructing these patients about how they must be compliant in all aspects of care because the care team has formed a plan that implements morals and ethics

Ensuring personal safety by taking such measures as getting between a patient and the door

The nurse is approached by the parents of a teen admitted with a uterine hemorrhage. The father asks, "Is my daughter pregnant?" Which response by the nurse is appropriate? "You can ask the admitting physician. I'm sure she'll discuss your daughter's condition with you." "I know that this situation must be hard for you to deal with. I'll let you know when I find out." "I cannot discuss her medical condition with you. All of our patients have privacy rights." "I don't think you have anything to worry about. She's a lovely young woman."

"I cannot discuss her medical condition with you. All of our patients have privacy rights."

d (To qualify for protection under the Whistleblower Protection​ Act, the nurse has to face a threat of or actual signs of retaliation from the employer. The nurse does not need to make appointments to further complain. The nurse does not need to request an OSHA inspection of the clinic. The nurse does not have to leave​ work, and resign the clinic position immediately.)

A clinic nurse discovers that all the fire extinguishers on the top two floors of the clinic are way past their expiration date. The nurse writes a letter to the​ clinic's Risk Manager and to the Safety Officer. After waiting a​ month, and receiving no reply from either​ individual, the nurse wrote again. This time the nurse added a statement about making a report to a state agency. What additional event must happen to have the nurse qualify for protection under the Whistleblower Protection​ Act? a The nurse must make appointments with the Risk Manager and the Safety Officer. b The nurse must leave​ work, and resign the clinic position immediately. c The nurse must request an OSHA inspection of the clinic. d The employer must threaten or engage in retaliation against the nurse for complaining.

d (Rationale The​ nurse's best approach is to contact the healthcare provider to clarify the stat nature of the lab order. The nurse should do that before waking up the​ client, talking to staff covering the next​ shift, or writing up an incident report.)

A night nurse makes two telephone calls to the covering healthcare provider during the early morning hours of the shift. Then the nurse discovers an order for a stat laboratory test that was​ requested, but not​ done, during daytime hours. Which action by the nurse is the most appropriate in this​ situation? a Write up an incident report about the error b Wake up the client for transport to the lab c Communicate the missed order to the next shift d Call the healthcare provider to clarify the need for the stat lab test

A nurse educator is planning a class for a group of nursing students regarding risk management. Which information should the educator include in this presentation? Select all that apply. A) Risk management seeks to prevent harm. B) Risk management empowers clients. C) Risk management controls the cost of supplies. D) Risk management examines past mistakes and identifies potential hazards. E) Risk management ensures that nurses are truthful.

AD

Two nursing students are assigned to work together to create a care plan. One of the students comes to class the following day with a fully completed care plan and tells their partner that their sister took this class 3 years earlier and they have just copied the sister's work. Which ethical dilemma does this represent? Professional values Academic dishonesty Conflicting loyalties and obligations Allocation of limited resources

Academic dishonesty

A client with acquired immune deficiency syndrome (AIDS) is admitted to the acute care floor. According to a 2015 American Nurses Association (ANA) position statement, which stance addressing this bioethical issue is appropriate? A) The nurse is morally obligated to care for the client unless the risk exceeds responsibility. B) The nurse has the responsibility to ensure the client gets adequate medical care. C) The client has the right to choose not to disclose his or her condition to staff. D) The client is morally bound to disclose every aspect of his or her condition to staff.

Answer: A Explanation: A) AIDS continues to bear a social stigma in our society because of its association with illicit drug use and sexual behavior. According to a 2015 ANA position statement, the nurse cannot set aside the moral obligation to care for the client infected with human immunodeficiency virus (HIV) unless the risk exceeds the responsibility.

The nurse administers morphine to a client after surgery to help manage pain even though morphine has a risk of creating dependence and addiction. What ethical principle does the nurse apply in this situation when planning care? A) Veracity B) Justice C) Autonomy D) Beneficence

Answer: D Explanation: A) Beneficence requires that the actions one takes should promote good. This includes giving treatments that have some risks when the nurse and others involved in client care have determined that the benefits outweigh the risks. Autonomy is the right to self-determination. Justice means treating all clients fairly. Veracity is the principle of always telling the truth.

The nurse is obtaining a medical history from a patient who has come from a corrupt background. The nurse quickly identifies that the patient is lacking in moral development. Which is the best approach to assessing the patient? Refraining from asking any further questions as part of the assessment Maintaining a calm, nonjudgmental attitude and ask open-ended questions Documenting that the results of the interview are invalid because the patient cannot participate responsibly Taking opportunities to correct the patient when he says something that is incorrect

Maintaining a calm, nonjudgemental attitude and ask open-ended questions

The nurse administers blood to a patient without verifying the patient's identity. As a result, the patient receives the wrong type of blood and has a severe reaction. Which principle of ethical decision making is demonstrated by the nurse's failure to verify the correct blood? Veracity Justice Beneficence Nonmaleficence

Nonmaleficence

Once a month, the nurses working in case management get together for a potluck lunch. They have found that this informal session promotes a sense of a united community. Which of the International Council of Nurses Code of Ethics' relationships is enhanced by this practice? Nurses and coworkers Nurses and practice Nurses and people Nurses and the profession

Nurses and coworkers

The nurse is caring for a client on a medical-surgical unit. The client tells the nurse that the healthcare provider has refused to treat the client further if the client continues to be noncompliant with the healthcare provider's recommendations. Which is the priority nursing action in this situation? A) Take the issue to the hospital ethics committee. B) Advise the client to sue the healthcare provider. C) Have the client contact a consumer agency. D) Notify the healthcare provider of the client's complaints.

Answer: A Explanation: A) Acting as a client advocate and protecting the client's rights, the nurse should enlist the help of the hospital ethics committee. The nurse never advises a client to sue but assists the client to find help resolving the issue. A consumer agency is not appropriate because this is an ethical matter. The nurse should act on behalf of the client, and the best way to do that is by taking the issue to the hospital ethics committee, not to the healthcare provider.

1. The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the incident report? a. The client fell out of bed b. The client climbed over the side rails c. The client was found lying on the floor d. The client became restless and tried to get out of bed.

1. C- The incident report should contain the client's name, age, and diagnosis. The report should contain a factual description of the incident, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options 1, 2, and 4 are interpretations of the situation and are not factual information as observed by the nurse.

10. Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive personnel (UAP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. Which legal tort has the UAP violated? a. Libel b. Slander c. Assault d. Negligence

10. B- Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (Libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or an offensive contact. Negligence involves the actions of professionals that fall below standard of care for a specific professional group

11. An 87-year-old woman is brought to the emergency department for treatment of a fractured arm. On assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. What is the most appropriate nursing response? a. "Oh really I will discuss this situation with your son" b. "Let's talk about the ways you can manage your time to prevent this from happening" c. "Do you have any friends that can help you out until you resolve these important issues with your son?" d. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay.

11. D- The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with nonmedical personnel or the client's family or friends without the client's permission. Clients should be assured under a legal obligation. Option 1, 2, and 3 do not address the legal implications of the situation and do not ensure a safe environment for the client.

12. The nurse calls the health care provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the HCP, and the medication is due to administered. Which action should the nurse take? a. Contact the nursing supervisor b. Administer the dose prescribed c. Hold the medication until the HCP can be contacted d. Administer the recommended dose until the HCP can be located

12. A- If the HCP writes a prescription that requires clarification, the nurse's responsibility is to contact the HCP. If there is no resolution regarding the prescription because the HCP cannot be located or because the prescription remains as it was written after talking with the HCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.

3. The nurse has just assisted a client back to bed after a fall. The nurse and health care provider have assessed the client and have determined that the client is not injured. After completing the incident report, the nurse should implement which action net? a. Reassess the client b. Conduct a staff meeting to describe the fall c. Document in the nurse's notes that an incident report was completed. d. Contact the nursing supervisor to update information regarding the fall

3. A- After a client's fall, the nurse must frequently reassess the client because potential complications do not always appear immediately after the fall. The client's fall should be treated as private information and shared on a "need to know" basis. Communication regarding the event should involve only the individuals participating in the client's care. An incident report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nursing supervisor has been made aware of the incident, the supervisor will contact the nurse if status update is necessary.

4. The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first? a. Call the hospital lawyer b. Refuse to float to the ICU c. Call the nursing supervisor d. Identify tasks that can be performed safely in the ICU

4. D- Floating is an acceptable legal practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Calling the hospital lawyer is a premature action.

5. The nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing clear liquid, in the antecubital area. Which is the most appropriate action by the nurse? a. Call security b. Call the police c. Call the nursing supervisor d. Lock the co-worker in the medication room until help is obtain

5. C- Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option 4 is an inappropriate and unsafe action.

A hospice nurse is working closely with a client who, on several occasions, has asked about guidance and support in ending life. The nurse recognizes which in regard to making ethical and moral decisions in this circumstance? A) Euthanasia has legal implications along with moral and ethical ones. B) Passive euthanasia is an easy decision to arrive at. C) Active euthanasia is supported in the Code for Nurses. D) Assisted suicide is illegal in all states.

Answer: A Explanation: A) Determining whether an action is legal is only one aspect of deciding whether it is ethical. Legality and morality are not one and the same. The nurse must know and follow the legal statutes of the profession and boundaries within the state before making any decision. Passive euthanasia involves the withdrawal of extraordinary means of life support and is never an easy decision. Active euthanasia and assisted suicide are in violation of the Code for Nurses, according to the position statement by the ANA (2013). Some states and countries have laws permitting assisted suicide for clients who are severely ill, are near death, and wish to commit suicide.

Which of the following is an advocacy intervention that a nurse may perform? A) Ensuring that clients and their families understand their legal rights. B) Deciding whether clients need to know information regarding their care. C) Following organizational policies and procedures in all cases without question. D) Leaving monitoring of clients' care to the clients themselves.

Answer: A Explanation: A) Educating clients and their families about their legal rights regarding informed decision-making is a specific advocacy intervention a nurse may make. Nurses should ensure that clients have all the information they need to give informed consent. They should review organizational policies and procedures to ensure protection of client rights, and they should monitor client care to ensure client rights.

A novice nurse attends a lecture regarding risk management. Which action should the nurse implement to reduce risks in practice? A) Not discussing errors made B) Questioning every order that the physician writes C) Urging the nurse's organization to purchase liability insurance D) Storing unused equipment in the halls of the unit

C

The nurse is reviewing the American Hospital Association's (AHA's) patient responsibilities with a 19-year-old patient at 34 weeks of gestation. As the nurse is speaking, the patient interrupts and says, "I get it. You're in charge, and I have to do what you tell me." Which response by the nurse is most appropriate? "Patient responsibilities are established to make sure that you know you can refuse care without suffering any consequences." "Patient responsibilities are designed to help you and your healthcare providers work together as a team." "Patient responsibilities are intended to help keep you and members of your healthcare team safe and comfortable." "Patient responsibilities are meant to help you understand that you are entitled to respectful, courteous care."

"Patient responsibilities are designed to help you and your healthcare providers work together as a team."

9. A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right? a. Performing a procedure without consent b. Threatening to give a client a medication c. Telling the client that he or she cannot leave the hospital d. Observing care provided to the client without the client's permission

9. D- Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure without consent is an example of battery. Threatening to a give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.

During an assessment of a child in the urgent care clinic, the nurse notes that the child has a swollen and split lip. When asking the parent how the child's lip injury occurred, the parent responds, "We are here for my child's ear not my child's lip." Which is the rationale for reporting this incident? A) The child reports that a parent caused the injury. B) The lip injury is unrelated to the ear infection. C) The nurse can be sued if there is no abuse. D) Suspected abuse must be reported.

Answer: D Explanation: A) Suspected child abuse must be reported by law. Healthcare personnel are protected by good faith immunity because the ultimate goal is the protection of the child. The lip injury being unrelated to the ear infection is not a reason to report the injury. Most children will not accuse an abuser; rather, they generally protect the abuser. The reason for the law is that experts can assess the situation and determine if abuse has occurred. The nurse is protected by good faith immunity.

A 9-year-old patient undergoing chemotherapy for leukemia tells the nurse that they have decided to refuse any future chemotherapy treatments because they make him so sick. Which is the most ethical action for the nurse to take in response to this statement? Telling the child that it is not their decision because they are a minor and do not have the right to refuse care Telling the child that they are making a very bad decision and that refusing chemotherapy will likely result in death Advising the parents to cancel future chemotherapy sessions because the child will refuse the treatment. Approaching the parents and telling them that the child is worried about future chemotherapy treatments, then helping facilitate a family discussion

Approaching the parents and telling them that the child is worried about future chemotherapy treatments, then helping facilitate a family discussion

The nurse is documenting the care of a 16-year-old girl who has just discovered that she is pregnant. The patient is tearful as she reports that her boyfriend broke up with her 2 weeks ago and states that her life has truly been ruined. Which nursing diagnosis is appropriate in this situation? Self-Esteem, Situational Low, Risk for Noncompliance Social Isolation Health Behavior, Risk-Prone

Self-esteem, Situational Low, Risk for

Which program was specifically designed to increase patient engagement and set forth patient rights? The Joint Commission's Speak Up Campaign The Patient Self-Determination Act American Hospital Association Bill of Rights American Nurses' Association Code of Ethics

The Joint Commission's Speak Up Campaign

c,d,e (An incident report includes the​ location, date, and time of the event. It often includes the​ client's account of the event in quotes. The client​'s home address and health insurance are not part of an incident report.)

Which elements are commonly found in an incident​ report? ​(Select all that​ apply.) ​a Client's health insurance b ​Client's home address c Location of event ​d Client's account of event e Date and time of event

The nurse is caring for a terminally ill pediatric client. The parents have decided to remove their child from life support. Which action by the nurse displays the role of client advocate? A) Respecting the parents' decision B) Telling the parents they are making the right decision C) Asking to be assigned to a different client D) Referring the parents to social services

Answer: A Explanation: A) The nurse best advocates for the family by supporting the family's right to make this decision. Telling the clients they are making the right decision is inappropriate and does not support advocacy. Referring the parents to another entity points to feelings of unease about the parents' choice. Asking to be assigned to another client does not honor the right of clients and families to make decisions about healthcare.

A 16-year-old client has requested that she be examined and receive counseling without her parents being present. Which response demonstrates a correct response to this request? A) The nurse asks the client's parents if this is okay with them. B) The nurse agrees but still informs the parents immediately of everything they did not witness. C) The nurse strongly urges the client to reconsider this request to receive the best possible care. D) The nurse agrees that the client has the right to make this request but suggests that the parents still be present and involved.

Answer: D Explanation: A) Adolescent clients may wish to be examined or receive counseling separate from their parents. The nurse should make every effort to honor this request, though doing so may lead to confrontation with the parents. Understanding state statutes and organizational policy related to adolescent confidentially is essential when situations such as this arise. When providing confidential care to adolescents, the nurse should encourage adolescents to consider involving parents or guardians in their decision making. The nurse should make it clear that this is a suggestion and not a requirement for receiving care. The nurse should not clear this request with the parents, involve the parents anyway, or make it sound as though competent care depends on the adolescent reconsidering her request.

A 16-year-old girl reports being sexually active and taking birth control pills. The patient tells the nurse that her parents don't know this and would kick her out of the house if they did. Which action should the nurse take? Telling the patient not to worry, that this information will not be documented Informing the parents because the patient is a minor Respecting the right to confidentiality provided for adolescents Telling the patient that the parents wouldn't really kick them out

Respecting the right to confidentiality provided for adolescents

A hospital that has a shortage of RNs but an increasing patient census is exploring ways to accommodate this increased patient volume without hiring additional RNs. The facility decides to increase the nurse/patient ratio and hire additional unlicensed assistive personnel (UAPs) to fill the gap. Which ethical dilemma does this solution present? This practice may discourage UAPs from furthering their careers because they already have steady employment. The hospital may not be able to attract qualified RNs if the nurse/patient ratio is increased. The decision could lead to a reduction in the quality of care provided. The hospital will be perceived as being cheap instead of cost-effective, resulting in bad publicity.

The decision could lead to a reduction in the quality of care provided.

a,c (Nurses should question the healthcare​ provider's orders that a client​ questions, and the healthcare​ provider's orders written before a​ client's condition changed. There is no need to question orders calling for medication with a decimal​ point, orders written after a​ client's condition​ improved, or orders for expensive​ in-house laboratory tests.)

Which healthcare provider​'s orders should nurses​ question, to protect themselves​ legally? ​(Select all that​ apply.) a Orders that a client questions b Orders written after​ client's condition improved c Orders written before​ client's condition changed d Orders for expensive​ in-house laboratory tests e Orders calling for a medication with a decimal point

6. A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance obtaining a witness to the will. Which is the most appropriate response to the client? a. "I will sign as a witness to your signature." b. "You will need to find a witness on your own.' c. "Whoever is available at the time will sign as a witness for you." d. "I will call the nursing supervisor to seek assistance regarding your request."

6. D- Living wills, also known as natural death acts in some states, are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding living wills vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option 2 is nontherapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.

Which statement describes the application of utilitarianism? A hospital expands its emergency department services in order to provide more efficient care. A behavioral health agency closes three small rural clinics to expand and improve services provided in their busiest facilities. A nurse leaves a job in home hospice because of morality issues tied to providing pain medications. A physician practice adds a second provider to help increase the number of patients in the practice.

A behavioral health agency closes three small rural clinics to expand and improve services provided in their busiest facilities

The nurse is assisting with the informed consent process for a patient who is to undergo an elective procedure. The surgeon has spoken to the patient, and the nurse brings the consent form for the patient to sign. The patient states, "I've changed my mind. I don't want to do this." Which is the most appropriate action for the nurse to take? Informing the patient that they have the right to refuse the procedure and discharging the patient home after documenting the refusal Telling the patient that they do have the right to refuse the procedure, then notifying the healthcare provider that the patient is refusing Telling the patient that they should have told the healthcare provider before the consent form was prepared Informing the patient that the healthcare provider has already obtained verbal consent and that they must now sign the form

Telling the patient that they do have the right to refuse the procedure, then notifying the healthcare provider that the patient is refusing

The nurse in an inpatient hospice realizes that part of hospice care is aggressive pain management, including the administration of high doses of pain medications to patients. The nurse is not morally opposed to this practice, believing that it gives comfort in a patient's final days. Which process does the nurse apply to reach this decision? Social justice Values clarification Continuing education Patient advocacy

Values clarification

13. The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate nursing action? a. Call the police b. Cut up the photograph and throw it away c. Call the nursing supervisor and report the incident d. Call the laboratory and ask for the individual's name who sent the photograph

13. C- Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. Sexually suggestive jokes, touching, pressuring a co-worker for a date, and open displays of or transmitting sexually oriented photographs or posters are examples of conducts that could be considered sexual harassment by another worker. If the nurse believes that he or she is being subjected to unwelcome sexual conduct, these concerns should be reported to the nursing supervisor immediately. Option 1 is unnecessary at this time. Options 2 and 4 are inappropriate initial actions.

2. A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? a. Obtain a court order for the surgical procedure b. Ask the EMS team to sign the informed consent c. Transport the victim to the operating room for surgery d. Call the police to identify the client and locate the family.

2. C- In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action

7. The nurse has made an error in a narrative documentation of an assessment finding on a client and obtains the client's record to correct the error. The nurse should take which action to correct the error? a. Documenting a late entry into the client's record b. Trying to erase the error for space to write in the correct data c. Using whiteout to delete the error to write in the correct data d. Drawing one line through the error, initialing and dating, and then documenting the correct information.

7. D- If the nurse makes an error in narrative documentation in the client's record, the nurse should follow agency policies to correct the error. This includes drawing one line through the error, initializing and dating the line, and then documenting the correct information. A late entry is used to document additional information not remembered at the initial time of documentation. Erasing data from the client's record and the use of whiteout are prohibited

8. Which identifies accurate nursing documentation notations? Select all that apply a. The client slept through the night b. Abdominal wound dressing is dry and intact without drainage c. The client seemed angry when awakened for vital sign measurement d. The client appears to become anxious when it is time for respiratory treatments e. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema

8. A, B, E- Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. The use of vague terms, such as seemed or appears is not acceptable because these words suggest that the nurse is stating an opinion.

c,d,e (Rationale The elements that need to be included are the exact location in the facility of the​ event, the identification of equipment involved in the​ event, and the name of the nurse completing the report. The names of all staff on duty at the time of the event are not recorded. All witnesses to the​ event, whether or not they are​ clients, are included.)

A nurse is filling out an incident report for the first time. The nurse wants to make sure that the report is complete. What elements must be included to give the best picture of the​ event? ​(Select all that​ apply.) a Witnesses to the​ event, except for other clients b Names of all staff on duty at the time of the event c The name of the nurse completing the report d The identification of equipment if involved in the event e The exact location in the facility of the event

c (Rationale The item the nurse would circle as being false is that if​ follow-up treatment was​ needed, the chart should not record that fact.​ Legally, the chart must record the delivery of​ follow-up treatment. It is true that most incidents do not result in lawsuits. It is true that incident report should be written as though discoverable. It is true that if an incident report was​ written, the chart should not record that fact.)

A nurse recently attended the​ hospital's mandatory annual education series about filling out incident reports. At the​ end, knowledge was tested using a​ True-False posttest. Which item would the nurse circle as being​ false? a If an incident report was​ written, the chart should not record that fact. b Most incidents do not result in the filing of a civil lawsuit in court. c If​ follow-up treatment was​ needed, the chart should not record that fact. d Incident reports should be written as though discoverable.

A nurse who reports suspected child abuse, honestly believing it to have occurred, is not subject to civil or criminal liabilities when the subsequent investigation does not make a determination of abuse. This is called A) good faith immunity. B) protection of privacy. C) breach of confidentiality. D) criminal malfeasance.

Answer: A Explanation: A) In every state, healthcare workers are protected from civil or criminal liabilities when they report suspected child abuse in good faith, even if the subsequent investigation does not make a determination of abuse. This is called good faith immunity. This is not protection of privacy, breach of confidentiality, or criminal malfeasance.

The home health nurse suspects that another nurse providing home care to a client has been taking the client's narcotics. Which action should the nurse carry out? A) Follow the reporting procedures for her agency. B) Tell the client to confront the other nurse. C) Confront the other nurse about the suspected theft. D) Have the client file a police report.

Answer: A Explanation: A) Nurses have a legal responsibility to report any professional whom they suspect of engaging in illegal, immoral, or unethical activities. Normally, the nurse making such a report will do so following established procedures at the facility at which the nurse is employed. Both state nurse practice acts and the ANA Code of Ethics require nurses to report unethical nurse behaviors, including boundary violations. The nurse should not leave the responsibility of addressing this problem to the client or directly confront the other nurse.

An adolescent client diagnosed with leukemia decides to stop chemotherapy treatments. The parents of the client, however, want the healthcare team to continue all treatments as necessary. Which action by the nurse is appropriate when providing care to this client and family? A) Helping the family by providing information and allowing them to voice concerns B) Confronting the parents and telling them not to be "selfish" in their child's time of need C) Calling the authorities immediately D) Obtaining a court order to determine the client legally able to make his or her own decisions

Answer: A Explanation: A) Parents have the authority to make healthcare decisions for their children. Dilemmas arise when parents and children do not agree on whether or not to go forward with a recommended treatment. In most cases, the nurse and other members of the healthcare team who have developed a therapeutic alliance with the child and family may be able to help the family come to a joint decision by providing additional information and opportunity to discuss their concerns with each other calmly and openly. In some cases, however, the healthcare team may need to seek guidance from the agency's ethics committee.

The nurse notices that there is broken equipment on the playground in a neighborhood where care is provided to low-income residents. The nurse tries unsuccessfully to get the owner to address this safety issue. Which additional action is most consistent with the role of the nurse as a public advocate? A) Write an article in the local newspaper to gain public attention. B) No action is required; this is a civil problem beyond the realm of the nurse. C) Call the police to report the owner's neglect. D) Tell the parents they should not pay their rent until the playground is fixed.

Answer: A Explanation: A) Prevention of injury to clients is very much a part of nursing. The nurse should initially contact the owner. Because this was ineffective, it is appropriate for the nurse to write an article or talk to an individual on the town council. The police are a protection against crime and are not likely to do anything about the situation. Telling the parents not to pay their rent until the playground is fixed is not appropriate. Civil problem or not, the nurse has an obligation to protect the neighborhood children from injury and should act on it.

A nurse is volunteering time in a local free clinic that provides care to the underinsured population. By volunteering time to work in the clinic, this nurse is demonstrating which professional value? A) Human dignity B) Social justice C) Integrity D) Autonomy

Answer: B Explanation: A) Social justice is upholding fairness on a social scale. This value is demonstrated in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality healthcare. Human dignity is respect for the worth and uniqueness of individuals and populations. Autonomy is respecting the client's right to make decisions about their healthcare. Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice.

The nurse is planning to carry out advocacy interventions when caring for a client with brain cancer. Which value should the nurse recognize as most basic to client advocacy? A) The client is a holistic, autonomous being who has the right to make choices and decisions. B) The nurse has the responsibility to ensure the client's decisions guide care regardless of whether the client is mentally competent. C) Clients should be advised that making their own care decisions is almost invariably detrimental to their well-being. D) The client is a dependent being who has the right to expect the nurse to solve all healthcare needs.

Answer: A Explanation: A) Safeguarding clients' autonomy is the first core attribute of advocacy. It requires respecting and promoting each client's right to self-determination, except in those situations when the client is incompetent to decide or does not wish to be involved in decision making. Clients should not be discouraged from making their own decisions or be treated as naturally dependent.

While making rounds on the night shift, a nursing supervisor notes that a 73-year-old client under observation following a myocardial infarction has multiple visible bruises on the arms and legs. The supervisor suspects abuse because nothing in the client's chart suggests this client should have sustained these injuries. This state's good faith immunity applies in cases of suspected abuse not only of children but also of older adults or adults with disabilities. Which action has the highest priority for the nursing supervisor in this situation? A) Notify authorities regarding the suspected abuse. B) Do nothing about the situation. C) Notify the security department. D) Ask a shift nurse about the source of the injuries.

Answer: A Explanation: A) States also have specific laws pertaining to the mistreatment of adults and older adults. These laws may be similar to those that govern the abuse and neglect of children. For example, many states generally offer good faith immunity to individuals who report suspected abuse or neglect of an older adult or an adult with a disability. This immunity would apply in the case of this client. Security is not the appropriate department to notify unless the injuries were sustained at work. Questioning a shift nurse about the source of the injuries is fine to do but should not replace reporting the injuries to the appropriate authorities, which should be done in this case because the supervisor suspects abuse.

Which of the following advocacy interventions might nurses provide that are within their role and scope of practice? Select all that apply. A) Educating clients and their families about their legal rights regarding informed decision-making B) Ensuring that clients have the necessary information to make an informed decision or give informed consent C) Evaluating organizational policies and procedures to ensure protection of client rights D) Supporting medical authority even when this goes against the client's wishes E) Declaring clients incompetent so family members can make medical decisions for them

Answer: A, B, C Explanation: A) Clients must understand their rights in order to be able to defend them. As an advocate, the nurse provides clients with the information they need to make informed decisions and supports the clients' rights to make their own healthcare decisions. Nurses should evaluate organizational policies and procedures and monitor clients' care to ensure protection of client rights. A nurse should understand that advocacy may require political action. Conflicts may arise over issues that require consultation, confrontation, or negotiation between the nurse and administrative personnel or between the nurse and primary care providers. Declaring clients incompetent is not the role of the nurse, and it should not be done just to please family members.

When faced with ethical dilemmas, which are some of the elements of risk management that can assist nurses in decision making? Select all that apply. A) Education B) Peer support and consultation C) Resource accumulation D) Righteousness E) Financial support

Answer: A, B, C Explanation: A) In addition to the ANA code of conduct in ethical situations, education and didactic training represent another source for developing primary risk-management skills. A practitioner's professional network, consisting of peers, supervisors, and colleagues, can be a significant resource for primary prevention of ethical challenges. Resource accumulation involves acquiring the requisite resources and skills prior to the occurrence of a dilemma. Righteousness and financial support are not elements of risk management.

Staff at the hospital have decided to strike in order to try to improve working conditions. Which are some of the ethical issues that a nurse working in the hospital will have to consider when deciding whether or not to honor the picket line? Select all that apply. A) The need to support coworkers in their efforts to improve working conditions B) The need to ensure that clients receive care and are not abandoned C) The desire to take some time off D) Loyalty to the nurse's employer E) The need for higher pay

Answer: A, B, D Explanation: A) Strikers may be concerned about client care as it is related to adequate staffing. Strikes may adversely affect client care and outcomes. Nurses may feel allegiance to a hospital where they have worked for years. The desire to take time off and the need for higher pay are not ethical issues.

A nurse working on a medical-surgical unit wants to ensure care is provided within the standard of nursing care. Which actions by the nurse are appropriate? Select all that apply. A) Analyze the position description. B) Review and become familiar with the policy and procedure manual. C) Question the value of collaborating with other disciplines. D) Review applicable state nurse practice act and administrative rules. E) Adhere to national standards of practice and care.

Answer: A, B, D, E Explanation: A) Nurses are expected to demonstrate competence within multiple areas of their professional role, including collaboration with the entire care team. The nurse's specific job description will contribute to defining the standard of care. Employers can limit but not expand the scope of practice, and the nurse will be held to functioning within the scope of employment. Agency policies and procedures serve in defining the standard of care. The applicable state nurse practice act and administrative rules form the basis of the standard of care to which each nurse is held. A primary source for defining the standard of care is the prevailing national nursing standards. Nurses who follow national standards of practice and standards of care will provide their clients with the best care possible and be far less likely to commit any unintentional act that may rise to the level of malpractice.

What are some reasons the nurse might withhold food and fluids from a client? Select all that apply. A) A competent and informed client refuses them. B) A son decides that it is his father's time to die. C) It is determined to be more harmful to administer them than to withhold them. D) A schizophrenic client believes that they are being poisoned. E) The nurse thinks that the client is in too much pain.

Answer: A, C Explanation: A) The autonomy of a competent and informed client must be respected. Family members cannot overrule client choices. Forcing an individual with terminal illness to eat, or starting artificial nutrition, will often make the client feel bloated, feel nauseated, and/or develop diarrhea. Clients must be capable of making informed choices. The nurse's opinion about the client's pain status is not a justification for withholding nourishment.

A hospice nurse is working with a client who has ovarian cancer. The client is concerned that her two daughters are at an increased risk for cancer and asks for the nurse's help. Which actions by the nurse are appropriate? Select all that apply. A) Provide the family with information on hereditary cancer risks. B) Assure the client that ovarian cancer is not hereditary. C) Offer to refer the daughters to a genetic counselor. D) Arrange for the client to have genetic testing. E) Tell the client that her additional worrying is too stressful.

Answer: A, C, D Explanation: A) A nurse's role as educator is crucial to ethical practice. Inaccurate reassurance or avoidance does not respect client rights. Providing appropriate alternatives and options for the client and the family are correct responses to the client's concerns.

The nurse is concerned about being sued for negligence when providing care. Which nursing actions may be grounds for negligence? Select all that apply. A) Client fell getting out of bed because the call light was not used. B) Client name band was checked prior to providing all medications. C) Client's morning medications were administered in the early afternoon. D) Client states not understanding activity restrictions and wound eviscerated. E) Client documentation did not include appearance of infiltrated IV site.

Answer: A, C, D, E Explanation: A) Checking the client name band before providing medications is not an action that is negligent. However, providing medications beyond the prescribed time can be viewed as negligent care. One strategy to prevent instances of professional negligence is to ensure client safety. The client fell when getting out of bed because the call light was not used. Because there is no way of knowing if the client knew how to use the call light, the nurse should be concerned with this situation. Clear communication of directions, explanations, and providing effective client education regarding the client's healthcare requirements can help decrease the risk of bad outcomes, so the wound evisceration could be viewed as negligent care. Poor documentation about care, wounds, and intravenous sites could be viewed as negligent care.

A school nurse who is concerned about an increase in sports injuries related to ineffective protective equipment decides to hold a community seminar related to the importance of proper protective equipment. Which advocacy activities is this nurse demonstrating? Select all that apply. A) Advocating for vulnerable populations B) Advocating for fair and equitable access to high-quality care for all clients C) Ensuring that clients have the necessary information to make an informed decision or give informed consent D) Informing the public about issues and concerns E) Speaking publicly for the health, welfare, and safety of their clients

Answer: A, C, D, E Explanation: A) Clients from vulnerable populations, such as children, particularly benefit from nursing advocacy. Through this seminar, the nurse is providing clients with information to make an informed decision and informing the public about issues and concerns that are important to them. The nurse is also speaking publicly to encourage safety practices for students. These are all important advocacy activities. Advocating for fair and equitable access to high-quality care is also an important advocacy activity, but it is not being demonstrated in this situation.

The nurse is caring for a 22-year-old client with Down syndrome. Because the client has an intellectual disability, he is under the legal care of his parents. The client needs medical treatment for aspiration pneumonia, but the parents are declining care because they have heard that aspiration pneumonia is often fatal in clients with chronic health conditions. In addition to ethics and advocacy, what other nursing concept must the nurse factor into care decisions made in this case? A) Informatics B) Development C) Mood and Affect D) Spirituality

Answer: B Explanation: A) Down syndrome causes intellectual disability, so the client's developmental stage needs to be taken into consideration when providing care, especially related to client teaching and advocating for the client whose rights appear to be in jeopardy. Informatics, mood and affect, and spirituality do not appear to play a role in this case.

An adolescent client with a sexually transmitted infection (STI) says to the nurse, "Promise you won't tell my parents about my condition." The agency policy is that all STIs must be reported in accordance with federal and state law. Which action by the nurse is appropriate? A) Disclosing information to the parents B) Reporting the STI to the proper authorities C) Respecting the client's privacy and confidentiality by not mentioning or reporting the STI D) Telling other nurses in the clinic that the client has an STI

Answer: B Explanation: A) In this case, the nurse is required to report information about the client's STI to the state health department. Because of confidentiality issues, the nurse should not report the STI to the parents or to other nurses not involved in the client's care.

Which action demonstrates correct reporting of suspected child abuse? A) The nurse includes the entirety of the client's medical record. B) The nurse compiles a report with all pertinent information that is factually true. C) The nurse recommends that the organization report the abuse to state authorities. D) The nurse reports only information the client has authorized for release.

Answer: B Explanation: A) Reports should be complete and accurate and should be made according to the policy of the organization for which the nurse works. In addition to reporting the abuse within the organizational framework, the nurse should personally report the abuse to the proper authorities. When abuse is reported, all pertinent information in the client's medical record (not simply the entire record) is required by law to be disclosed to the reporting agency. As such, reporting abuse or suspected abuse represents an exception to client confidentiality rules.

Which statement accurately describes the purpose of the American Nurse's Association's Code of Ethics for Nurses? A) It serves as a statement of nurses' personal values and standards. B) It serves as the profession's nonnegotiable ethical standard. C) It serves as an announcement of nurses' commitment to the profession. D) It serves as a standard protocol for performing nursing procedures.

Answer: B Explanation: A) The ANA Code of Ethics for Nurses serves as a statement of nurses' ethical obligations and duties (not their personal values and standards), as the profession's nonnegotiable ethical standard, and as the nursing profession's statement of commitment to society (not the nurse's commitment to the profession). Nurses should refer to the ANA Code of Ethics for Nurses to direct how they perform their duties in daily practice, but it does not provide standard protocols for performing nursing procedures.

A charge nurse notices that a client has a black eye that was not present when admitted to the facility. Which action by the charge nurse is appropriate in this situation? A) Ask a staff nurse to question the client about the situation. B) Discuss the situation with the client in a private setting. C) Ask the other staff members if abuse is involved. D) Ignore the situation until the client shows a willingness to talk.

Answer: B Explanation: A) The charge nurse should discuss the situation with the client in private and offer options of help. The charge nurse should not ignore the situation and should advocate for the client. The charge nurse herself should address this situation. The nurse should speak to the client first, not the staff, and not assume abuse until the client has given her version of events.

By providing volunteer client care to an inadequately insured population, the nurse is demonstrating which value of client advocacy? A) The client has the right to make choices and decisions. B) The nurse has the responsibility to ensure the client has access to healthcare services. C) The client has the right to expect a nurse-client relationship based on shared respect. D) The nurse has the responsibility to make choices and decisions.

Answer: B Explanation: A) The nurse has the responsibility to ensure the client has access to healthcare services that meet health needs. Although the client does have the right to make choices and decisions, the nurse volunteering at a free clinic to provide healthcare to the underinsured does not demonstrate this value. Although the client does have the right to expect a nurse-client relationship based on shared respect, the nurse volunteering at a free clinic to provide healthcare to the underinsured does not demonstrate this value. The nurse's responsibility to make choices and decisions is not one of the values basic to client advocacy.

The nurse is caring for a client in the intensive care unit (ICU) who was in a motor vehicle crash. The healthcare provider asks the nurse to extubate the client because there is no communication between the brain and body due to a cervical fracture. The family agrees with the decision of the healthcare provider, but the nurse is uncomfortable pulling the tube. Which is the reason the nurse is experiencing difficulty with this task? A) An ethical conflict B) Personal values C) Legal issues D) Cultural values

Answer: B Explanation: A) The nurse is distressed because of personal values, which are in conflict with causing the client's death. The decision is within ethical principles. Cultural values are not in evidence in this instance. Extubating this client would not be a legal decision.

The nurse is caring for a client on a mental health unit who is yelling at other clients and some of the staff. Which verbal intervention by the nurse is most consistent with the concept of advocacy? A) "You should be ashamed of your behavior. No wonder you ended up on a mental health unit." B) "You seem upset. Can you tell me what you think might help to calm you down?" C) "You need to behave. If this doesn't stop you are going to be placed in restraints." D) "You are out of control. You have no choice but to take more medication."

Answer: B Explanation: A) The nurse's role is to advocate for the rights of the individual with mental illness or disability. The nurse should validate the meaning of the behavior and encourage safe coping methods. Disparaging the client or threatening to restrain them or sedate them is inconsistent with client rights.

Every year, the nurse attends a nursing conference and takes several continuing education courses to help maintain licensure. Which section of the ICN Code of Ethics does this uphold? A) Nurses and people B) Nurses and practice C) Nurses and the profession D) Nurses and co-workers

Answer: B Explanation: A) The nurses and practice section of the ICN Code of Ethics states that nurses carry the professional responsibility and accountability for nursing practice and for maintaining competence by continual learning. The other sections of the ICN Code of Ethics do not address continuing education for nurses.

A nurse educator is talking to a student about how to deal with an ethical dilemma in practice. Which does the nurse educator explain to the student as important regarding actions during an ethical dilemma? A) Examining all conflicts in the situation B) Investigating all aspects of the situation C) Relying on nursing judgment D) Making a decision based on the policy of the agency

Answer: B Explanation: A) To avoid making a premature decision, the nurse plans to investigate all aspects of the dilemma before deciding. Overconfidence can lead to poor decision making. Reading the agency policy regarding the matter addresses only one aspect of the situation. Examining the conflicts surrounding the issue is only one aspect of the situation to consider.

The nurse is talking with a parent who decides to decline treatment for a 3-year-old client whose cancer has metastasized. There is a conflict between the parents and the rest of the family regarding the withdrawal of care from the child. Which should the nurse consider when determining the appropriate action for this client? A) The beliefs of the child B) The values of the parents C) The age of the child D) The values of the rest of the family

Answer: B Explanation: A) When confronted with a conflict regarding care, one of the first actions by the nurse is to consider the values and beliefs of the parents who are making the decision. The age of the child is not a relevant factor in the decision making if the child is under 18 years. The child is too young to have values and beliefs. The nurse is respectful with the rest of the family but should consider the parents' decision only.

An older adult client with metastasized breast cancer informs the nurse that her doctor is insisting that she participate in a course of chemotherapy, even though the client does not want to have any further treatment. Which actions by the nurse exemplify advocacy for this client? Select all that apply. A) Tell the client that it is in her best interest to follow the doctor's advice. B) Inform the doctor about the client's clear wishes not to have further chemotherapy. C) Ascertain whether or not the client has an advance care directive and, if not, assist her in creating one. D) Discuss the implications of various choices with the client. E) Avoid interfering in the doctor-client relationship.

Answer: B, C, D Explanation: A) Nurses acting as advocates should honor the moral principles and standards and respect clients' right to make their own choices. The nurse should continuously advocate for the client in a professional manner. The nurse serves as both a teacher and an advocate by informing clients about their rights. When the client makes decisions about his or her treatment other than what is recommended, it is the nurse's role to ensure that the client is making an informed decision and, if so, to advocate for the client's right to make autonomous choices.

The nurse is in the midst of a complicated client care situation and is not sure what needs to be done with some information. Which healthcare issues must the nurse report to the state? Select all that apply. A) Amputation of a limb B) Death of a client C) Death of a neonate D) Diagnosis of tuberculosis E) Kidney transplant

Answer: B, C, D Explanation: A) The term mandatory reporting refers to a legal requirement to report an act, event, or situation that is designated by state or local law as a reportable event. All states mandate the reporting of certain vital statistics, including deaths. Many states also require healthcare providers to report neonatal deaths. Federal and state laws mandate the reporting of communicable diseases such as tuberculosis. Limb amputations and transplants do not need to comply with mandatory reportable events.

The nurse observes a healthcare provider discussing an operative procedure with a client and determines that informed consent was achieved. Which information was included in the informed consent process? Select all that apply. A) The provider's disapproval if the surgery is not performed B) The health problem that requires surgery C) The purpose of the surgery D) The expectations of the surgery E) Outcome if surgery is not performed

Answer: B, C, D, E Explanation: A) For informed consent to be achieved, the client should receive the following information: the diagnosis or condition that requires treatment, purposes of the treatment, what the client can expect to feel and experience, intended benefits of the treatment, risks, and what could occur if the surgery is not performed or if alternatives to the treatment are chosen. To give informed consent voluntarily, the client must not be coerced in any manner. If the client provides consent due to fear of disapproval by a healthcare provider, such consent is not considered to be voluntary. Coercion of any kind invalidates the consent.

A client is receiving care in the hospital for life-threatening injuries sustained in a motor vehicle crash and is taken immediately to surgery. There is no family available to provide consent; however, the client's medical record is available and reviewed by the nurse. Which treatments are inappropriate in this situation? Select all that apply. A) Emergency surgery B) Treatment that was previously refused C) Treatment that violates religious beliefs D) Medications to treat the injury E) Experimental medications for a research study

Answer: B, C, E Explanation: A) In most states, the law assumes an individual's consent to medical treatment when the person is in imminent danger of loss of life or limb and unable to give informed consent. In other words, the emergency doctrine assumes that the individual would reasonably consent to treatment if able to do so. This doctrine serves as a guiding principle that permits healthcare providers to perform potentially life-saving procedures under circumstances that make it impossible or impractical to obtain consent. Treatment that was previously refused or violates the client's documented religious beliefs is not appropriate. Experimental medications that are being initiated in conjunction with a research study are also not appropriate.

A nurse suspects another healthcare provider is under the influence of alcohol at work. Which actions by the nurse are correct? Select all that apply. A) Assume that healthcare provider is handling any problem. B) Immediately report it to a supervisor. C) Respect the privacy of the healthcare provider. D) Assist the provider while care is provided to clients. E) Follow the state board guidelines.

Answer: B, E Explanation: A) A nurse who suspects a colleague of engaging in illegal, immoral, or unethical conduct and fails to act is in direct violation of the ANA Code of Ethics for Nurses. Nurses have a legal responsibility to report any professional whom they suspect of engaging in illegal, immoral, or unethical activities. Although an impaired healthcare provider may view this intervention as an invasion of privacy, such prompt action will safeguard the client from harm, at the same time offering the impaired healthcare provider a chance at recovery. Impairment of a coworker or team member is the most common situation encountered by healthcare professionals. Nurses should follow guidelines set forth by the board of nursing for the state in which they work.

A student nurse administers a medication to the wrong client while the instructor is with another student. Which statement by the instructor is most appropriate in this situation? A) "You have placed the nursing student program in danger." B) "You may be sued by the hospital for the extra care cost to the client." C) "You are expected to practice like a licensed nurse." D) "You have set a bad example for the other students."

Answer: C Explanation: A) A nursing student is held to the standard of conduct of an experienced, licensed professional nurse. Students are required to know the standards and to follow them. Hospitals do not generally sue nurses to recover money for extended care due to an error. It is not likely that the teaching program is in danger, as people do make mistakes and hospitals do rely on nursing schools to help provide care to clients. It is not likely that the other students are apt to follow the example of a student who fails to follow policy.

A client comes to the clinic and is found to have a sexually transmitted infection (STI). The client states to the nurse, "Promise you won't tell anyone about my condition." According to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which action must the nurse take? A) Honor the client's wishes. B) Respect the client's privacy and confidentiality. C) Communicate only necessary information. D) Not disclose any information to anyone.

Answer: C Explanation: A) HIPAA includes standards that protect the confidentiality, integrity, and availability of data as well as standards that define appropriate disclosures of identifiable health information and client rights protection. Nurses are entrusted with sensitive information, which at times must be revealed to other healthcare personnel in order to provide appropriate healthcare. In this case, the nurse may be required to report information to the state health department. Clients must be able to trust that their information is secure and will only be shared with appropriate entities. Nurses should not make promises to keep necessary information private.

A pregnant client with a history of drug use refuses testing for human immunodeficiency virus (HIV), despite the recommendation of her nurse-midwife. Which actions by the nurse are appropriate in this situation? Select all that apply. A) Refuse to treat the client. B) Do the testing anyway. C) Re-emphasize the importance of HIV testing. D) Offer counseling. E) Throughout the pregnancy, encourage the client to reconsider the decision not to be tested.

Answer: C, D, E Explanation: A) Refusing HIV testing is legal and is not mandatory for obtaining care. However, if the mother-to-be is HIV-positive, the test will help her protect her health and the health of her child by obtaining appropriate treatment. The nurse should emphasize the importance of HIV testing and encourage her to receive the test. Offering counseling would also be appropriate. Refusing to treat the client is against the ANA position statement on risk and responsibility in nursing. Doing the test anyway goes against the client's right to autonomy.

Which of the following statements describes the nurse's duty to investigate suspected abuse of a pediatric client before reporting it? A) The nurse must question a parent or guardian about the suspected abuse. B) The nurse must personally observe the client being abused. C) The nurse must identify at least two witnesses who will testify that the client was abused. D) The nurse does not need to investigate suspected abuse of a pediatric client.

Answer: D Explanation: A) Regardless of the situation, the nurse is not required to conduct any type of investigation or otherwise confirm that the suspected abuse of a pediatric client has, in fact, occurred. The nurse is required only to have a good faith suspicion based on information disclosed by a client, physical symptoms observed in a client, or the nurse's personal observations of behavior on the part of a client, colleague, or third party. The nurse is not required, therefore, to question a parent or guardian about the abuse, personally observe the client being abused, or identify witnesses who will testify to the abuse.

The nurse has been working in a long-term care facility for 1 week. The nurse notes that during the evening meal, an unlicensed assistive personnel (UAP) gives a tray to a client who is unable to cut up and eat the food independently, and then leaves. After the nurse assists the client with eating the meal, which action is appropriate to advocate for this client? A) Report the UAP for neglect. B) Notify the healthcare provider. C) Call the client's family to have them assist with evening meals. D) Discuss the situation with the director of nursing.

Answer: D Explanation: A) The nurse would advocate getting the client's plan changed because the goal is to have someone available to help the client eat for every meal. Notifying the doctor will not help the client. The family might be able to help at times but cannot be expected to come for every meal. The nurse assesses that this happens at every meal and seeks to change how this client is cared for, not just changing one healthcare worker. The UAP is not neglecting the client. The UAP is assigned tasks by the nurse in charge of the client.

A patient who feels that they have been treated badly during an emergency department visit asks the nurse where to find relevant information to report this. Which is the appropriate response by the nurse? Asking the patient whether there is any specific issue they'd like to discuss and providing the information for reporting a complaint in the Patient's Bill of Rights Telling the patient that the information is available online but that the hospital will not provide it to them Asking the patient to please not report the facility or they may not be able to return for care Asking the patient whether they are planning to file a lawsuit and notifying risk management

Asking the patient whether there is any specific issue they'd like to discuss and providing the information for reporting a complaint in the Patient's Bill of Rights

a,b (Two facts would disqualify nurses for protection under the Whistleblower Protection​ Act: the employer did not know that the activity was a violation of​ law, or the nurse made a​ verbal, not​ written, complaint to administration. To qualify for​ protection, the nurse must follow the​ employer's internal reporting​ procedures, and give the employer time to correct the issue. Also to qualify for​ protection, the employer has to threaten or engage in retaliation against the nurse.)

What facts would disqualify nurses for protection when reporting observed misconduct under the Whistleblower Protection​ Act? ​(Select all that​ apply.) a Nurse making a verbal complaint to administration b Employer not knowing that the activity was a violation of law c Employer engaging in retaliation against the nurse d Nurse following​ employer's internal reporting procedures e Nurse giving employer time to correct the issue