Title | Ch 03 Critical Thinking, Ethical Decision Making and the Nursing Process |
---|---|
Author | REN |
Course | Fundamentals of Nursing |
Institution | University of California Los Angeles |
Pages | 23 |
File Size | 140.8 KB |
File Type | |
Total Downloads | 75 |
Total Views | 147 |
Practice questions for Ch 03 Critical Thinking, Ethical Decision Making and the Nursing Process...
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Chapter03:CriticalThinking,EthicalDecisionMakingandtheNursing Process 1.
Anursehasbeenofferedapositiononanobstetricunitandhaslearnedthattheunitofferstherapeutic abortions,aprocedurewhichcontradictsthenursespersonalbeliefs.Whatisthenursesethical obligationtothesepatients?
A)
Thenurseshouldadheretoprofessionalstandardsofpracticeandofferservicetothesepatients.
B)
Thenurseshouldmakethechoicetodeclinethispositionandpursueadifferentnursingrole.
C)
Thenurseshoulddeclinetocareforthepatientsconsideringabortion.
D)
Thenurseshouldexpressalternativestowomenconsideringterminatingtheirpregnancy.
Ans:
B Feedback: Toavoidfacingethicaldilemmas,nursescanfollowcertainstrategies.Forexample,whenapplyingfora job,anurseshouldaskquestionsregardingthepatientpopulation.Ifanurseisuncomfortablewitha particularsituation,thennotacceptingthepositionwouldbethebestoption.Thenurseisonlyrequired bylaw(andpracticestandards)toprovidecaretothepatientstheclinicaccepts;thenursemaynot discriminatebetweenpatientsandthenurseexpressinghisorherownopinionandprovidinganother optionisinappropriate.
2.
Aterminallyillpatientyouarecaringforiscomplainingofpain.Thephysicianhasorderedalargedose ofintravenousopioidsbycontinuousinfusion.Youknowthatoneoftheadverseeffectsofthismedicine isrespiratorydepression.Whenyouassessyourpatientsrespiratorystatus,youfindthattheratehas decreasedfrom16breathsperminuteto10breathsperminute.Whatactionshouldyoutake?
A)
DecreasetherateofIVinfusion.
B)
Stimulatethepatientinordertoincreaserespiratoryrate.
C)
Reportthedecreasedrespiratoryratetothephysician.
D)
Allowthepatienttorestcomfortably.
Ans:
C Feedback: End-oflifeissuesthatofteninvolveethicaldilemmasincludepaincontrol,donotresuscitateorders,life-
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supportmeasures,andadministrationoffoodandfluids.Theriskofrespiratorydepressionisnotthe intentoftheactionofpaincontrol.Respiratorydepressionshouldnotbeusedasanexcusetowithhold painmedicationforaterminallyillpatient.Thepatientsrespiratorystatusshouldbecarefullymonitored andanychangesshouldbereportedtothephysician. 3.
Anadultpatienthasrequestedadonotresuscitate(DNR)orderinlightofhisrecentdiagnosiswithlate stagepancreaticcancer.Thepatientssonanddaughter-in-lawarestronglyopposedtothepatients request.Whatistheprimaryresponsibilityofthenurseinthissituation?
A)
Performaslowcodeuntiladecisionismade.
B)
Honortherequestofthepatient.
C)
Contactasocialworkerormediatortointervene.
D)
Temporarilywithholdnursingcareuntilthephysiciantalkstothefamily.
Ans:
B Feedback: Thenursemusthonorthepatientswishesandcontinuetoproviderequirednursingcare.Discussingthe matterwiththephysicianmayleadtofurthercommunicationwiththefamily,duringwhichthefamily mayreconsidertheirdecision.Itisnotnormallyappropriateforthenursetoseektheassistanceofa socialworkerormediator.Aslowcodeisconsideredunethical.
4.
Anelderlypatientisadmittedtoyourunitwithadiagnosisofcommunity-acquiredpneumonia.During admissionthepatientstates,Ihavealivingwill.Whatimplicationofthisshouldthenurserecognize?
A)
Thisdocumentisalwayshonored,regardlessofcircumstances.
B)
Thisdocumentspecifiesthepatientswishesbeforehospitalization.
C)
Thisdocumentthatisbindingforthedurationofthepatientslife.
D)
ThisdocumenthasbeendrawnupbythepatientsfamilytodetermineDNRstatus.
Ans:
B Feedback: Alivingwillisonetypeofadvancedirective.Inmostsituations,livingwillsarelimitedtosituationsin whichthepatientsmedicalconditionisdeemedterminal.Theotheranswersareincorrectbecauseliving willsarenotalwayshonored,theyarenotbindingforthedurationofthepatientslife,andtheyarenot drawnupbythepatientsfamily.
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5.
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Anursehasbeenprovidingethicalcareformanyyearsandisawareoftheneedtomaintaintheethical principleofnonmaleficence.Whichofthefollowingactionswouldbeconsideredacontradictionofthis principle?
A)
DiscussingaDNRorderwithaterminallyillpatient
B)
Assistingasemi-independentpatientwithADLs
C)
Refusingtoadministerpainmedicationasordered
D)
Providingmorecareforonepatientthanforanother
Ans:
C Feedback: Thedutynottoinflictaswellaspreventandremoveharmistermednonmaleficence.DiscussingaDNR orderwithaterminallyillpatientandassistingapatientwithADLswouldnotbeconsidered contradictionstothenursesdutyofnonmaleficence.Somepatientsjustifiablyrequiremorecarethan others.
6.
Youhavejusttakenreportforyourshiftandyouaredoingyourinitialassessmentofyourpatients.One ofyourpatientsasksyouifanerrorhasbeenmadeinhermedication.Youknowthatanincidentreport wasfiledyesterdayafteranurseinadvertentlymissedascheduleddoseofthepatientsantibiotic.Which ofthefollowingprincipleswouldapplyifyougiveanaccurateresponse?
A)
Veracity
B)
Confidentiality
C)
Respect
D)
Justice
Ans:
A Feedback: Theobligationtotellthetruthandnotdeceiveothersistermedveracity.Theotheranswersareincorrect becausetheyarenotobligationstotellthetruth.
7.
A)
Anursehasbeguncreatingapatientsplanofcareshortlyafterthepatientsadmission.Itisimportantthat thewordingofthechosennursingdiagnosesfallswithinthetaxonomyofnursing.Whichorganizationis responsiblefordevelopingthetaxonomyofanursingdiagnosis? AmericanNursesAssociation(ANA)
TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)
B)
NANDA
C)
NationalLeagueforNursing(NLN)
D)
JointCommission
Ans:
B
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Feedback: NANDAInternationalistheofficialorganizationresponsiblefordevelopingthetaxonomyofnursing diagnosesandformulatingnursingdiagnosesacceptableforstudy.TheANA,NLN,andJoint Commissionarenotchargedwiththetaskofdevelopingthetaxonomyofnursingdiagnoses. 8.
Inresponsetoapatientscomplaintofpain,thenurseadministeredaPRNdoseofhydromorphone (Dilaudid).Inwhatphaseofthenursingprocesswillthenursedeterminewhetherthismedicationhas hadthedesiredeffect?
A)
Analysis
B)
Evaluation
C)
Assessment
D)
Datacollection
Ans:
B Feedback: Evaluation,thefinalstepofthenursingprocess,allowsthenursetodeterminethepatientsresponseto nursinginterventionsandtheextenttowhichtheobjectiveshavebeenachieved.
9.
Amedicalnursehasobtainedanewpatientshealthhistoryandcompletedtheadmissionassessment. Thenursehasfollowedthisbydocumentingtheresultsandcreatingacareplanforthepatient.Whichof thefollowingisthemostimportantrationalefordocumentingthepatientscare?
A)
Itprovidescontinuityofcare.
B)
Itcreatesateachinglogforthefamily.
C)
Itverifiesappropriatestaffinglevels.
D)
Itkeepsthepatientfullyinformed.
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A Feedback: Thisrecordprovidesameansofcommunicationamongmembersofthehealthcareteamandfacilitates coordinatedplanningandcontinuityofcare.Itservesasthelegalandbusinessrecordforahealthcare agencyandfortheprofessionalstaffmemberswhoareresponsibleforthepatientscare.Documentation isnotprimarilyateachinglog;itdoesnotverifystaffing;anditisnotintendedtoprovidethepatient withinformationabouttreatments.
10. Thenurseiscaringforapatientwhoiswithdrawingfromheavyalcoholuseandwhoisconsequently combativeandconfused,despitetheadministrationofbenzodiazepines.Thepatienthasafracturedhip thathesufferedinatraumaticaccidentandistryingtogetoutofbed.Whatisthemostappropriate actionforthenursetotake? A)
Leavethepatientandgethelp.
B)
Obtainaphysiciansordertorestrainthepatient.
C)
Readthefacilityspolicyonrestraints.
D)
Ordersoftrestraintsfromthestoreroom.
Ans:
B Feedback: Itismandatoryinmostsettingstohaveaphysiciansorderbeforerestrainingapatient.Beforerestraints areused,otherstrategies,suchasaskingfamilymemberstositwiththepatient,orutilizingaspecially trainedsitter,shouldbetried.Apatientshouldneverbeleftalonewhilethenursesummonsassistance.
11. Apatientadmittedwithrightlegthrombophlebitisistobedischargedfromanacute-carefacility. Followingtreatmentwithaheparininfusion,thenursenotesthatthepatientslegispain-free,without rednessoredema.Whichstepofthenursingprocessdoesthisreflect? A)
Diagnosis
B)
Analysis
C)
Implementation
D)
Evaluation
Ans:
D
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Feedback: Thenursingactionsdescribedconstituteevaluationoftheexpectedoutcomes.Thefindingsshowthat theexpectedoutcomeshavebeenachieved.Analysisconsistsofconsideringassessmentinformationto derivetheappropriatenursingdiagnosis.Implementationisthephaseofthenursingprocesswherethe nurseputsthecareplanintoaction.Thisnursesactionsdonotconstitutediagnosis. 12. Duringreport,anursefindsthatshehasbeenassignedtocareforapatientadmittedwithan opportunisticinfectionsecondarytoAIDS.Thenurseinformstheclinicalnurseleaderthatsheis refusingtocareforhimbecausehehasAIDS.Thenursehasanobligationtothispatientunderwhich legalpremise? A)
GoodSamaritanAct
B)
NursingInterventionsClassification(NIC)
C)
PatientSelf-DeterminationAct
D)
ANACodeofEthics
Ans:
D Feedback: TheethicalobligationtocareforallpatientsisclearlyidentifiedinthefirststatementoftheANACode ofEthicsforNurses.TheGoodSamaritanActrelatestolaypeoplehelpingothersinneed.TheNICisa standardizedclassificationofnursingtreatmentthatincludesindependentandcollaborative interventions.ThePatientSelf-DeterminationActencouragespeopletoprepareadvancedirectivesin whichtheyindicatetheirwishesconcerningthedegreeofsupportivecaretobeprovidediftheybecome incapacitated.
13. Anemergencydepartmentnurseiscaringfora7-year-oldchildsuspectedofhavingmeningitis.The patientistohavealumbarpunctureperformed,andthenurseisdoingpreprocedureteachingwiththe childandthemother.Thenursesactionisanexampleofwhichtherapeuticcommunicationtechnique? A)
Informing
B)
Suggesting
C)
Expectation-setting
D)
Enlightening
Ans:
A Feedback:
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Informinginvolvesprovidinginformationtothepatientregardinghisorhercare.Suggestingisthe presentationofanalternativeideaforthepatientsconsiderationrelativetoproblemsolving.Thisaction isnotcharacterizedasexpectation-settingorenlightening. 14. Thenurse,incollaborationwiththepatientsfamily,isdeterminingprioritiesrelatedtothecareofthe patient.Thenurseexplainsthatitisimportanttoconsidertheurgencyofspecificproblemswhensetting priorities.Whatprovidesthebestframeworkforprioritizingpatientproblems? A)
Availabilityofhospitalresources
B)
Familymemberstatements
C)
Maslowshierarchyofneeds
D)
Thenursesskillset
Ans:
C Feedback: Maslowshierarchyofneedsprovidesausefulframeworkforprioritizingproblems,withthefirstlevel giventomeetingphysicalneedsofthepatient.Availabilityofhospitalresources,familymember statements,andnursingskilldonotprovideaframeworkforprioritizationofpatientproblems,though eachmaybeconsidered.
15. Amedicalnurseiscaringforapatientwhoispalliativefollowingmetastasis.Thenurseisawareofthe needtoupholdtheethicalprincipleofbeneficence.Howcanthenursebestexemplifythisprinciplein thecareofthispatient? A)
Thenursetactfullyregulatesthenumberandtimingofvisitorsasperthepatientswishes.
B)
Thenursestayswiththepatientduringhisorherdeath.
C)
ThenurseensuresthatallmembersofthecareteamareawareofthepatientsDNRorder.
D)
Thenurseliaiseswithmembersofthecareteamtoensurecontinuityofcare.
Ans:
B Feedback: Beneficenceisthedutytodogoodandtheactivepromotionofbenevolentacts.Enactingthepatients wishesaroundvisitorsisanexampleofthis.Eachoftheothernursingactionsisconsistentwithethical practice,butnonedirectlyexemplifiestheprincipleofbeneficence.
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16. Thecareteamhasdeemedtheoccasionaluseofrestraintsnecessaryinthecareofapatientwith Alzheimersdisease.Whatethicalviolationismostoftenposedwhenusingrestraintsinalong-termcare setting? A)
Itlimitsthepatientspersonalsafety.
B)
Itexacerbatesthepatientsdiseaseprocess.
C)
Itthreatensthepatientsautonomy.
D)
Itisnotnormallylegal.
Ans:
C Feedback: Becausesafetyrisksareinvolvedwhenusingrestraintsonelderlyconfusedpatients,thisisacommon ethicalproblem,especiallyinlong-termcaresettings.Bydefinition,restraintslimittheindividuals autonomy.Restraintsarenotwithoutrisks,buttheyshouldnotnormallylimitapatientssafety. Restraintswillnotaffectthecourseofthepatientsunderlyingdiseaseprocess,thoughtheymay exacerbateconfusion.Theuseofrestraintsiscloselylegislated,buttheyarenotillegal.
17. Whilereceivingreportonagroupofpatients,thenurselearnsthatapatientwithterminalcancerhas grantedpowerofattorneyforhealthcaretoherbrother.Howdoesthisaffectthecourseofthepatients care? A)
Anotherindividualhasbeenidentifiedtomakedecisionsonbehalfofthepatient.
B)
Therearebindingparametersforcareevenifthepatientchangeshermind.
C)
Thenamedindividualisinchargeofthepatientsfinances.
D)
Thereisadocumentdelegatingcustodyofchildrentootherthanherspouse.
Ans:
A Feedback: Apowerofattorneyissaidtobeineffectwhenapatienthasidentifiedanotherindividualtomake decisionsonherbehalf.Thepatienthastherighttochangehermind.Apower-of-attorneyforhealth caredoesnotgiveanyonetherighttomakefinancialdecisionsforthepatientnordoesitdelegate custodyofminorchildren.
18. Intheprocessofplanningapatientscare,thenursehasidentifiedanursingdiagnosisofIneffective HealthMaintenancerelatedtoalcoholuse.Whatmustprecedethedeterminationofthisnursing diagnosis?
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A)
Establishmentofaplantoaddresstheunderlyingproblem
B)
Assigningapositivevaluetoeachconsequenceofthediagnosis
C)
Collectingandanalyzingdatathatcorroboratesthediagnosis
D)
Evaluatingthepatientschancesofrecovery
Ans:
C
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Feedback: Inthediagnosticphaseofthenursingprocess,thepatientsnursingproblemsaredefinedthroughanalysi ofpatientdata.Establishingaplancomesaftercollectingandanalyzingdata;evaluatingaplanisthelast stepofthenursingprocessandassigningapositivevaluetoeachconsequenceisnotdone. 19. Youarefollowingthecareplanthatwascreatedforapatientnewlyadmittedtoyourunit.Whichofthe followingaspectsofthecareplanwouldbeconsideredanursingimplementation? A)
Thepatientwillexpressanunderstandingofherdiagnosis.
B)
Thepatientappearsdiaphoretic.
C)
Thepatientisatriskforaspiration.
D)
Ambulatethepatienttwiceperdaywithpartialassistance.
Ans:
D Feedback: Implementationreferstocarryingouttheplanofnursingcare.Theotherlistedoptionsexemplifygoals, assessmentfindings,anddiagnoses.
20. Thephysicianhasrecommendedanamniocentesisforan18-year-oldprimiparouswoman.Thepatientis 34weeksgestationanddoesnotwantthisprocedure.Thephysicianisinsistentthepatienthavethe procedure.Thephysicianarrangesfortheamniocentesistobeperformed.Thenurseshouldrecognize thatthephysicianisinviolationofwhatethicalprinciple? A)
Veracity
B)
Beneficence
C)
Nonmaleficence
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D)
Autonomy
Ans:
D
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Feedback: Theprincipleofautonomyspecifiesthatindividualshavetheabilitytomakeachoicefreefromexternal constraints.Thephysiciansactionsinthiscaseviolatethisprinciple.Thisactionmayormaynotviolate theprincipleofbeneficence.Veracitycentersontruth-tellingandnonmaleficenceisavoidingthe inflictionofharm. 21. Duringdiscussionwiththepatientandthepatientshusband,youdiscoverthatthepatienthasaliving will.Howdoesthepresenceof...