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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter03:CriticalThinking,EthicalDecisionMakingandtheNursing Process  1.

Anursehasbeenofferedapositiononanobstetricunitandhaslearnedthattheunitofferstherapeutic abortions,aprocedurewhichcontradictsthenursespersonalbeliefs.Whatisthenursesethical obligationtothesepatients?

A)

Thenurseshouldadheretoprofessionalstandardsofpracticeandofferservicetothesepatients.

B)

Thenurseshouldmakethechoicetodeclinethispositionandpursueadifferentnursingrole.

C)

Thenurseshoulddeclinetocareforthepatientsconsideringabortion.

D)

Thenurseshouldexpressalternativestowomenconsideringterminatingtheirpregnancy.

Ans:

B Feedback: Toavoidfacingethicaldilemmas,nursescanfollowcertainstrategies.Forexample,whenapplyingfora job,anurseshouldaskquestionsregardingthepatientpopulation.Ifanurseisuncomfortablewitha particularsituation,thennotacceptingthepositionwouldbethebestoption.Thenurseisonlyrequired bylaw(andpracticestandards)toprovidecaretothepatientstheclinicaccepts;thenursemaynot discriminatebetweenpatientsandthenurseexpressinghisorherownopinionandprovidinganother optionisinappropriate.

2.

Aterminallyillpatientyouarecaringforiscomplainingofpain.Thephysicianhasorderedalargedose ofintravenousopioidsbycontinuousinfusion.Youknowthatoneoftheadverseeffectsofthismedicine isrespiratorydepression.Whenyouassessyourpatientsrespiratorystatus,youfindthattheratehas decreasedfrom16breathsperminuteto10breathsperminute.Whatactionshouldyoutake?

A)

DecreasetherateofIVinfusion.

B)

Stimulatethepatientinordertoincreaserespiratoryrate.

C)

Reportthedecreasedrespiratoryratetothephysician.

D)

Allowthepatienttorestcomfortably.

Ans:

C Feedback: End-oflifeissuesthatofteninvolveethicaldilemmasincludepaincontrol,donotresuscitateorders,life-

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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supportmeasures,andadministrationoffoodandfluids.Theriskofrespiratorydepressionisnotthe intentoftheactionofpaincontrol.Respiratorydepressionshouldnotbeusedasanexcusetowithhold painmedicationforaterminallyillpatient.Thepatientsrespiratorystatusshouldbecarefullymonitored andanychangesshouldbereportedtothephysician. 3.

Anadultpatienthasrequestedadonotresuscitate(DNR)orderinlightofhisrecentdiagnosiswithlate stagepancreaticcancer.Thepatientssonanddaughter-in-lawarestronglyopposedtothepatients request.Whatistheprimaryresponsibilityofthenurseinthissituation?

A)

Performaslowcodeuntiladecisionismade.

B)

Honortherequestofthepatient.

C)

Contactasocialworkerormediatortointervene.

D)

Temporarilywithholdnursingcareuntilthephysiciantalkstothefamily.

Ans:

B Feedback: Thenursemusthonorthepatientswishesandcontinuetoproviderequirednursingcare.Discussingthe matterwiththephysicianmayleadtofurthercommunicationwiththefamily,duringwhichthefamily mayreconsidertheirdecision.Itisnotnormallyappropriateforthenursetoseektheassistanceofa socialworkerormediator.Aslowcodeisconsideredunethical.

4.

Anelderlypatientisadmittedtoyourunitwithadiagnosisofcommunity-acquiredpneumonia.During admissionthepatientstates,Ihavealivingwill.Whatimplicationofthisshouldthenurserecognize?

A)

Thisdocumentisalwayshonored,regardlessofcircumstances.

B)

Thisdocumentspecifiesthepatientswishesbeforehospitalization.

C)

Thisdocumentthatisbindingforthedurationofthepatientslife.

D)

ThisdocumenthasbeendrawnupbythepatientsfamilytodetermineDNRstatus.

Ans:

B Feedback: Alivingwillisonetypeofadvancedirective.Inmostsituations,livingwillsarelimitedtosituationsin whichthepatientsmedicalconditionisdeemedterminal.Theotheranswersareincorrectbecauseliving willsarenotalwayshonored,theyarenotbindingforthedurationofthepatientslife,andtheyarenot drawnupbythepatientsfamily.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

5.

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Anursehasbeenprovidingethicalcareformanyyearsandisawareoftheneedtomaintaintheethical principleofnonmaleficence.Whichofthefollowingactionswouldbeconsideredacontradictionofthis principle?

A)

DiscussingaDNRorderwithaterminallyillpatient

B)

Assistingasemi-independentpatientwithADLs

C)

Refusingtoadministerpainmedicationasordered

D)

Providingmorecareforonepatientthanforanother

Ans:

C Feedback: Thedutynottoinflictaswellaspreventandremoveharmistermednonmaleficence.DiscussingaDNR orderwithaterminallyillpatientandassistingapatientwithADLswouldnotbeconsidered contradictionstothenursesdutyofnonmaleficence.Somepatientsjustifiablyrequiremorecarethan others.

6.

Youhavejusttakenreportforyourshiftandyouaredoingyourinitialassessmentofyourpatients.One ofyourpatientsasksyouifanerrorhasbeenmadeinhermedication.Youknowthatanincidentreport wasfiledyesterdayafteranurseinadvertentlymissedascheduleddoseofthepatientsantibiotic.Which ofthefollowingprincipleswouldapplyifyougiveanaccurateresponse?

A)

Veracity

B)

Confidentiality

C)

Respect

D)

Justice

Ans:

A Feedback: Theobligationtotellthetruthandnotdeceiveothersistermedveracity.Theotheranswersareincorrect becausetheyarenotobligationstotellthetruth.

7.

A)

Anursehasbeguncreatingapatientsplanofcareshortlyafterthepatientsadmission.Itisimportantthat thewordingofthechosennursingdiagnosesfallswithinthetaxonomyofnursing.Whichorganizationis responsiblefordevelopingthetaxonomyofanursingdiagnosis? AmericanNursesAssociation(ANA)

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

NANDA

C)

NationalLeagueforNursing(NLN)

D)

JointCommission

Ans:

B

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Feedback: NANDAInternationalistheofficialorganizationresponsiblefordevelopingthetaxonomyofnursing diagnosesandformulatingnursingdiagnosesacceptableforstudy.TheANA,NLN,andJoint Commissionarenotchargedwiththetaskofdevelopingthetaxonomyofnursingdiagnoses. 8.

Inresponsetoapatientscomplaintofpain,thenurseadministeredaPRNdoseofhydromorphone (Dilaudid).Inwhatphaseofthenursingprocesswillthenursedeterminewhetherthismedicationhas hadthedesiredeffect?

A)

Analysis

B)

Evaluation

C)

Assessment

D)

Datacollection

Ans:

B Feedback: Evaluation,thefinalstepofthenursingprocess,allowsthenursetodeterminethepatientsresponseto nursinginterventionsandtheextenttowhichtheobjectiveshavebeenachieved.

9.

Amedicalnursehasobtainedanewpatientshealthhistoryandcompletedtheadmissionassessment. Thenursehasfollowedthisbydocumentingtheresultsandcreatingacareplanforthepatient.Whichof thefollowingisthemostimportantrationalefordocumentingthepatientscare?

A)

Itprovidescontinuityofcare.

B)

Itcreatesateachinglogforthefamily.

C)

Itverifiesappropriatestaffinglevels.

D)

Itkeepsthepatientfullyinformed.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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A Feedback: Thisrecordprovidesameansofcommunicationamongmembersofthehealthcareteamandfacilitates coordinatedplanningandcontinuityofcare.Itservesasthelegalandbusinessrecordforahealthcare agencyandfortheprofessionalstaffmemberswhoareresponsibleforthepatientscare.Documentation isnotprimarilyateachinglog;itdoesnotverifystaffing;anditisnotintendedtoprovidethepatient withinformationabouttreatments.

10. Thenurseiscaringforapatientwhoiswithdrawingfromheavyalcoholuseandwhoisconsequently combativeandconfused,despitetheadministrationofbenzodiazepines.Thepatienthasafracturedhip thathesufferedinatraumaticaccidentandistryingtogetoutofbed.Whatisthemostappropriate actionforthenursetotake? A)

Leavethepatientandgethelp.

B)

Obtainaphysiciansordertorestrainthepatient.

C)

Readthefacilityspolicyonrestraints.

D)

Ordersoftrestraintsfromthestoreroom.

Ans:

B Feedback: Itismandatoryinmostsettingstohaveaphysiciansorderbeforerestrainingapatient.Beforerestraints areused,otherstrategies,suchasaskingfamilymemberstositwiththepatient,orutilizingaspecially trainedsitter,shouldbetried.Apatientshouldneverbeleftalonewhilethenursesummonsassistance.

11. Apatientadmittedwithrightlegthrombophlebitisistobedischargedfromanacute-carefacility. Followingtreatmentwithaheparininfusion,thenursenotesthatthepatientslegispain-free,without rednessoredema.Whichstepofthenursingprocessdoesthisreflect? A)

Diagnosis

B)

Analysis

C)

Implementation

D)

Evaluation

Ans:

D

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Thenursingactionsdescribedconstituteevaluationoftheexpectedoutcomes.Thefindingsshowthat theexpectedoutcomeshavebeenachieved.Analysisconsistsofconsideringassessmentinformationto derivetheappropriatenursingdiagnosis.Implementationisthephaseofthenursingprocesswherethe nurseputsthecareplanintoaction.Thisnursesactionsdonotconstitutediagnosis. 12. Duringreport,anursefindsthatshehasbeenassignedtocareforapatientadmittedwithan opportunisticinfectionsecondarytoAIDS.Thenurseinformstheclinicalnurseleaderthatsheis refusingtocareforhimbecausehehasAIDS.Thenursehasanobligationtothispatientunderwhich legalpremise? A)

GoodSamaritanAct

B)

NursingInterventionsClassification(NIC)

C)

PatientSelf-DeterminationAct

D)

ANACodeofEthics

Ans:

D Feedback: TheethicalobligationtocareforallpatientsisclearlyidentifiedinthefirststatementoftheANACode ofEthicsforNurses.TheGoodSamaritanActrelatestolaypeoplehelpingothersinneed.TheNICisa standardizedclassificationofnursingtreatmentthatincludesindependentandcollaborative interventions.ThePatientSelf-DeterminationActencouragespeopletoprepareadvancedirectivesin whichtheyindicatetheirwishesconcerningthedegreeofsupportivecaretobeprovidediftheybecome incapacitated.

13. Anemergencydepartmentnurseiscaringfora7-year-oldchildsuspectedofhavingmeningitis.The patientistohavealumbarpunctureperformed,andthenurseisdoingpreprocedureteachingwiththe childandthemother.Thenursesactionisanexampleofwhichtherapeuticcommunicationtechnique? A)

Informing

B)

Suggesting

C)

Expectation-setting

D)

Enlightening

Ans:

A Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Informinginvolvesprovidinginformationtothepatientregardinghisorhercare.Suggestingisthe presentationofanalternativeideaforthepatientsconsiderationrelativetoproblemsolving.Thisaction isnotcharacterizedasexpectation-settingorenlightening. 14. Thenurse,incollaborationwiththepatientsfamily,isdeterminingprioritiesrelatedtothecareofthe patient.Thenurseexplainsthatitisimportanttoconsidertheurgencyofspecificproblemswhensetting priorities.Whatprovidesthebestframeworkforprioritizingpatientproblems? A)

Availabilityofhospitalresources

B)

Familymemberstatements

C)

Maslowshierarchyofneeds

D)

Thenursesskillset

Ans:

C Feedback: Maslowshierarchyofneedsprovidesausefulframeworkforprioritizingproblems,withthefirstlevel giventomeetingphysicalneedsofthepatient.Availabilityofhospitalresources,familymember statements,andnursingskilldonotprovideaframeworkforprioritizationofpatientproblems,though eachmaybeconsidered.

15. Amedicalnurseiscaringforapatientwhoispalliativefollowingmetastasis.Thenurseisawareofthe needtoupholdtheethicalprincipleofbeneficence.Howcanthenursebestexemplifythisprinciplein thecareofthispatient? A)

Thenursetactfullyregulatesthenumberandtimingofvisitorsasperthepatientswishes.

B)

Thenursestayswiththepatientduringhisorherdeath.

C)

ThenurseensuresthatallmembersofthecareteamareawareofthepatientsDNRorder.

D)

Thenurseliaiseswithmembersofthecareteamtoensurecontinuityofcare.

Ans:

B Feedback: Beneficenceisthedutytodogoodandtheactivepromotionofbenevolentacts.Enactingthepatients wishesaroundvisitorsisanexampleofthis.Eachoftheothernursingactionsisconsistentwithethical practice,butnonedirectlyexemplifiestheprincipleofbeneficence.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

48

16. Thecareteamhasdeemedtheoccasionaluseofrestraintsnecessaryinthecareofapatientwith Alzheimersdisease.Whatethicalviolationismostoftenposedwhenusingrestraintsinalong-termcare setting? A)

Itlimitsthepatientspersonalsafety.

B)

Itexacerbatesthepatientsdiseaseprocess.

C)

Itthreatensthepatientsautonomy.

D)

Itisnotnormallylegal.

Ans:

C Feedback: Becausesafetyrisksareinvolvedwhenusingrestraintsonelderlyconfusedpatients,thisisacommon ethicalproblem,especiallyinlong-termcaresettings.Bydefinition,restraintslimittheindividuals autonomy.Restraintsarenotwithoutrisks,buttheyshouldnotnormallylimitapatientssafety. Restraintswillnotaffectthecourseofthepatientsunderlyingdiseaseprocess,thoughtheymay exacerbateconfusion.Theuseofrestraintsiscloselylegislated,buttheyarenotillegal.

17. Whilereceivingreportonagroupofpatients,thenurselearnsthatapatientwithterminalcancerhas grantedpowerofattorneyforhealthcaretoherbrother.Howdoesthisaffectthecourseofthepatients care? A)

Anotherindividualhasbeenidentifiedtomakedecisionsonbehalfofthepatient.

B)

Therearebindingparametersforcareevenifthepatientchangeshermind.

C)

Thenamedindividualisinchargeofthepatientsfinances.

D)

Thereisadocumentdelegatingcustodyofchildrentootherthanherspouse.

Ans:

A Feedback: Apowerofattorneyissaidtobeineffectwhenapatienthasidentifiedanotherindividualtomake decisionsonherbehalf.Thepatienthastherighttochangehermind.Apower-of-attorneyforhealth caredoesnotgiveanyonetherighttomakefinancialdecisionsforthepatientnordoesitdelegate custodyofminorchildren.

18. Intheprocessofplanningapatientscare,thenursehasidentifiedanursingdiagnosisofIneffective HealthMaintenancerelatedtoalcoholuse.Whatmustprecedethedeterminationofthisnursing diagnosis?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Establishmentofaplantoaddresstheunderlyingproblem

B)

Assigningapositivevaluetoeachconsequenceofthediagnosis

C)

Collectingandanalyzingdatathatcorroboratesthediagnosis

D)

Evaluatingthepatientschancesofrecovery

Ans:

C

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Feedback: Inthediagnosticphaseofthenursingprocess,thepatientsnursingproblemsaredefinedthroughanalysi ofpatientdata.Establishingaplancomesaftercollectingandanalyzingdata;evaluatingaplanisthelast stepofthenursingprocessandassigningapositivevaluetoeachconsequenceisnotdone. 19. Youarefollowingthecareplanthatwascreatedforapatientnewlyadmittedtoyourunit.Whichofthe followingaspectsofthecareplanwouldbeconsideredanursingimplementation? A)

Thepatientwillexpressanunderstandingofherdiagnosis.

B)

Thepatientappearsdiaphoretic.

C)

Thepatientisatriskforaspiration.

D)

Ambulatethepatienttwiceperdaywithpartialassistance.

Ans:

D Feedback: Implementationreferstocarryingouttheplanofnursingcare.Theotherlistedoptionsexemplifygoals, assessmentfindings,anddiagnoses.

20. Thephysicianhasrecommendedanamniocentesisforan18-year-oldprimiparouswoman.Thepatientis 34weeksgestationanddoesnotwantthisprocedure.Thephysicianisinsistentthepatienthavethe procedure.Thephysicianarrangesfortheamniocentesistobeperformed.Thenurseshouldrecognize thatthephysicianisinviolationofwhatethicalprinciple? A)

Veracity

B)

Beneficence

C)

Nonmaleficence

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Autonomy

Ans:

D

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Feedback: Theprincipleofautonomyspecifiesthatindividualshavetheabilitytomakeachoicefreefromexternal constraints.Thephysiciansactionsinthiscaseviolatethisprinciple.Thisactionmayormaynotviolate theprincipleofbeneficence.Veracitycentersontruth-tellingandnonmaleficenceisavoidingthe inflictionofharm. 21. Duringdiscussionwiththepatientandthepatientshusband,youdiscoverthatthepatienthasaliving will.Howdoesthepresenceof...