Chapter 03 Ethical and Legal Issues in Critical Care Nursing PDF

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Sole: Introduction to Critical Care Nursing, 5th Edition Chapter 03: Ethical and Legal Issues in Critical Care Nursing Test Bank MULTIPLE CHOICE 1. Ideally, advanced directives should be developed by the: a. b. c. d.

family, if the patient is in critical condition. patient as part of the hospital admission process. patient before hospitalization. patient's health care surrogate.

ANS: C Advance directives should be made and signed while a person is in good health and in a state of mind to make decisions about what should happen if he or she becomes incapacitated (e.g., during a critical illness). Incorrect: A: Advance directives should be made and signed while a person is in good health and in a state of mind to make decisions about what should happen if he or she becomes incapacitated (e.g., during a critical illness). B: Advance directives should be made and signed while a person is in good health and in a state of mind to make decisions about what should happen if he or she becomes incapacitated (e.g., during a critical illness). D: Advance directives should be made and signed while a person is in good health and in a state of mind to make decisions about what should happen if he or she becomes incapacitated (e.g., during a critical illness). DIF: Cognitive Level: Application REF: Page 37 OBJ: Discuss ethical principles and legal concepts related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 2. A critically ill patient has a living will in his chart. His condition has deteriorated. His wife says she wants "everything done," regardless of the patient's wishes. Which ethical principle is the wife violating? a. Autonomy b. Beneficence

c. Justice d. Nonmaleficence

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ANS: A Autonomy is respect for the individual and the ability of individuals to make decisions with regard to their own health and future. The wife is violating the patient's autonomy in decision making. Incorrect: B: Beneficence consists of actions intended to benefit the patients or others. C: Justice is being fair. D: Nonmaleficence is the duty to prevent harm. DIF: Cognitive Level: Analysis REF: Page 30 | Box 3-1 OBJ: Discuss ethical principles and legal concepts related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 3. Which of the following statements is true? a. A living will is the same as a health care proxy. b. A signed donor card ensures that organ donation will occur in the event of brain death. c. A surrogate is a competent adult designated by a person to make health care decisions in the event the person is incapacitated. d. A persistent vegetative state is the same as brain death in most states. ANS: C A surrogate is a competent adult designated by a person to make health care decisions if that person becomes incapacitated. Incorrect: A: A living will is a witnessed document that states a person's wishes regarding lifeprolonging procedures while a health care proxy is a person authorized by state statute to make health care decisions. B: In many states, consent by family members or health care proxy is required for organ donation even if an individual has a signed donor card. D: A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact; brain death is cessation of brain function. DIF: Cognitive Level: Analysis REF: Page 36 | Box 3-5 OBJ: Discuss ethical principles and legal concepts related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

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4. A critical care nurse connects a patient's tube feeding through the cuff of the endotracheal tube (instead of the nasogastric tube); this results in aspiration and hypoxemia. This situation is an example of: a. assault. b. battery.

c. futility. d. negligence.

ANS: D This example meets the criteria of negligence; the nurse is not following standard care procedures, and the patient was harmed. Incorrect: A: Assault is threatening to batter. B: Battery is touching a patient against his or her will. C: Futility is when actions will not impact patient outcomes. DIF: Cognitive Level: Analysis REF: Page 33 OBJ: Discuss legal accountability related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 5. All of the following are strategies for addressing ethical issues EXCEPT: a. b. c. d.

discussions during change-of-shift report. ethics consultation services. ethics referral services. formal multidisciplinary ethics committees.

ANS: A Formal mechanisms such as committees, services, or referral can all address ethical issues. Nurse-to-nurse communication can help share information from shift to shift, but it is not the best way to address ethical issues. Incorrect: B: Formal mechanisms such as committees, services, or referral can all address ethical issues. Nurse-to-nurse communication can help share information from shift to shift, but it is not the best way to address ethical issues. C: Formal mechanisms such as committees, services, or referral can all address ethical issues. Nurse-to-nurse communication can help share information from shift to shift, but it is not the best way to address ethical issues. D: Formal mechanisms such as committees, services, or referral can all address ethical issues. Nurse-to-nurse communication can help share information from shift to shift, but it is not the best way to address ethical issues.

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DIF: Cognitive Level: Comprehension REF: Page 31 OBJ: Discuss ethical principles and legal concepts related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 6. Which of the following statements about resuscitation is true? a. Family members should never be present during resuscitation. b. It is not necessary for a physician to write "do not resuscitate" orders in the chart if a patient has a health care surrogate. c. "Slow codes" are ethical and should be considered in futile situations if advanced directives are not available. d. Withholding "extraordinary" resuscitation is legal and ethical if specified in advance directives and physician orders. ANS: D Withholding resuscitation and other care is legal and ethical if based on the patient's wishes. Formal orders should be written that specify what is to be done if a patient suffers a cardiopulmonary arrest. Incorrect: A: Family presence during resuscitation and invasive procedures should be encouraged. B: A written order for "do not resuscitate" must be documented in the medical record. The decision to write the order is made in collaboration with the health care surrogate. C: "Slow codes" sometimes occur in the clinical setting while attempts are made to contact the health care surrogate or proxy. However, they are neither legal nor ethical. Specific written orders determine what is to be done for resuscitation efforts. DIF: Cognitive Level: Synthesis REF: Page 37 OBJ: Discuss ethical and legal issues that arise in the critical care setting. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 7. A medical situation in which goals of care are not achievable is: a. futility. b. incompetence.

c. life-prolonging procedure. d. persistent vegetative state.

ANS: A This is the definition of futility. Incorrect: B: Incompetence (in this chapter) is when a patient is unable to make decisions regarding health care treatment. C: A life-prolonging procedure is one that sustains, restores, or supplants a spontaneous vital function. D: A persistent vegetative state is a permanent, irreversible unconscious condition.

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DIF: Cognitive Level: comprehension REF: Page 29 OBJ: Discuss ethical and legal issues that arise in the critical care setting. TOP: Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 8. A patient who has profound neurological impairment with little or no chance of recovery is said to be: a. an organ donor. b. brain dead.

c. in a persistent vegetative state. d. in a terminal condition.

ANS: C A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment. Incorrect: A: A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment. B: A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment. D: A persistent vegetative state is a permanent, irreversible unconscious condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment. DIF: Cognitive Level: Comprehension REF: Page 36 OBJ: Discuss ethical and legal issues that arise in the critical care setting. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 9. "Not to intentionally inflict harm" is an example of which ethical principle? a. Beneficence b. Fidelity

c. Nonmaleficence d. Veracity

ANS: C Nonmaleficence: Actions intended not to harm or bring harm to others. Incorrect: A: Beneficence: Actions intended to benefit the patients or others. B: Fidelity: The moral duty to be faithful to the commitments that one makes to others. D: Veracity: The obligation to tell the truth. DIF: Cognitive Level: Comprehension REF: Page 30 | Box 3-1 OBJ: Discuss ethical principles and legal concepts related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment

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Test Bank 10. An important element of negligence is that the health care provider: a. b. c. d.

acted in a reasonable, prudent manner. caused harm by accident. failed to exercise the standard of care. reported an incident that resulted in injury.

ANS: C Negligence is defined as the failure to exercise the standards of care. Incorrect: A: Negligence is defined as the failure to exercise the standards of care. B: Negligence is defined as the failure to exercise the standards of care. D: Negligence is defined as the failure to exercise the standards of care. DIF: Cognitive Level: Comprehension REF: Page 32 OBJ: Discuss legal accountability related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 11. Which of the following organizations requires a mechanism for addressing ethical issues? a. b. c. d.

American Association of Critical Care Nurses American Hospital Association Society of Critical Care Medicine The Joint Commission

ANS: D The Joint Commission requires that a formal mechanism be in place to address patients' ethical concerns. Incorrect: A: The Joint Commission requires that a formal mechanism be in place to address patients' ethical concerns. B: The Joint Commission requires that a formal mechanism be in place to address patients' ethical concerns. C: The Joint Commission requires that a formal mechanism be in place to address patients' ethical concerns. DIF: Cognitive Level: Knowledge REF: Page 31 OBJ: Discuss ethical principles and legal concepts related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 12. Your moral values conflict with your duty to treat, and you tell your supervisor you are "sick." This action may be considered: a. abandonment. b. battery.

c. futility. d. negligence.

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ANS: A Abandonment is defined as the unilateral severance of a professional relationship while a patient is still in need of health care. If values conflict, it is important to use proper channels to communicate the conflict to your supervisor. Leaving because of "illness" is lying and avoids addressing the situation. Incorrect: B: Battery is touching the patient against his or her will. C: Futility is a medical situation in which goals of care are not achievable. D: Negligence is failure to act according to the standard of care. DIF: Cognitive Level: Comprehension REF: Page 33 OBJ: Discuss legal accountability related to critical care nursing. TOP: Nursing Process Step: N/A MSC: NCLEX: Safe, Effective Care Environment 13. All of the following are often considered criteria for brain death EXCEPT: a. b. c. d.

absence of cerebral blood flow. absence of brainstem reflexes on neurological examination. Cheyne-Stokes respirations. flat electroencephalogram.

ANS: C A criterion for brain death is absence of spontaneous respiration. Incorrect: A: Absence of cerebral blood flow is a criterion for brain death. B: Absence of brainstem reflexes is a criterion for brain death. D: A flat electroencephalogram (in the absence of hypothermia or drug-induced states) is a criterion for brain death.

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DIF: Cognitive Level: Analysis REF: Page 39 | Box 3-6 OBJ: Discuss ethical and legal issues that arise in the critical care setting. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 14. Which of the following statements about organ donation following brain death is true? a. A signed donor card mandates that organs be retrieved in the event of brain death. b. After brain death is determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room. c. The health care proxy does not need to give consent for the retrieval of organs. d. Once a patient is established as brain dead, life support is withdrawn and organs are retrieved. ANS: B After brain death is determined, the organs must be perfused to maintain viability. Therefore the patient remains on life support even though he or she is legally dead. Incorrect: A: A signed donor card indicates the individual’s wishes; however, most organ procurement agencies require family consent even if a donor card has been signed. C: In most states, the health care surrogate or proxy is required to give consent for organ donation. D: After brain death is determined, perfusion and oxygenation of organs is maintained until organs can be removed in the operating room. DIF: Cognitive Level: Analysis REF: Page 39 OBJ: Discuss ethical and legal issues that arise in the critical care setting. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 15. When a patient is declared brain dead, the time of death is recorded as the time when: a. b. c. d.

all organs have been retrieved for donation. brain death was determined and documented in the medical record. the heart stops beating, as documented by a rhythm strip. the ventilator is disconnected.

ANS: B The time of death is when brain death is confirmed and documented in the chart, even though the patient's heart is still beating.

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Incorrect: A: The time of death is when brain death is confirmed and documented in the chart, even though the patient's heart is still beating. Organs are retrieved after brain death has been documented. C: The time of death is when brain death is confirmed and documented in the chart, even though the patient's heart is still beating. D: The time of death is when brain death is confirmed and documented in the chart, even though the patient's heart is still beating. DIF: Cognitive Level: Analysis REF: Page 39 | Box 3-6 OBJ: Discuss ethical and legal issues that arise in the critical care setting. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 16. Elements of informed consent include all of the following EXCEPT: a. b. c. d.

competence to make a decision. sufficient knowledge to make a decision. verbal agreements about decisions. voluntary decision making.

ANS: C Informed consent requires written documentation of consent that is witnessed. Incorrect: A: Competence is an element of informed consent. B: Sufficient knowledge to make a decision is an element of informed consent. D: Voluntary consent is an important element of the process. DIF: Cognitive Level: Comprehension REF: Page 34 OBJ: Discuss legal accountability related to critical care nursing. TOP: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 17. A critically ill patient with terminal cancer shows asystole on the monitor. He does not have a do-not-resuscitate order written on the chart. What are your actions? a. Contact the attending physician immediately to determine if CPR should be initiated. b. Contact the family immediately to determine if they want CPR to be started. c. Give emergency medications but withhold intubation. d. Initiate CPR and call a code.

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ANS: D Because no orders have been written, it is imperative that a code be called. In this example, decisions regarding resuscitation status should be determined as soon as possible before a code event. Incorrect: A: Because no orders have been written, it is imperative that a code be called. B: Because no orders have been written, it is imperative that a code be called. C: Because no orders have been written, it is imperative that a code be called. DIF: Cognitive Level: Analysis REF: Page 37 OBJ: Discuss legal accountability related to critical care nursing. TOP: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment 18. All of the following are examples of withholding or withdrawing treatment and would require consultation with the health care surrogate or family EXCEPT: a. adjustment of antibiotics. b. do not resuscitate.

c. stop blood transfusions. d. discontinue tube feedings.

ANS: A All orders except antibiotic adjustment may be considered withdrawal or withholding of life support and should be written only after informed consent from the health care surrogate or family has been obtained. Incorrect: B: All orders except antibiotic adjustment may be considered withdrawal or withholding of life support and should be written only after informed consent from the health care surrogate or family has been obtained. C: All orders except antibiotic adjustment may be considered withdrawal or withholding of life support and should be written only after informed consent from the health care surrogate or family has been obtained. D: All orders except antibiotic adjustment may be considered withdrawal or withholding of life support and should be written only after informed consent from the health care surrogate or family has been obtained. DIF: Cognitive Level: Analysis REF: Page 37 OBJ: Discuss ethical and legal issues that arise in ...