Chapt.3 Legal and Ethical Aspects of Nursing
You witness a nursing assistant force a patient who is trying to stand into a chair saying, "Don't keep trying to get up or I will restrain you." The nursing assistant's behavior is an example of:
A - Assault
B - Battery
C - Assault and Battery
D - Negligence
C - Assault and battery
Rationale: Assault is a threat to do bodily harm or to touch someone against their permission. Battery is unlawful physical contact. In the example, the nursing assistant does both.
Which principle is most important when setting priorities for patient care?
A - Rank problem statements/nursing diagnoses and interventions as high, medium, and low
B - Reevaluate and assess your priorities every 45 mins
C - Respond to the loudest, most difficult patient first so that the others can rest
D - Keep patients with visiting family well informed but delay treatments
A - Rank problem statements/nursing diagnoses and interventions as high, medium, and low
Rationale: Ranking allows for evaluation of what is potentially life-threatening and what is less harmful. This allows for best prioritization
A postoperative patient is having incisional pain. As part of the nurse's assessment, the nurse notes that the patient is grimacing when they change position. The patient's grimace can be useful in the assessment and can be described in what manner?
A - Nursing diagnosis
B - Cue
C - Diagnosis
D - Inference
Rationale: A cue is a piece of data that influences clinical decisions. In this example, the grimacing of a postoperative patient "cues" the nurse that the patient may be experiencing discomfort.
A - "You should eat first. It'll be easier for you to talk to the pastor once you've had some food."
B - "I'll contact our pastoral care department to arrange the pastor visit and the kitchen to order a meal for you. Your meal will be here for you when you are ready to eat."
C - "I'll contact the pastor as soon as possible to come in. So you should eat while you are waiting for them to arrive"
D - "The pastor doesn't mind if you eat before the two of you visit. If you eat food, you will feel better."
B
Rationale: This choice demonstrates respect for the patient's spiritual needs, while also allowing him to make his own decision about food
Comfort care for a terminally ill patient would include:
A - Scheduled MRI's to determine whether metastases are causing bone pain
B - Use of medication to relieve nausea
C - Insertion of an IV line to provide fluids
D - A gastrostomy tube to provide nutrition when the patient is unable to eat normally
B - Use of medication to relieve nausea
Rationale: A goal of end-of-life care is to relieve suffering.
A patient confides that their broken arm is the result of domestic violence. In this instance, the nurse is required to:
A - Get a 2nd nurse to witness
B - Report abuse to authorities
C - Assure the patient that the information will be kept private
D - Confirm the abuse with another family member and then notify the charge nurse
B - Report abuse to authorities
Rationale: Nurses have a duty to report any suspected abuse and cannot keep the information "private"
Critical thinking will help you in the clinical setting to:
A - Delegate work more efficiently.
B - Make good decisions most of the time.
C - Identify the best problem statements/nursing diagnoses
D - Write care plans more effectively.
B - Make good decisions most of the time.
Rationale: Critical thinking skills will help you make sound clinical decisions much of the time, this is the MOST comprehensive answer choice. Delegation may require critical thinking but is not allowed by the LPN in each state.
A patient who is 14 hours postop complains of shortness of breath. Which action should be implemented first?
A - Auscultate the lungs
B - Question about previous shortness of breath
C - Check for an order for oxygen therapy
D - Reassure the patient
D - Reassure the patient
Rationale: The patient should be reassured to prevent an increased level of anxiety that could make the shortness of breath worse. Then the lungs would be auscultated and then the medical record can be checked for an order for oxygen if assessment indicates the need.
An older adult who does not speak English is admitted to the unit after major abdominal surgery. The nurse cannot speak the patient's language. To assess for pain, which action should the nurse take? (select all that apply):
A - Look for nonverbal indicators of pain: grimacing, moaning, or restlessness
B - Obtain the services of an interpreter to devise question-and-answer cards regarding pain.
C - Wait for the family to come to ask the patient about pain.
D - Use nonverbal gestures to get the patient to indicate their pain level.
E - Write the 1-10 pain scale on a white board and ask the patient to point.
B - Obtain the services of an interpreter to devise question-and-answer cards regarding pain.
Rationale: Translating the patient's native language will give the most accurate account of the patient's experience. Immediately postoperative patients may have an easier time with cards containing frequently encountered questions or issues ("Are you having pain?", "Are you short of breath?), although later a translation service may be required.
A patient recently diagnosed with cancer says to the nurse, "If I can just live until my son graduates from college, I'll donate 10% of my estate to the church." The patient is in a stage described by Kubler-Ross as
Bargaining
Rationale: The patient wants good behavior rewarded.
Your patient has experienced severe complications during surgery and remains on life support. Decisions about care can be more easily made if the patient has which document in place?
A - A power of attorney over financial affairs
B - An advance directive
C - A will
D - No special documentation is needed
B - An advance directive
Rationale: An advance directive is a consent that delineates a patient's wishes regarding surgery or diagnostic or therapeutic treatments. These provide direction for making decisions in the event a patient's condition is such that they cannot make the decisions themselves.
Attributes to critical thinkers include (select all that apply):
A - Admitting what you don't know
B - Consulting with PCP/HCP's
C - Anticipating problems
D - Reflecting on experience
E - Accepting others' decisions
A - Admitting what you don't know, C - Anticipating problems, D - Reflecting on experience
Rationale: All of the correct choices involve the elements of critical thinking. The 2 incorrect choices require no critical thinking skills because they are akin to "following orders".
Which sentence correctly describes a problem statement/nursing diagnosis when compared with a medical diagnosis?
A - Problem statements and medical diagnoses are essentially the same
B - A problem statement supports a medical diagnosis.
C - Medical diagnoses and problem statements are not related to one another
D - The problem statement/nursing diagnosis describes a patient response to the medical diagnosis
D - The problem statement/nursing diagnosis describes a patient response to the medical diagnosis
Rationale: A nursing diagnosis is a description using specific taxonomy, of a patient's response to a medical condition, any tx's, their life situation, and their environment.
An older adult is grimacing and refusing to eat when served hospital food. What should the nurse do to meet the patient's nutritional needs?
A - Contact the kitchen and order a peanut butter sandwich for protein.
B - Continue serving hospital food until the patient decides to eat it.
C - Contact the primary caregiver to assess the patient's dietary habits.
D - Use a certified health care interpreter to explain to the patient that the kitchen will try to accommodate nutritional requests if possible
C - Contact the primary caregiver to assess the patient's dietary habits.
Rationale: The nurse should perform assessment/data collection prior to implementing any other interventions listed. Talking to the primary caregiver can give us data about our patient's normal eating habits.
A therapeutic response the nurse could make when a patient says, "I don't want to die" is:
A - "I'm sure you don't want to die"
B - "You have an excellent healthcare team, maybe you won't die"
C - "None of us want to die"
D - "I'm sorry you're going through this; would you like to talk about it?"
D - "I'm sorry you're going through this; would you like to talk about it?"
Rationale: Patients can often calm themselves by discussing their feelings.
Which action(s) violate HIPPA? (Select all that apply)
A - Discussing the comatose patient's condition with the patient's father-in-law
B - Discussing the outcome of a patient's test with another nurse from the unit while in a crowded elevator
C - Relaying info about the patient's concerns to the nurse who will provide care on the next shift.
D - Relaying a complaint about the quality of nursing care by the patient's wife to the charge nurse.
E - Updating your social media site about a difficult clinical day, including hospital and patient's diagnosis, but NOT the patient's name.
A, B, E
Rationale: Patient medical info is private, and all of these examples would constitute an invasion of privacy about medical information. These actions are unethical according to nursing standards.
What are the 2 versions of the nursing process?
1 - Formal: Following the care plan from the formal documentation in patients chart
2 - Informal: Using the nursing assessment process, not in the care plan, treating situations as they arise
When evaluating a patient admitted with a lower respiratory tract infection, which data are most important for the nurse to obtain?
A - Level of pain/discomfort
B - Medications taken at home
C - Duration of the illness
D - Bilateral lung sounds
D - Bilateral lung sounds
Rationale: Auscultating he lung sounds to obtain data about the quality of air movement is the most important action for this patient with a respiratory infection.
Your 45-year-old, mentally competent patient is having excessive blood loss from surgery. The patient is a Jehovah's Witness and refuses a blood transfusion stating, "Please remember I signed a DNR statement." The BP is falling, and the patient has a rapid heart rate. Which nursing intervention is appropriate?
A - Assist the RN in administering fluid boluses and medications to support the blood pressure.
B - Make the patient comfortable with a warm blanket because they are avoiding life-saving measures.
C - Prepare to help the RN administer blood after the patient loses consciousness.
D - Try to convince the patient that they should have the blood transfusion.
A - Assist the RN in administering fluid boluses and medications to support the blood pressure.
Rationale: Although the patient who is Jehovah's Witness will refuse blood transfusion, that does not mean other emergency measures, such as IV fluids and vasoactive medications, should be avoided.
A patient with prostate cancer is declining rapidly. He is frightened and asks if there is any hope. What is the nurse's best response?
A - "Your cancer is incurable, can I discuss comfort measures with you?"
B - "Would you like me to call a Chaplain for you?"
C - "There is always hope, let's look at how we can address your issues together. What is it you're hoping for at this point?"
D - "You cannot give up! A positive attitude helps effect a cure."
C - "There is always hope, let's look at how we can address your issues together. What is it you're hoping for at this point?"
Rationale: Hope encompasses more than just hope for a cure.
The student neglects to raise the head of the bed of a patient receiving continuous tube feedings. The patient aspirates and develops pneumonia. Which correctly describes the student's liability in this situation?
A - The charge nurse is responsible because care was not delegated appropriately.
B - The LPN caring for the patient is solely responsible because that nurse is licensed, and the student is not.
C - The student is expected to provide the same standard of care as the LPN.
D - Both the nursing instructor and the student are equally liable.
C - The student is expected to provide the same standard of care as the LPN.
Rationale: Students caring for patients in the clinical setting are expected to perform all tasks and duties to which they are assigned at the level of the LPN.
Clinical reasoning is most important when:
A - Planning wound care for a pressure injury
B - Organizing nursing care for several patients
C - Collaborating with other health team members
D - Drawing sound conclusions from assessment data
D - Drawing sound conclusions from assessment data
Rationale: Although critical thinking skills may be used in any of the answer choices, the most comprehensive answer choice is D because drawing conclusions requires analysis of data and synthesizing it
A difference in the assessment of a patient entering a long-term care facility versus that of a hospital patient is that the long-term care resident is assessed for:
A - Functional abilities
B - Psychosocial concerns
C - Emotional concerns
D - Skin problems
A - Functional abilities
Rationale: Functional abilities are assessed to determine how much assistance with activities of daily living the resident will need while in the facility
What is the difference between Potential Nursing Interventions and Appropriate Nursing Interventions?
Potential - specific, possible actions a nurse could take depending on the patients condition
Appropriate - following plan/orders, evidence-based, safe, and relevant to nursing diagnosis and goals
After receiving palliative care for several months, your patient has died. The family is feeling deep grief. The nurse also feels saddened and knows that:
A - Crying is inappropriate because the nurse is not a family member or a close friend
B - It is appropriate for the nurse to shed some tears, allowing movement of grief rather than trying to avoid it
C - The nurse needs to ignore their feelings and stay strong for the family in order to provide better nursing care
D - The nurse should avoid the family and allow them to grieve in private
B - It is appropriate for the nurse to shed some tears, allowing movement of grief rather than trying to avoid it
Rationale: Palliative care is a tremendous challenge and involves personal commitment. The nurse will feel grief at the patient's death