Ethical Practice
The nurse on the rehabilitation unit is being sent to the neonatal intensive care unit (NICU) to work because the unit is short-staffed. The nurse has never worked in the NICU. Which response by the nurse supports the ethical principle of nonmalfeasance?
1. The nurse requests not to be floated to the NICU.
2. The nurse accepts the assignment to the NICU.
3. The nurse asks why another nurse can’t go to the NICU.
4. The nurse talks another nurse into going to the NICU.
ANSWER: 1. The nurse requests not to be floated to the NICU.
Rationale: Nonmalfeasance is the duty to prevent or avoid doing harm. The nurse asking not to be assigned to the NICU because of lack of experience in caring for critically ill infants is supporting the ethical principle of nonmalfeasance.
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2. The NICU is a very specialized unit requiring the nurse to be knowledgeable with equipment and caring for critically ill infants. Accepting the assignment may cause harm to one of the neonates.
3. This is challenging the charge nurse’s assignment, and this does not support the ethical principle of nonmalfeasance.
4. This is blatantly violating the charge nurse’s authority and does not support the ethical principle of nonmalfeasance.
What PPE will the RN put on before entering a patients room who is on Contact Isolation?
What is Gown & Gloves
Recommended infusion rate of K+ is how many mEq/L per hour?
What is What is 10 mEq/L
To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review?
What is What is B-type natriuretic peptide (BNP) (a hormone produced by your heart, released in response to changes in pressure inside the heart, these changes can be related to heart failure and other cardiac problems. Levels goes up when heart failure develops or gets worse, and levels goes down when heart failure is stable)
A nurse is discussing disaster planning with the board members of a hospital. Which of the following individuals should the nurse expect to request extra supplies and staffing for the facility?
A. Incident commander
B. Medical command physician
C. Triage officer
D. Media liaison
What is B. The nurse should expect the medical command physician to oversee use of resources such as equipment and personnel
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A. The nurse should expect the incident commander to manage the incident and key leaders within the facility.
C. The nurse should expect the triage officer to prioritize the treatment of incoming clients
D. The nurse should expect the media liaison to communicate with members of the media and press on behalf of the facility.
The female nurse is discussing an upcoming surgical procedure with a 76-year-old male client diagnosed with cancer. Which action is an example of the ethical principle of fidelity?
1. The nurse makes sure the client understands the procedure before signing the permit.
2. The nurse refuses to disclose the client’s personal information to the CNO.
3. The nurse tells the client his diagnosis when the family did not want him to know.
4. The nurse tells the client that she does not know the client’s diagnosis.
ANSWER: 2. The nurse refuses to disclose the client’s personal information to the CNO.
Rationale: This is an example of fidelity. Fidelity is the duty to be faithful to commitments and involves keeping information confidential and maintaining privacy and trust.
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1. This is an example of autonomy. The client needs all pertinent information prior to making an informed choice.
3. This is an example of veracity, the duty to tell the truth.
4. This is an example of nonmalfeasance, the duty to do no harm. This avoids telling a client facing surgery that he has cancer.
What isolation precaution SIGN(s) will the RN hang outside of a patients room who is positive for influenza (flu) & pertussis (whooping cough)?
What is Droplet
Patient is on a Heparin drip. Which lab test results should the RN monitor for Heparin to see if it is therapeutic?
A. INR
B. PTT
C. PT
ANSWER: PTT
Normal PTT level is 30 to 40 seconds .... 1.5 to 2.5 times the control value if receiving heparin therapy
INR & PT are monitored for Coumadin
(INR normal level is 0.8 to 1.1 ...desired goal of 2 to 3 if patient is on warfarin therapy)
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PT/PTT are laboratory tests that measure the clotting time (how long it takes blood to clot.)
PT/PTT are blood tests and INR is a ratio calculated from the PT.
The greater the PT/PTT values, the longer it takes the blood to clot. HIGH PT/PTT = risk for BLEEDING. LOW PT/PTT = risk for blood clots/ stroke.
The greater the INR, the longer it takes the blood to clot.
Normal Range of PaCO2
What is What is 35-45 mm Hg
A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings?
A. American Nurses Association Code of Ethics
B. HIPAA
C. Patient Self‑Determination Act
D. Patient Care Partnership
What is: D. Patient Care Partnership: a document that addresses clients’ rights when receiving care. .......................................................................A. The American Nurses Association Code of Ethics provides nurses with a set of standards for nursing practice.
B. T he Privacy Rule of HIPAA ensures client privacy and confidentiality.
C. T he Patient Self‑Determination Act is federal legislation that requires that all clients admitted to a health care facility be asked whether they have advance directives.
The client is admitted to the critical care unit after a motor vehicle accident. The client asks the nurse, “Do you know if the person in the other car is all right?” The nurse knows the person died. Which statement does not support the ethical principle of beneficence?
1. “I am not sure how the other person is doing.”
2. “I will try to find out how the other person is doing.”
3. “You should rest now and try not worry about it.”
4. “I am sorry to have to tell you, but the person died.”
ANSWER: 4. “I am sorry to have to tell you, but the person died.”
Rationale: This statement supports the ethical principle of veracity, which is the duty to tell the truth. This statement will probably further upset the client and cause psychological distress that may hinder the recovery period.
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1. Beneficence is the ethical principle to do good actively for the client. Because the client is in the ICU, the client is critically ill and does not need any type of news that will further upset the client. This statement supports the ethical principle of beneficence.
2. The statement supports beneficence, but the stem asks which option does not support beneficence.
3. This statement avoids directly telling the client the other individual is dead.
What PPE would RN need to wear before entering a patients room who has Smallpox?
What is: N95 mask, gown, gloves. (per ATI: contact and airborne precautions)
Which laboratory data should the charge nurse notify the HCP?
1. The potassium level of 3.6 mEq/L in a client diagnosed with heart failure who is taking the loop diuretic furosemide (Lasix).
2. The PTT level of 78 in the client diagnosed with pulmonary embolism who is receiving IV heparin.
3. The blood urea nitrogen (BUN) of 84 mg/dL in a client diagnosed with end-stage renal disease and peripheral edema.
4. The blood glucose level of 543 mg/dL in a client diagnosed with uncontrolled diabetes mellitus type 1.
ANSWER: 4. The blood glucose level of 543 mg/dL in a client diagnosed with uncontrolled diabetes mellitus type 1.
Rationale: This is a very high blood glucose level, and the client diagnosed with type 1 diabetes will be catabolizing fats at this level and is at risk for diabetic ketoacidosis (DKA) coma.
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1. This is a normal potassium level, and the
HCP does not need to be notified.
2. This data is within therapeutic range. and
the HCP does not need to be notified.
3. A BUN of 84 mg/dL is an abnormal lab
value, but it would be expected in a client
diagnosed with ESRD. The HCP does
not need to be notified.
A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the chest tube was accidentally removed. Which of the following actions should the nurse take first?
A. Obtain a chest x‑ray.
B. Apply sterile gauze to the insertion site.
C. Place tape around the insertion site.
D. Assess respiratory status.
What is: B. Apply sterile gauze to the insertion site.
A new scheduling policy is implemented within the organization. The nurse manager should recognize that change is a common cause of conflict. This is an example of what type of conflict?
What is LATENT conflict
The night nurse walks into the client’s room and finds the client crying. The client asks the nurse “Am I dying? I think something bad is wrong but they aren’t telling me.” The nurse knows the client has cancer and has less than 6 months to live. Which response is an example of the ethical principle of veracity?
1. “You are concerned they are not telling you something is wrong.”
2. “I am sorry to tell you but you have cancer and less than 6 months to live.”
3. “If you think something is wrong you should speak with your doctor in the morning.”
4. “What makes you think there is something wrong and you are dying?”
ANSWER: 2. “I am sorry to tell you but you have cancer and less than 6 months to live.”
Rationale: The ethical principle of veracity is the duty to tell the truth.
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1. This statement is a therapeutic response, but it is not telling the client the truth.
3. This statement is “passing the buck,” which the nurse should not do if at all possible.
4. This is attempting to obtain more information about the situation, but it is not telling the truth.
The RN knows that a patient who has measles would be placed on this type of isolation ______.
What is Airborne precautions
This sign is a twitching response when a set of facial nerves is tapped. 1.What is it called? 2.It is used to check for what? *Must answer both correctly*
What is 1.(+) Chvostek’s sign 2.Assessed for Hypocalcemia
A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply.)
A. Continuous bubbling in the water seal chamber
B. Gentle constant bubbling in the suction control chamber
C. Rise and fall in the level of water in the water seal chamber with inspiration and expiration
D. Exposed sutures without dressing
E. Drainage system upright at chest level
What is: B. (gentle constant bubbling in water seal) & C. (Rise and fall in the level of water in the water seal chamber with inspiration and expiration
INCORRECT are: A, D, E
A = air leak
D = sutures should be covered with an airtight dressing
E = drainage system should be below chest level
A nurse is reviewing the hospital’s fire safety policies and procedures with newly hired assistive personnel. The nurse is describing what to do when there is a fire in a client’s trash can. Which of the following information should the nurse include? (Select all that apply.)
A. The first step is to pull the alarm.
B. Use a Class C fire extinguisher to put out the fire.
C. Instruct ambulatory clients to evacuate to a safe place.
D. Pull the pin on the fire extinguisher prior to use. E. Close all doors.
What is C, D, E ...................................................................... A. When a fire occurs in a client’s room, the first step for the employee to take is to remove or evacuate the client from the room. The employee should know the RACE sequence: rescue the client, pull the alarm, confine the fire, and then extinguish the fire.
B. Class A fire extinguishers are used for paper, wood, and cloth.
C. CORRECT: Ambulatory clients can walk by themselves to a safe place.
D. CORRECT: The fire extinguisher PASS sequence is pull the pin, aim at the base of the fire, squeeze the lever, and sweep the fire extinguisher from side to side.
E. CORRECT: The employee should close all doors to contain the fire.
The clinic nurse is discussing a tubal ligation with a 17-year-old adolescent with Down syndrome. The adolescent does not want the surgery, but her parents (who are also in the room) are telling her she must have it. Which statement by the nurse would be an example of the ethical principle of justice?
1. “I think this requires further discussion before scheduling this procedure.”
2. “You will not be able to have children after you have this procedure.”
3. “You should have this procedure because you could not care for a child.”
4. “You can refuse this procedure and your parents can’t make you have it.”
ANSWER: 1. “I think this requires further discussion before scheduling this procedure.”
Rationale: 1. The ethical principle of justice is to treat all clients fairly, without regard to age, socioeconomic status, or any other variable, including clients with special needs. This statement supports the adolescent’s right to her opinion even though she has Down syndrome.
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2. If the adolescent needs clarification of the procedure, this would be an appropriate response, which is an example of the ethical principle of veracity or truth telling.
3. This statement is an example of the ethical principle of paternalism, in which the nurse knows what is best for the client.
4. This is an example of autonomy, in which the client has the right to self-determination. The Nuremburg code of ethics specifically supports the right of individuals with special needs against being forced to participate in procedures against their will.
What type of Isolation SIGN(s) would the nurse hang outside of patients room who is infected with Anthrax?
Answer: No isolation required. Standard precautions per CDC. Infected patients do not generally pose a transmission risk.
The HH nurse received laboratory results on the following clients. Which client should the HH nurse contact first?
1. The client who has an INR of 2.8.
2. The client who has a serum potassium level of 3.8 mEq/L.
3. The client who has a serum digoxin level of 2.6 mg/dL.
4. The client who has a glycosylated hemoglobin of 6%.
ANSWER: 3. The client who has a serum digoxin level of 2.6 mg/dL.
Rationale: The client’s digoxin level is higher than the therapeutic level for digoxin, which is 0.8 to 2 mg/dL. This client should be contacted first to assess for signs/symptoms of digoxin toxicity.
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1. The therapeutic range for INR is 2 to 3; therefore; this client would not need to be contacted first.
2. The client’s serum potassium level is within the normal range—3.5 to 5.5 mEq/L. Therefore, this client would not need to be contacted first.
4. The glycosylated hemoglobin, which is the average of blood glucose levels over 3 months, should not be more than 8%. This client, with a level of 6%, does not need to be contacted.
What will the RN anticipate the MD will order to treat an elevated INR level?
Name at least 2
What is Vitamin K, FFP, DDAVP
Select ALL the Measures an RN should take to prevent electrical shock
1.Ensure that all electrical equipment has a three-way plug and grounded outlet.
2.Ensure that outlet covers are used in areas such as pediatric and mental health units.
3.When unplugging equipment, grasp the cord, not the plug.
4.Disconnect all equipment prior to cleaning.
5.Ensure that outlets are not overcrowded.
6.Use extension cords only when absolute necessary. If used in an open area, tape the cords to the floor.
What is 1, 2, 4, 5, 6
#3 Should be: When unplugging equipment, grasp the PLUG, not the CORD.