QUESTION AND ANSWERS TO EACH CHAPTER | Study notes Nursing

Page 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 nurse's personal beliefs.

What is the nurse's ethical obligation to these patients?

The nurse should adhere to professional standards of practice and offer service to

these patients.

The nurse should make the choice to decline this position and pursue a different

nursing role.

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

The nurse should express alternatives to women considering terminating their

pregnancy.

Ans:

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.

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

patient's respiratory status, you find that the rate has decreased from 16 breaths per

minute to 10 breaths per minute. What action should you take?

Decrease the rate of IV infusion.

Stimulate the patient in order to increase respiratory rate.

Report the decreased respiratory rate to the physician.

Allow the patient to rest comfortably.

Ans:

Feedback:

End-of life issues that often involve ethical dilemmas include pain control, “do not

resuscitate” orders, life-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 patient's respiratory status should be carefully monitored and any

changes should be reported to the physician.

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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 nurse's personal beliefs. What is the nurse's 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.
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 patient's 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-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 patient's respiratory status should be carefully monitored and any changes should be reported to the physician.

An adult patient has requested a “do not resuscitate” (DNR) order in light of his recent diagnosis with late stage pancreatic cancer. The patient's son and daughter-in-law are strongly opposed to the patient's 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 patient's 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.
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 patient's wishes before hospitalization. C) This document that is binding for the duration of the patient's life. D) This document has been drawn up by the patient's 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 patient's 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 patient's life, and they are not drawn up by the patient's family.

In response to a patient's 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 patient's response to nursing interventions and the extent to which the objectives have been achieved.
A medical nurse has obtained a new patient's 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 patient's 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. Ans: 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 patient's 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.

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 physician's order to restrain the patient. C) Read the facility's policy on restraints. D) Order soft restraints from the storeroom. Ans: B Feedback: It is mandatory in most settings to have a physician's 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.
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 patient's 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 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 nurse's actions do not constitute diagnosis.

The nurse, in collaboration with the patient's 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) Maslow's hierarchy of needs D) The nurse's skill set Ans: C Feedback: Maslow's 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.
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 patient's 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 patient's 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 patient's 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.

The care team has deemed the occasional use of restraints necessary in the care of a patient with Alzheimer's disease. What ethical violation is most often posed when using restraints in a long-term care setting? A) It limits the patient's personal safety. B) It exacerbates the patient's disease process. C) It threatens the patient's 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 individual's autonomy. Restraints are not without risks, but they should not normally limit a patient's safety. Restraints will not affect the course of the patient's underlying disease process, though they may exacerbate confusion. The use of restraints is closely legislated, but they are not illegal.
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 patient's 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 patient's 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.
In the process of planning a patient's 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? 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 patient's chances of recovery Ans: C Feedback: In the diagnostic phase of the nursing process, the patient's nursing problems are defined through analysis 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.

During discussion with the patient and the patient's husband, you discover that the patient has a living will. How does the presence of a living will influence the patient's care? A) The patient is legally unable to refuse basic life support. B) The physician can override the patient's desires for treatment if desires are not evidence-based. C) The patient may nullify the living will during her hospitalization if she chooses to do so. D) Power-of-attorney may change while the patient is hospitalized. Ans: C Feedback: Because living wills are often written when the person is in good health, it is not unusual for the patient to nullify the living will during illness. A living will does not make a patient legally unable to refuse basic life support. The physician may disagree with the patient's wishes, but he or she is ethically bound to carry out those wishes. A power-of-attorney is not synonymous with a living will.
Your older adult patient has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief of her symptoms with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this patient's plan of care, which nursing diagnosis would most likely be appropriate? A) Self-care deficit related to fatigue and joint stiffness B) Ineffective airway clearance related to chronic pain C) Risk for hopelessness related to body image disturbance D) Anxiety related to chronic joint pain Ans: A Feedback: Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely. Ineffective airway clearance is unlikely.

You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and you note decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate nursing diagnosis for this patient? A) Ineffective airway clearance related to tracheobronchial secretions B) Pneumonia related to progression of disease process C) Poor ventilation related to acute lung infection D) Immobility related to fatigue Ans: A Feedback: Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis for this patient is “ineffective airway clearance related to copious tracheobronchial secretions.” “Pneumonia” and “poor ventilation” are not nursing diagnoses. Immobility is likely, but is less directly related to the patient's admitting medical diagnosis and the nurse's assessment finding.
You are providing care for a patient who has a diagnosis of pneumonia attributed to Streptococcus pneumonia infection. Which of the following aspects of nursing care would constitute part of the planning phase of the nursing process? A) Achieve SaO 2 ≥ 92% at all times. B) Auscultate chest q4h. C) Administer oral fluids q1h and PRN. D) Avoid overexertion at all times. Ans: A Feedback: The planning phase entails specifying the immediate, intermediate, and long-term goals of nursing action, such as maintaining a certain level of oxygen saturation in a patient with pneumonia. Providing fluids and avoiding overexertion are parts of the implementation phase of the nursing process. Chest auscultation is an assessment.
You are the nurse who is caring for a patient with a newly diagnosed allergy to peanuts. Which of the following is an immediate goal that is most relevant to a nursing diagnosis of “deficient knowledge related to appropriate use of an EpiPen”? A) The patient will demonstrate correct injection technique with today's teaching session. B) The patient will closely observe the nurse demonstrating the injection. C) The nurse will teach the patient's family member to administer the injection. D) The patient will return to the clinic within 2 weeks to demonstrate the injection. Ans: A Feedback: Immediate goals are those that can be reached in a short period of time. An appropriate immediate goal for this patient is that the patient will demonstrate correct administration of the medication today. The goal should specify that the patient administer the EpiPen. A 2-week time frame is inconsistent with an immediate goal.

An audit of a large, university medical center reveals that four patients in the hospital have current orders for restraints. You know that restraints are an intervention of last resort, and that it is inappropriate to apply restraints to which of the following patients? A) A postlaryngectomy patient who is attempting to pull out his tracheostomy tube B) A patient in hypovolemic shock trying to remove the dressing over his central venous catheter C) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode D) A patient with depression who has just tried to commit suicide and whose medications are not achieving adequate symptom control Ans: C Feedback: Restraints should never be applied for staff convenience. The patient with urosepsis who is frequently ringing the call bell is requesting assistance to the bedside commode; this is appropriate behavior that will not result in patient harm. The other described situations could plausibly result in patient harm; therefore, it is more likely appropriate to apply restraints in these instances.
A patient has been diagnosed with small-cell lung cancer. He has met with the oncologist and is now weighing the relative risks and benefits of chemotherapy and radiotherapy as his treatment. This patient is demonstrating which ethical principle in making his decision? A) Beneficence B) Confidentiality C) Autonomy D) Justice Ans: C Feedback: Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that cases should be treated equitably.

A patient with migraines does not know whether she is receiving a placebo for pain management or the new drug that is undergoing clinical trials. Upon discussing the patient's distress, it becomes evident to the nurse that the patient did not fully understand the informed consent document that she signed. Which ethical principle is most likely involved in this situation? A) Sanctity of life B) Confidentiality C) Veracity D) Fidelity Ans: C Feedback: Telling the truth (veracity) is one of the basic principles of our culture. Three ethical dilemmas in clinical practice that can directly conflict with this principle are the use of placebos (nonactive substances used for treatment), not revealing a diagnosis to a patient, and revealing a diagnosis to persons other than the patient with the diagnosis. All involve the issue of trust, which is an essential element in the nurse–patient relationship. Sanctity of life is the perspective that life is the highest good. Confidentiality deals with privacy of the patient. Fidelity is promise-keeping and the duty to be faithful to one's commitments.
The nursing instructor is explaining critical thinking to a class of first-semester nursing students. When promoting critical thinking skills in these students, the instructor should encourage them to do which of the following actions? A) Disregard input from people who do not have to make the particular decision. B) Set aside all prejudices and personal experiences when making decisions. C) Weigh each of the potential negative outcomes in a situation. D) Examine and analyze all available information. Ans: D Feedback: Critical thinking involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. A full disregard of one's own experiences is not possible. Critical thinking does not denote a focus on potential negative outcomes. Input from others is a valuable resource that should not be ignored.

The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse should describe skills in which of the following domains? Select all that apply. A) Self-esteem B) Self-regulation C) Inference D) Autonomy E) Interpretation Ans: B, C, E Feedback: Skills needed in critical thinking include interpretation, analysis, evaluation, inference, explanation, and self-regulation. Self-esteem and autonomy would not be on the list because they are not skills.
The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The nurse's most recent assessment reveals an SaO 2 of 89%. The nurse is aware that part of critical thinking is determining the significance of data that have been gathered. What characteristic of critical thinking is used in determining the best response to this assessment finding? A) Extrapolation B) Inference C) Characterization D) Interpretation Ans: D Feedback: Nurses use interpretation to determine the significance of data that are gathered. This specific process is not described as extrapolation, inference, or characterization.
A nurse is admitting a new patient to the medical unit. During the initial nursing assessment, the nurse has asked many supplementary open-ended questions while gathering information about the new patient. What is the nurse achieving through this approach? A) Interpreting what the patient has said B) Evaluating what the patient has said C) Assessing what the patient has said D) Validating what the patient has said Ans: D Feedback: Critical thinkers validate the information presented to make sure that it is accurate (not just supposition or opinion), that it makes sense, and that it is based on fact and evidence. The nurse is not interpreting, evaluating, or assessing the information the patient has given.

A nurse uses critical thinking every day when going through the nursing process. Which of the following is an outcome of critical thinking in nursing practice? A) A comprehensive plan of care with a high potential for success B) Identification of the nurse's preferred goals for the patient C) A collaborative basis for assigning care D) Increased cost efficiency in health care Ans: A Feedback: Critical thinking in nursing practice results in a comprehensive plan of care with maximized potential for success. Critical thinking does not identify the nurse's goal for the patient or provide a collaborative basis for assigning care. Critical thinking may or may not lead to increased cost efficiency; the patient's outcomes are paramount.
A nurse provides care on an orthopedic reconstruction unit and is admitting two new patients, both status post knee replacement. What would be the best explanation why their care plans may be different from each other? A) Patients may have different insurers, or one may qualify for Medicare. B) Individual patients are seen as unique and dynamic, with individual needs. C) Nursing care may be coordinated by members of two different health disciplines. D) Patients are viewed as dissimilar according to their attitude toward surgery. Ans: B Feedback: Regardless of the setting, each patient situation is viewed as unique and dynamic. Differences in insurance coverage and attitude may be relevant, but these should not fundamentally explain the differences in their nursing care. Nursing care should be planned by nurses, not by members of other disciplines.
A class of nursing students is in their first semester of nursing school. The instructor explains that one of the changes they will undergo while in nursing school is learning to “think like a nurse.” What is the most current model of this thinking process? A) Critical-thinking Model B) Nursing Process Model C) Clinical Judgment Model D) Active Practice Model Ans: C Feedback: To depict the process of “thinking like a nurse,” Tanner (2006) developed a model known as the clinical judgment model.

Your patient has been admitted for a liver biopsy because the physician believes the patient may have liver cancer. The family has told both you and the physician that if the patient is terminal, the family does not want the patient to know. The biopsy results are positive for an aggressive form of liver cancer and the patient asks you repeatedly what the results of the biopsy show. What strategy can you use to give ethical care to this patient? A) Obtain the results of the biopsy and provide them to the patient. B) Tell the patient that only the physician knows the results of the biopsy. C) Promptly communicate the patient's request for information to the family and the physician. D) Tell the patient that the biopsy results are not back yet in order temporarily to appease him. Ans: C Feedback: Strategies nurses could consider include the following: not lying to the patient, providing all information related to nursing procedures and diagnoses, and communicating the patient's requests for information to the family and physician. Ethically, you cannot tell the patient the results of the biopsy and you cannot lie to the patient.
The nurse admits a patient to an oncology unit that is a site for a study on the efficacy of a new chemotherapeutic drug. The patient knows that placebos are going to be used for some participants in the study but does not know that he is receiving a placebo. When is it ethically acceptable to use placebos? A) Whenever the potential benefits of a study are applicable to the larger population B) When the patient is unaware of it and it is deemed unlikely that it would cause harm C) Whenever the placebo replaces an active drug D) When the patient knows placebos are being used and is involved in the decision-making process Ans: D Feedback: Placebos may be used in experimental research in which a patient is involved in the decision-making process and is aware that placebos are being used in the treatment regimen. Placebos may not ethically be used solely when there is a potential benefit, when the patient is unaware, or when a placebo replaces an active drug.

The nurse caring for a patient who is two days post hip replacement notifies the physician that the patient's incision is red around the edges, warm to the touch, and seeping a white liquid with a foul odor. What type of problem is the nurse dealing with? A) Collaborative problem B) Nursing problem C) Medical problem D) Administrative problem Ans: A Feedback: In addition to nursing diagnoses and their related nursing interventions, nursing practice involves certain situations and interventions that do not fall within the definition of nursing diagnoses. These activities pertain to potential problems or complications that are medical in origin and require collaborative interventions with the physician and other members of the health care team. The other answers are incorrect because the signs and symptoms of infection are a medical complication that requires interventions by the nurse.
While developing the plan of care for a new patient on the unit, the nurse must identify expected outcomes that are appropriate for the new patient. What resource should the nurse prioritize for identifying these appropriate outcomes? A) Community Specific Outcomes Classification (CSO) B) Nursing-Sensitive Outcomes Classification (NOC) C) State Specific Nursing Outcomes Classification (SSNOC) D) Department of Health and Human Services Outcomes Classification (DHHSOC) Ans: B Feedback: Resources for identifying appropriate expected outcomes include the NOC and standard outcome criteria established by health care agencies for people with specific health problems. The other options are incorrect because they do not exist.

QUESTION AND ANSWERS TO EACH CHAPTER, Study notes of Nursing

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