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***HERE IS A SAMPLE FOR YOU TO CHECK OUT – NOT THE FULL CHAPTER ***

Chapter: Chapter 03: Critical Thinking, Ethical Decision Making, and the Nursing Process

Multiple Choice

1. A nurse is offered a position at a clinic that offers therapeutic abortions. This procedure contradicts the nurse’s personal beliefs. The nurse knows that she is unable to care for these patients objectively. What is the nurse’s ethical obligation to these patients?
A) The nurse is required by law to continue service to these patients.
B) The nurse should make the choice to decline this position.
C) The nurse may discriminate between patients and refuse to care for the patient.
D) The nurse may express his or her opinion and provide another option to terminating the pregnancy.

Ans: B
Chapter: 3
Client Needs: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Caring
Objective: 5
Page and Header: 28, Ethical Nursing Care

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 an option. The other answers would be incorrect because the nurse is only required by law to provide care to the patients the clinic accepts, the nurse may not discriminate between patients, and the nurse expressing 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 narcotic via intravenous infusion. You know that one of the side 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 IV infusion
B) Stimulate the patient
C) Report the decreased respiratory rate to the physician
D) Allow the patient to rest comfortably

Ans: C
Chapter: 3
Client Needs: D-2
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 5
Page and Header: 28, Ethical Nursing Care

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.

3. When a terminally ill patient has requested a “do not resuscitate” (DNR) order and the family of the patient is strongly opposed to the patient’s request, what is the responsibility of the nurse?
A) Perform a “slow code” until a decision is made
B) Honor the request of the patient
C) Contact a lawyer to intervene
D) Terminate nursing care until the physician talks to the family

Ans: B
Chapter: 3
Client Needs: D-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 4
Page and Header: 28, Ethical Nursing Care

Feedback: Discussing the matter with the physician may lead to further communication with the family, during which the family may reconsider their decision. The nurse must also honor the patient’s wishes and continue to provide required nursing care. It is not appropriate for the nurse to seek the assistance of a lawyer or to perform a “slow code” in this situation.

4. A new patient comes to your unit. During admission the patient states, “I have a living will.” What is the correct definition of a living will?
A) A legal document that is always honored
B) A legal document that specifies the patient’s wishes before hospitalization
C) A legal document that is binding for the duration of the patient’s life
D) A legal document drawn by the patient’s family to determine DNR status

Ans: B
Chapter: 3
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 5
Page and Header: 29, Ethical Nursing Care

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 by the patient’s family.

5. A nurse has a duty of nonmaleficence. Which of the following would be considered a contradiction to that duty?
A) Provide comfort measures for a terminally ill patient
B) Assist the patient with ADLs
C) Refuse to administer pain medication as ordered
D) Provide all information related to procedures

Ans: C
Chapter: 3
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Page and Header: 25, Ethical Nursing Care

Feedback: The duty not to inflict as well as prevent and remove harm is termed nonmaleficence. Providing comfort measures for a terminally ill patient, assisting a patient with ADLs, and providing information related to procedures would not be considered a contradiction to the nurse’s duty of nonmaleficence.

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 there has been an error made in her medication. Which of the following principles would apply if you give an accurate response?
A) Veracity
B) Confidentiality
C) Respect
D) Justice

Ans: A
Chapter: 3
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 3
Page and Header: 26, Ethical Nursing Care

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

7. It is important that the wording of a nursing diagnosis falls within the taxonomy of nursing. Which organization is responsible for developing the taxonomy of a nursing diagnosis?
A) American Nurses Association (ANA)
B) North American Nursing Diagnosis Association (NANDA)
C) National League for Nursing (NLN)
D) Joint Commission

Ans: B
Chapter: 3
Client Needs: A-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Page and Header: 32, The Nursing Process

Feedback: North American Nursing Diagnosis Association (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. What phase of the nursing process is the nurse in when he determines a medication is effective and documents this in the patient’s record?
A) Analysis
B) Evaluation
C) Assessment
D) Data collection

Ans: B
Chapter: 3
Client Needs: D-2
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Page and Header: 30, The Nursing Process

Feedback: Evaluation, the final step of the nursing process, allows the nurse to determine the patient’s response to the nursing interventions and the extent to which the objectives have been achieved. The other answers are incorrect because they are not the correct phase of the nursing process.

9. After the health history and admission assessment are completed, the nurse establishes a care plan for the patient. What is the rationale for documenting and planning the patient’s care?
A) It provides continuity of care.
B) It creates a teaching log for family.
C) It verifies staffing.
D) It provides the patient with information about treatments.

Ans: A
Chapter: 3
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 6
Page and Header: 32, The Nursing Process

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. A care plan is not 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 combative and confused. The patient has a fractured hip 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
Chapter: 3
Client Needs: A-2
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 4
Page and Header: 28, Ethical Nursing Care

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. The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO) and the Centers for Medicare and Medicaid Services (CMS) have designated standards for the use of restraints. A patient should never be left alone while the nurse summons assistance. All staff members require annual instruction on the use of restraints, and the nurse should be familiar with the facility’s policy. This makes all other answers incorrect.

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