NR 222- Exam 2 review(updated 2023)graded A+., Exams of Nursing

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NR 222- Exam 2 review(updated

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A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best described as: A. Assimilation. B. Acculturation. C. Biculturalism. D. Enculturation. - correct answer D. Enculturation. Socialization into one's primary culture as a child is known as enculturation. A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she: A .Chose to be bicultural. B. Adapted to and adopted the American culture. C. Had an extremely negative experience with the American culture. D. Gave up part of her ethnic identity in favor of the American culture. - correct answer B. Adapted to and adopted the American culture. Assimilation results when an individual gradually adopts and incorporates the characteristics of the dominant culture. To enhance their cultural awareness, nursing students need to make an in-depth self- examination of their own: A. Motivation and commitment to caring. B. Social, cultural, and biophysical factors. C. Engagement in cross-cultural interactions. D. Background, recognizing her biases and prejudices. - correct answer D. Background, recognizing her biases and prejudices. Cultural awareness is an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people. Which of the following is required in the delivery of culturally congruent care? A. Learning about vast cultures

B. Motivation and commitment to caring C. Influencing treatment and care of patients D. Acquiring specific knowledge, skills, and attitudes - correct answer D. Acquiring specific knowledge, skills, and attitudes Specific knowledge, skills, and attitudes are required in the delivery of culturally congruent care. A registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient? A. "What are your dietary preferences?" B. "What time do you typically go to bed?" C. "Do you bathe and use deodorant more than one time a week?" D. "Do you have any health issues that we should know about?" - correct answer C. "Do you bathe and use deodorant more than one time a week?" Nurses need to avoid stereotypes or unwarranted generalizations about any particular group that prevents further assessment of the individual's unique characteristics. When action is taken on one's prejudices: A. Discrimination occurs. B. Delivery of culturally congruent care is ensured. C. Effective intercultural communication develops. D. Sufficient comparative knowledge of diverse groups is obtained. - correct answer A. Discrimination occurs. Prejudices associate negative permanent characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs. A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n): A. Illness attributed to natural and biological forces. B. Creation of the student's interpretation and descriptions of the data. C. Influence of socioeconomic factors in morbidity and mortality. D. Combination of naturalistic, religious, and supernatural modalities. - correct answer C. Influence of socioeconomic factors in morbidity and mortality.

Health disparity populations are populations that have a significant increased incidence or prevalence of disease or that have increased morbidity, mortality, or survival rates compared to the health status of the general population. Culture strongly influences pain expression and need for pain medication. However, cultural pain is: A. Not expressed verbally or physically. B. Expressed only to others from a similar culture. C. Usually more intense than physical pain. D. Suffered by a patient whose valued way of life is disregarded by practitioners. - correct answer D. Suffered by a patient whose valued way of life is disregarded by practitioners. Patients suffer cultural pain when health care providers disregard values or cultural beliefs. Which of the following best represents the dominant values in American society on individual autonomy and self-determination? A. Physician orders B. Advance directive C. Durable power of attorney D. Court-appointed guardian - correct answer B. Advance directive Informed consent and advance directives protect the right of the individual to know and make decisions ensuring continuity of individual autonomy and self-determination. The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next? A. Ask the patient how much salt he is consuming each day B. Discuss the health implications of sodium and hypertension C. Remind the patient that many foods such as soy sauce contain "hidden" sodium D. Suggest some low-sodium dietary alternatives - correct answer A. Ask the patient how much salt he is consuming each day In an Asian culture spoken messages often have little to do with their meanings. It is important for the nurse to clarify how much salt the patient is consuming in his diet. A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is:

A. Give her a copy of the city bus schedule. B. Call her the day before her appointment as a reminder to be on time. C. Explore what has prevented her from being at the clinic in time for her appointment. D. Refer her to a clinic that is closer to her home. - correct answer C. Explore what has prevented her from being at the clinic in time for her appointment Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. Nurses need to expect conflicts and make adjustments when caring for ethnic groups. A nursing student is taking postoperative vital signs in the postanesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension? A. Ashkenazi Jew B. Chinese American C. African American D. Filipino - correct answer C. African American Certain genetic disorders are linked with specific ethnic groups such as malignant hypertension among African Americans. A community health nurse is making a healthy baby visit to a new mother who recently emigrated to the United States from Ghana. When discussing contraceptives with the new mom, the mother states that she won't have to worry about getting pregnant for the time being. The nurse understands that the mom most likely made this statement because: A. She won't resume sexual relations until her baby is weaned. B. She is taking the medroxyprogesterone (Depo-Provera) shot. C. Her husband was recently deployed to Afghanistan. D. She has access to free condoms from the clinic. - correct answer A. She won't resume sexual relations until her baby is weaned. In some African cultures such as in Ghana and Sierra Leone some women will not resume sexual relations with their husbands until the baby is weaned. During their clinical post-conference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different: A. Ethnicity. B. Culture. C. Heritage. D. Religion. - correct answer B. Culture.

Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. This includes events such as birth, illness, and dying. It is the system of meanings by which people make sense of their experiences. When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? (Select all that apply.) A. Do you use any folk remedies? B. Do you have a family physician? C. Do you use a Shaman? D. Does your family have a history of alcohol abuse? - correct answer A. Do you use any folk remedies? B. Do you have a family physician? C. Do you use a Shaman? Obtain information about folk remedies and cultural healers that the patient uses. Assessment data yield information about the patient's beliefs about the illness and the meaning of the signs and symptoms. The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. What principles would be a priority in a discussion about ethics? A. Accountability because you as the nurse are accountable for the well-being of this patient B. Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant C. Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources - correct answer D. Justice because the first and greatest question in this situation is how to determine the just distribution of resources Accountability, respect or autonomy and ethics of care are not necessarily wrong, but they deflect attention from the less personal but more pertinent issue that is at stake in this situation: justice. The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement?

A. Beneficence B. Accountability C. Nonmaleficence D. Respect for autonomy - correct answer C. Nonmaleficence Nonmaleficence refers specifically to the concept of avoiding harm. Beneficence refers more to generosity and goodness, accountability to keeping promises, and respect for autonomy to the commitment by providers to include patients in decisions about all aspects of care. A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy - correct answer B. Beneficence The immunization is a clear effort to provide benefit. Beneficence refers to "doing good." Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding health care plans. When a nurse assesses a patient for pain and offers a plan to manage the pain, which principal is used to encourage the nurse to monitor the patient's response to the pain? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy - correct answer A. Fidelity Requiring a return to the patient to evaluate the effectiveness of an intervention exemplifies keeping a promise, a concrete example of fidelity. What is the best example of the nurse practicing patient advocacy? A. Seek out the nursing supervisor in conflicting procedural situations B. Document all clinical changes in the medical record in a timely manner C. Work to understand the law as it applies to an error in following standards of care D. Assess the patient's point of view and prepare to articulate it - correct answer D. Assess the patient's point of view and prepare to articulate it

Seeking out the nursing supervisor, documenting clinical change in the medical record in a timely manner and working to understand the law as it applies to an error in following standards of care are not wrong; but advocacy generally refers to the nurse's ability to help speak for the patient. Successful ethical discussion depends on people who have a clear sense of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principals of utilitarianism. This philosophy proposes which of the following? A. The value of something is determined by its usefulness to society. B. People's values are determined by religious leaders. C. The decision to perform a liver transplant depends on a measure of the moral life that the patient has led so far. D. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider. - correct answer A. The value of something is determined by its usefulness to society. Utilitarianism specifically refers to the greatest good for the greatest number of people, whereas goodness is determined primarily by usefulness. The concept is easier to apply in a community where shared values allow for agreement about a definition of usefulness. The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? A. Patients B. Relationships C. Ethical principles D. Code of ethics for nurses - correct answer B. Relationships The foundation of the ethics of care is its attention to relationships, as distinguished from other more principal based philosophies. In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? A. Nurses understand the principle of autonomy to guide respect for patient's self- worth. B. Nurses have a scope of practice that encourages their presence during ethical discussions. C. Nurses develop a relationship to the patient that is unique among all professional health care providers.

D. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care. - correct answer C. Nurses develop a relationship to the patient that is unique among all professional health care providers. None of these options is wrong, but the point of the question is to build confidence and even pride in the value of the special body of knowledge that a nurse acquires about patients, the result of a unique relationship with them. Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? A. Consult a professional ethicist to ensure that the steps of the process occur in full. B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. C. Ensure that the attending physician or health care provider has written an order for an ethics consultation to support the ethics process. D. List the ethical principles that inform the dilemma so negotiations agree on the language of the discussion. - correct answer B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. Before proceeding with discussion about any difficult situation, just as in the nursing process, participants take time to gather all relevant information as insurance for reliability and validity during the discussion. The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? A. Yes because patient privacy would not be violated as long as the patient identifiers were removed B. Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work D. No because the principal of justice requires you to allocate resources fairly - correct answer C. No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work

Respect for patient privacy includes making the most conservative decisions possible regarding disclosure of personal health information. When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote? A. Yes because ethics is essentially a democratic process, with all participants sharing an equal voice B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do C. Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care D. No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department - correct answer B. No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do Voting about an outcome implies that participants simply express an opinion without regard for negotiating differences. The real goal in processing ethical dilemmas is to resolve differences, not simply to express opinion. Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations B. To await new clinical orders from the physician C. To limit discussions about ethical principals D. To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues - correct answer A. To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Nursing plays a unique and critical role in the resolution of difficult ethical situations. The nurse is often able to contribute information not available to others on the team, the result of the special relationship that nurses build with patients. In providing this information, it is important to remain aware of one's own values and how they may differ from those of the patient and others on the health care team. A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.)

A. Quality of life is measured by potential income, and average income varies in different regions of the country. B. Community values are subject to change, and communities influence definitions of "quality." C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging. - correct answer B. Community values are subject to change, and communities influence definitions of "quality." C. Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. D. Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging. Definitions of quality depend on individual experience and value integrated into community standards, but value refers to elements beyond monetary value. Which of the following explain how health care reform is an ethical issue? (Select all that apply.) A. Access to care is an issue of beneficence, a fundamental principal in health care ethics. B. Reforms promote the principle of beneficence, a hallmark of health care ethics. C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics. - correct answer B. Reforms promote the principle of beneficence, a hallmark of health care ethics. C. Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. D. Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics. Since health care reform focuses on the public good, discussions about it inevitably involve reference to all aspects of ethical discourse. Reference to ethical principles helps to shape the discussion, even when individual values differ. Access to care is an issue of justice. Which is the best method of negotiating or processing difficult ethical situations? A. Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain.

B. Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. D. Medical experts are best able to resolve conflicts about outcome predictions. - correct answer C. Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. Ethics is ultimately an activity of community, resolved successfully through institutional ethics committees and not easily resolved by deference to a single expert or leader. The increasing number of ethnic groups in the United States has been influenced by what? A. Communicable diseases in disadvantaged countries B. Increasing immigration C. Homelessness D. Healthcare reform - correct answer B. Increasing immigration Currently, emerging populations include ethnic minorities and persons who are homeless. Ethnic minority populations could include Asian Americans/Pacific Islanders, Blacks/African Americans, Latinos/Hispanic Americans, Native Americans, and Arab Americans. The increasing population of immigrants has been a significant contributor to the presence of increasing numbers of major ethnic groups in the United States. The nurse recognizes that a minority group is perceived as: A. capturing biological variations within human populations. B. people who receive less than their share of wealth, power, or social status. C. people set apart on the basis of cultural or national origin characteristics. D. socially organized groups with salient differences with respect to other groups in society. - correct answer B. people who receive less than their share of wealth, power, or social status. A minority group may be perceived as consisting of people who receive less than their share of the wealth, power, or social status The U.S Department of Health and Human Services and the Institute of Medicine have well documented that racial and ethnic minorities have less access to health care, receive lower-quality health care, and have higher rates of illness, injury, and premature death. Race has been viewed as capturing biological variations within human populations. It emphasizes the physical and biological heredity. An ethnic group is a group that is set apart by insiders or outsiders primarily on the basis of cultural or national origin characteristics subjectively selected. Ethnic

groups are socially organized with salient differences compared with other groups in society. Which of the following diseases are Arab Americans at the highest risk for? A. colon cancer. B. hypertension. C. adult-onset diabetes. D. end-stage renal disease. - correct answer C. adult-onset diabetes. There is limited health information about Arab Americans who suffer from chronic health problems such as diabetes and coronary artery disease. Several factors put Arab Americans at high-risk for developing adult onset diabetes and cardiovascular disease including obesity, age, gender, and low employment rates. Health concerns on the rise for Arab Americans include mental illness and tobacco consumption among adolescents. Priority nursing assessments of Asian Americans/Pacific Islanders should be on which disease process? A. COPD B. Hypertension C. Diabetes mellitus D. Breast cancer - correct answer A. COPD Asian Americans have a high prevalence and risk factors of chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, tuberculosis, and liver disease. Asian American/Pacific Islander women are less likely to die of breast cancer, and infant mortality rates are lower compared with other ethnic groups. They have lower rates of being overweight, lower rates of hypertension, and are less likely to be cigarette smokers. Priority nursing assessments of Latino/Hispanic Americans should focus on what disease process, because of its higher incidence in this population? A. Cancer B. Stroke C. Diabetes D. Cardiovascular - correct answer D. Cardiovascular Cardiovascular disease is the number one cause of morbidity and mortality among Latino/Hispanic Americans. Cancer is the second most prevalent cause of morbidity and mortality. Diabetes is twice as prevalent in Latino/Hispanics as in non-Hispanic White Americans.

What two groups comprise emerging populations in the United States? (select two that apply) A. Older Americans B. Ethnic minorities C. Homeless D. Baby boomers - correct answer B. Ethnic minorities C. Homeless Currently, emerging populations in the United States include ethnic minorities, and persons who are homeless. Ethnic minority populations could include Asian Americans/Pacific Islanders, Blacks/African Americans, Latinos/Hispanic Americans, Native Americans, and Arab Americans. The increasing population of immigrants has been a significant contributor of the presence of increasing populations of major ethnic groups in the United States. Older Americans and baby boomers do not comprise emerging populations in the United States. Which of the following statements accurately describe race and ethnic categories in the United States as defined by the Office of Management and Budget? (select all that apply) A. Race and ethnicity have the same definition. B. Ethnicity is associated with power and indexes the history or ongoing imposition of one group's authority above another. C. Ethnicity focuses on differences in meaning, values, and ways of living. D. Ethnicity refers to commonalities in language, history, nation, or region of origin. E. A minority group consists of people living in society that is usually disadvantaged. - correct answer C. Ethnicity focuses on differences in meaning, values, and ways of living. D. Ethnicity refers to commonalities in language, history, nation, or region of origin. E. A minority group consists of people living in society that is usually disadvantaged. Ethnicity focuses on differences in meaning, values, and ways of living. Ethnicity is defined as a dynamic set of historically derived and institutionalized ideas and practices that allows people to identify or be identified with groupings of people on the presumed basis of commonalities in language, history, nation or region of origin, customs, ways of being, religion, names, physical appearance, and/or genealogy or ancestry. A minority group consists of people who are living within a society which is usually disadvantaged in relation to power, control of their own lives, and wealth. Race and ethnicity are different but somewhat alike. Race is associated with power and indexes the history or ongoing imposition of one group's authority above another.

Ethnicity is evident in customs of particular groups. Which of the following statements accurately reflect the definitions of culture, values and value orientation? (select all that apply) A. Culture refers to patterns of human behavior that include language, communication, customs and beliefs. B. Ethnicity is shaped by values, beliefs, norms, and practices that are shared by members of the same group. C. Health care beliefs and attitudes among ethnic groups are congruent with health care providers. D. Values are beliefs about the worth of something and serve as standards that influence behavior. E. Value orientations reflect the personality type of a particular society. - correct answer A. Culture refers to patterns of human behavior that include language, communication, customs and beliefs. D. Values are beliefs about the worth of something and serve as standards that influence behavior. E. Value orientations reflect the personality type of a particular society. Culture is an element of ethnicity that refers to patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Values are beliefs about the worth of something and serve as standards that influence behavior. Value orientations reflect the personality type of a particular society. Culture is shaped by values, beliefs, norms, and practices that are shared by members of the same cultural group. Ethnic groups have unique beliefs and attitudes about health and health care services. Beliefs are generally incongruent with health care providers and prove to be major barriers to improving the health status of ethnic group members. Which of the following statements are true about cultural competency in health care? (select all that apply) A. Recognizing and accepting cultural diversity achieves cultural competency. B. Cultural competency is a major element in eliminating health disparities. C. There is no association between the care recipient's cultural background and the health care providers' cultural beliefs. D. Health care services are to be provided that are respectful of and responsive to the diverse health beliefs of the care recipient. E. Health care providers must be aware of how people interpret their health issues or illnesses. - correct answer B. Cultural competency is a major element in eliminating health disparities. D. Health care services are to be provided that are respectful of and responsive to the diverse health beliefs of the care recipient. E. Health care providers must be aware of how people interpret their health issues or illnesses.

Cultural competency is one of the major elements in eliminating the health disparities and starts with an honest desire not to allow biases. Health care services should be provided that are respectful of and responsive to the diverse health beliefs of the client. It is very important for health care providers to be aware of how people interpret their health issues or illnesses and be capable to provide culturally competent care. Culture is an element of ethnicity that refers to patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Values are beliefs about the worth of something and serve as standards that influence behavior. Value orientations reflect the personality type of a particular society. Culture is shaped by values, beliefs, norms, and practices that are shared by members of the same cultural group. Ethnic groups have unique beliefs and attitudes about health and health care services. Beliefs are generally incongruent with health care providers and prove to be major barriers to improving the health status of ethnic group members. Nurses caring for the Black/African American population need to maintain an awareness of which of the following health-related cultural aspects of care? (select two that apply) A. Severe high blood pressure is more common for African Americans. B. Cancer and mortality rates for African Americans is higher than that for White Americans. C. African Americans are less likely to be diagnosed with diabetes. D. African Americans have the highest percentage of women with low or no prenatal care in the first trimester. - correct answer A. Severe high blood pressure is more common for African Americans. B. Cancer and mortality rates for African Americans is higher than that for White Americans. Severe high blood pressure is more common for African Americans in both men and women. African American adults are 40% more likely to have high blood pressure. The incidence of cancer and mortality rates for African Americans is higher than that for White Americans. African Americans are two times more likely to be diagnosed with diabetes than non-Hispanic whites, and they are more likely to suffer complications from diabetes. African Americans experience high infant and maternal mortality rates and they have the second-highest percentage of women who lack prenatal care in the first trimester of pregnancy. Which nursing intervention would be based upon utilitarian theory? A. Initiating resuscitation of a 20-week gestation newborn B. Preparing a 52-year-old woman with uterine cancer for a hysterectomy C. Placing a 92-year-old client with terminal congestive heart failure on a ventilator

D. Administering chemotherapy to a 17-year-old with leukemia who states that he wants everything terminated - correct answer B. Preparing a 52-year-old woman with uterine cancer for a hysterectomy Utilitarian theory proposes that actions are good in so far as they are aimed at yielding the greatest amount of happiness or pleasure, or cause the least amount of harm or pain, to persons and overall within the society. Any decision making must take into account the consequences of the decision. The professional involved in the decision making must also possess the appropriate skills and knowledge to undertake actions that will promote a "good" for persons. The situations stated above require the nurse to determine which situation has the greatest amount of good for society and which causes the least amount of pain. The woman with the uterine cancer diagnosis preparing for surgery has the most promising outcome, and therefore should be selected as the priority intervention based on utilitarian theory. The 20-week gestation newborn has almost no chance of surviving outside of the mother's womb. The adolescent with leukemia who has stated that he does not want the chemotherapy should be respected, even though his parents will make the final decision. Being placed on the ventilator will not cure the 92-year-old client with terminal congestive heart failure. Even with extraordinary interventions, the client with a terminal disease prognosis is one who will not be cured of that disease process. The nurse recognizes that the American Nurses Association (ANA) Code of Ethics identifies expectations of ethical behavior through statements regarding: A. the primary goals, values, and obligations of the profession. B. specific standards of care for selected populations. C. disciplinary actions for incompetent nursing practice. D. legal standards of practice. - correct answer A. the primary goals, values, and obligations of the profession. The ANA Code of Ethics identifies the primary goals, values, and obligations of the profession of nursing. The specific standards of care and practice are developed by professional organizations and the Nursing Practice Acts of each state based on evidence-based practice. The Board of Nurse Examiners for each state also has been charged with the disciplinary actions for incompetent nurses in the respective state. Which statement supports the principle of beneficence that overrides a person's autonomy? A. The nurse presses the button to administer pain medication through a patient- controlled analgesia (PCA) infusion. B. The nurse maintains confidentiality to an HIV-positive husband who does not want his wife informed of his HIV status. C. The nurse instructs parents that their newborn must be placed in a car seat that faces the back of the seat in the back seat of the car.

D. The nurse counsels a 21-year-old woman delivering her third child that she should request a tubal ligation. - correct answer C. The nurse instructs parents that their newborn must be placed in a car seat that faces the back of the seat in the back seat of the car. Beneficence means to do good. As a moral principle, beneficence presents us with the duty to maximize the benefits of actions while minimizing harm. When society formulates rules that are designed to protect persons against the negative effects of their own actions, these rules are considered "beneficent," yet they override a person's autonomy. One example of this is the use of safety restraints—car seats for children and seat belts for adults—when driving or riding in an automobile. It is inappropriate to consider beneficence as a moral principle when withholding confidential information that may harm another, as in the case of the HIV-positive husband. The client must control the PCA infusion and choice of when to administer additional pain medication. If the nurse presses the button to administer additional medication, the client may suffer adverse effects related to receiving too much medication, because the client is not determining pain medication needs. Counseling a client regarding when to request a tubal ligation is inappropriate based on the nurses' cultural values. The client should be given information on the advantages and disadvantages of the surgical procedure and its consequences, and the client has the autonomy to make her decision. Which of the following statements best supports the ethical principle of justice? A. Access to health care should be provided for all people. B. Dialysis should be available for clients who adhere to their prescribed dietary regimes. C. Transplant organs should be allocated based on ability to pay for hospital costs. D. Health-promotion interventions should be provided to those who agree to pay more for health services. - correct answer A. Access to health care should be provided for all people. Justice is a major ethical principle of importance in health-promotion settings. Justice is involved with the fair distribution of "goods" such as health, education, food, and shelter. Justice is the equalizing of benefits across society regardless of merit. Evaluating the four options above, it is apparent that the first statement supports justice related to provision of health care to all people, without regard to ability for payment. The other options place conditions on receiving care and interventions based on ability to pay or maintain medical regimes, which does not support the concept of justice. When a nurse utilizes aggressive action on behalf of a care recipient, he or she is considered to be practicing: A. social justice. B. advocacy. C. moral agency.

D. assertiveness. - correct answer B. advocacy. Advocacy, as an expectation of nurses, is strongly reinforced both in the Code of Ethics and in innumerable scholarly articles. In legal jurisprudence, advocacy is aggressive action taken on behalf of an individual, or perhaps a group viewed as an individual entity, to protect or secure that individual's rights. Nurses and other health care professionals have a responsibility to speak up on behalf of people whose rights have been compromised or endangered. This is part of the nurse's role because people may not recognize either what is needed to meet their needs or when the care they are receiving is substandard. Social justice is concerned with disparities in socioeconomic conditions leading to poor health and fairness in the distribution of goods such as health, education, food, and shelter. Moral agency on the part of a nurse requires action and motivation directed to some moral end that is enacted through relationships. Utilizing aggressive action on behalf of a care recipient is not defined as assertiveness. In health promotion settings, individual autonomy may be limited by: A. freedom of action. B. freedom of speech. C. the duty of protecting the health and safety of society. D. public policy. - correct answer C. the duty of protecting the health and safety of society. In health-promotion settings and endeavors the concept of autonomy can be understood from two different perspectives. From the vantage point of public health, the extent of individual autonomy, or freedom of action, may be limited by the duty of protecting the health and safety of the society. From this perspective there is an age-old struggle between civil rights and public safety. Moral questions ask to what degree society is justified in regulating the health and safety of society at large. There is an inevitable tension associated with curtailing civil liberties in the name of safety or health. Freedom of speech is not associated with individual autonomy as it relates to health promotion. Which of the following statements accurately describe ethical theories? (Select all that apply) A. Normative theories are concerned with ensuring good actions. B. Descriptive theories tell us what actions to take. C. Consequentialist theories hold that decisions should take into account all knowable potential consequences. D. Religions and duty-based theories assert that certain duties will produce good outcomes. E. Descriptive theories are directive. - correct answer A. Normative theories are concerned with ensuring good actions.

C. Consequentialist theories hold that decisions should take into account all knowable potential consequences. D. Religions and duty-based theories assert that certain duties will produce good outcomes. Descriptive theories do not tell us what actions we ought to take. They are not directive; they merely tell us how people act toward each other and their environments and what they seem to believe are good or moral actions. Normative theories, on the other hand, are concerned with ensuring good actions. The consequentialist theory holds that the consequences or intended consequences of actions matter. Therefore from the consequentialist perspective, any decision about intended actions or interventions must take into account all knowable potential consequences. Duty-based theories, such as that of Immanuel Kant (1724-1804) and those of various religions (Judaism, Christianity, Islam), depend more on adherence to duties than on good consequences. Individuals are viewed as having certain duties that cannot be circumvented, even if deliberately side-stepping the duty would result in good outcomes. For religions, these rules are imparted in some way by a divine being. What are some of the definitions that support using the term profession to denote the status of nursing? (select all that apply) A. Nursing is considered a profession because it provides a service to society. B. Nursing is considered a profession because of the stable employment opportunities. C. Nursing is self-governing. D. Members of the nursing profession are accountable for their actions. E. Members of a profession abide by a code of ethics. - correct answer A. Nursing is considered a profession because it provides a service to society. C. Nursing is self-governing. D. Members of the nursing profession are accountable for their actions. E. Members of a profession abide by a code of ethics. Using the term profession to denote the status of nursing and other disciplines is controversial. Nursing is a profession insofar as it provides a service to society, is self- governing, and its members are accountable for their actions (Grace, 2001). One important characteristic of professions, especially those that provide crucial services to society, is that they have codes of ethics that provide essential elements of their promises of service to society. A significant consequence of professional status is that members can be held accountable for their practice formally by professional licensure boards. More importantly, they are morally accountable for practicing according to their discipline's implicit or explicit code of ethics. Codes of ethics provide a normative framework for professional actions. A professional implicitly accepts these codes on acquiring membership in the discipline.

In health-promotion activities, which of the following statements is accurate regarding respect for autonomy? (select all that apply) A. Individuals must be given the information they need to make choices. B. Choices are autonomous when public policy dictates the action. C. Autonomous choices are made when the person can understand the risks and benefits of the choices. D. Autonomous choices are acceptable even when mental capacity is questionable. E. Choices are considered autonomous in the absence of coercive influence. - correct answer A. Individuals must be given the information they need to make choices. C. Autonomous choices are made when the person can understand the risks and benefits of the choices. E. Choices are considered autonomous in the absence of coercive influence. In health-promotion activities, respect for autonomy requires that individuals be given the information they need to make choices. Choices can be considered autonomous only if certain criteria are met. The criteria that determine whether or not a person is actually capable of autonomous (voluntary) choice include cognitive maturity, possession of appropriate information to permit decision-making, intact mental capacities (the ability to reason logically), the absence of internal or external coercive influences, and the ability to appreciate the risks and benefits of alternative choices. The nurse participates in the process of ethical inquiry in health promotion to: (select all that apply) A. facilitate in-depth data gathering. B. resolve all ethical problems related to health promotion. C. understand what is expected of the health-promotion agent viewed as a moral agent. D. gain clarity on actual or potential issues regarding health-promotion endeavors. E. foresee all possible consequences of ethical issues related to health promotion. F. permit the uncovering of hidden agendas and interests. G. focus on salient aspects of problems, thus enhancing professional judgment. - correct answer A. facilitate in-depth data gathering. C. understand what is expected of the health-promotion agent viewed as a moral agent. D. gain clarity on actual or potential issues regarding health-promotion endeavors. F. permit the uncovering of hidden agendas and interests. G. focus on salient aspects of problems, thus enhancing professional judgment. The purpose of ethical inquiry in health promotion is to gain clarity on actual or potential moral issues arising in the context of health-promotion endeavors, and to understand what is expected of the health-promotion agent viewed as a moral agent. Ethical inquiry will not permit the resolution of all problems, mainly because the environments in which

health-promotion efforts are conceptualized are incredibly complex. It is impossible to foresee all possible consequences of an action. But ethical reasoning can facilitate appropriate and in-depth data gathering, permit the uncovering of hidden agendas and interests, and focus on salient aspects of a particular problem, thus enhancing professional judgment.