NR222 Unit 2 Exam Review Questions with 100% Correct Answers | Verified | Updated, Exams of Advanced Education

Download NR222 Unit 2 Exam Review Questions with 100% Correct Answers | Verified | Updated and more Exams Advanced Education in PDF only on Docsity! NR222 Unit 2 Exam Review Questions with 100% Correct Answers | Verified | Updated Nurses provide health education to people to assist them in achieving a goal of: - Correct Answer--enhanced wellness. -lifestyle behaviors to prevent chronic illness. -Improved health literacy. -patient empowerment. The goal of health education is to help individuals, families, and communities achieve, through their own actions and initiative, optimal states of health. Health education facilitates voluntary actions to promote health. Another important goal of health education is improving health literacy.Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Another goal of health education that may foster successful changes in health behavior is empowerment. People who believe that they can make a difference in health and who are involved in decision- making are more likely to make changes.Changes in health behaviors that are related to health education help prevent disease and disability. Two main objectives of health education and counseling are to change health behaviors and to improve health status. Information alone does not change behavior.Health education and health counseling are mutually supportive activities. Health educators often use one-to-one and group counseling techniques as strategies for active health learning. Counselors may refer people to health- education resources or assist them in acquiring information pertinent to solving a health problem. Which statement supports the principle of beneficence that overrides a person's autonomy? - Correct Answer-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 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. What are some of the definitions that support using the term profession to denote the status of nursing? - Correct Answer-- Nursing is considered a profession because it provides a service to society. -Nursing is self-governing. -Members of the nursing profession are accountable for their actions. -Members of a profession abide by a code of ethics. Nursing is a profession insofar as it provides a service to society and is self-governing, and its members are accountable for their actions. 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. 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. Codes of ethics provide a normative framework for professional actions. A professional implicitly accepts these codes on acquiring membership in the discipline. Thus, each professional should establish a personal perspective on ethical practice within the broad framework of professional codes. When a nurse utilizes aggressive action on behalf of a care recipient, he or she is considered to be practicing: - Correct Answer-advocacy. Advocacy, as an expectation of nurses, is strongly reinforced both in the Code of Ethics and in innumerable scholarly articles. However, advocacy is a controversial topic. The meaning of the term advocacy is derived from its use in law. In legal jurisprudence, advocacy is an 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. The individual lawyer does not have an opposing obligation to attend to social justice issues. This attention to broader questions of justice is the responsibility of other areas of the justice system.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. The nurse recognizes that the American Nurses Association (ANA) Code of Ethics identifies expectations of ethical behavior through statements regarding: - Correct Answer- prescribing goals and expectations for nursing conduct. Codes of ethics are examples of normative ethics in that they prescribe how members of a profession ought to act, given the goals and purposes of the profession related to individuals and society. The provisions of codes of ethics for nurses provide direction and expectations of ethical behavior. They represent the profession's promises to society. Although the public is not directly involved in the formulation of such codes and, indeed, is for the most part not even aware of their existence, the profession is responsive to the evolving needs of a given society. It can be said that codes of ethics are the tentative end results of a discipline's political process in that they are not static but result from debate and discussion over -Choices are made when the person can understand the risks and benefits of the choices. -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. Which of the following statements accurately describe ethical theories? - Correct Answer--Normative theories are concerned with ensuring good actions. -Consequentialist theories hold that decisions should take into account all knowable potential consequences. -Religions and duty-based theories assert that certain duties will produce good outcomes. The theories that emerge as a result of philosophical inquiry about good action are called value theories; they are concerned with either discovering what humans seem to value (descriptive theories) or proposing what they ought to value (normative theories) to achieve predetermined goals. Value theories are based on observations of human behavior over time and in a variety of settings. 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, in contrast, are concerned with ensuring good action. 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 to 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. In health-promotion settings, individual autonomy may be limited by: - Correct Answer-the duty of protecting the health and safety of society. Autonomy as civil liberty: 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. This tension arises from perceptions that, in most Western contexts, freedom of action is a prerequisite of human flourishing.Currently there are many indirect threats to the health and safety of our society including, but by no means limited to, bioterrorism and the spread of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and drug-resistant tuberculosis. Actions to resolve any of these threats have the potential to impinge on civil liberties; such actions might include, for instance, surveilling citizens or requiring disclosure of disease status. Advances in genetic knowledge present the possibility of discrimination from a variety of sources. It will be difficult to fullness occurs is a practice that decreases the time the urine remains in the bladder, thus decreasing the chance for bacterial growth to occur. Decreasing oral intake will cause the urine to become concentrated. Urinary frequency is a symptom seen with urinary tract infections. Research indicates that delayed time between urinations is associated with increased incidence of urinary tract infection. The individual's perceived health and well-being and how health is managed describes the: - Correct Answer-health perception-health management pattern. The health perception-health management pattern involves individuals' health status and health practices used to reach the current level of health or wellness with a focus on perceived health status and meaning of health. When eliciting this information, nurses discover areas for further exploration under other functional health patterns. For example, if the individual reports shortness of breath when mowing the lawn, the nurse stores this information to retrieve later when assessing activity and exercise patterns or cognitive- perceptual patterns.Health perception-health management patterns affect lifestyle and ability to function even when individuals do not perceive actual health problems, are unaware of necessary health promotion in the absence of problems, do not feel capable of managing their health, or believe activity on their part is useless to promote health. The focus is on perceived health status and the meaning of health, along with the individual's level of commitment to maintaining health.The cognitive-perceptual pattern focuses on sensory perceptual and cognitive patterns. The coping- stress tolerance pattern identifies the general coping pattern and effectiveness on stress tolerance. The self-perception-self- concept pattern describes the individual's perception of self to include body comfort, body image, and feeling state as well as self-conception and self-esteem. The nurse, teaching a class on primary prevention at a women's health club, emphasizes participation in: - Correct Answer-recommended immunization schedules. Nurses typically use assessment strategies including health promotion that address interactions among individual's biophysical, psychosocial, and spiritual states and patterns with the environment. When assessing for primary prevention, techniques also include generalized health promotion and specific protection from disease, both of which fall within the scope of nursing practice. The active process of promoting health involves protection (immunizations, occupational safety, and environmental control) along with lifestyle, value, and belief system behaviors that enhance health.Antibiotics should only be taken when there is evidence of an infection. As such, it would fall under the category of tertiary prevention, i.e., limiting the scope of the disease, once it has occurred. Screening is aimed at early detection thus is classified as secondary prevention. When teaching about proper nutrition for a patient with hypertension, which of the following factors will be significant in determining whether the patient will accept and comply with the information? - Correct Answer-The individual's values-belief pattern The nurse must identify the individual's goals and expectations concerning health, clarifying to help the individual achieve them. To be effective, health-promotion interventions are based on the individual's value system and health beliefs. Unless the patient "buys into" the principles of sound nutrition as a determinant of health, the information taught may not be implemented. Competence with cooking skills is not a prerequisite for good nutrition. There are many healthy food options available for persons with no ability to cook. Healthy foods can be purchased which require minimal or no cooking, e.g., fresh fruit, low-fat cheese and whole grain breads, yogurt, and canned tuna fish. Being a vegetarian is not a limitation to healthy eating. Healthy food options are available for persons who are vegetarian especially with respect to hypertension where minimizing salt and fat is expenditure, mobility limitations, or decreased motivation caused by depression, grieving, or incongruent values?There is not a standard concerning "age-appropriate" activities. Clients vary widely with respect to athletic ability and activity tolerance. What is appropriate for the patient is not a function of his or her age. There is also not a standard ratio of active vs sedentary activity. The goal is for the patient to have regular physical exercise 3 to 5 times per week which raises the heart rate to a specified level. While there is evidence that exer When assessing the older adult for sleep quality, the nurse expects to find that the person will state: - Correct Answer-"I experience difficulty returning to sleep." Research indicates that subjective reporting of sleep quality and measures of sleep time closely approximate electroencephalographic findings.Nursing care focuses on the need to identify evidence of sleep disturbances to design appropriate interventions before sleep deprivation occurs. Frequent awakenings do not necessarily imply sleep interruption. Many individuals awaken numerous times during the night but return to sleep within seconds. These awakenings occur in older adults who generally spend most of the night in stages of light sleep. The normal developmental pattern of aging does not include deep sleep; therefore, awakenings may not affect the sleep cycles. Older individuals, however, more often experience difficulty returning to sleep because they experience discomfort or anxiety. Biological rhythm and peak performance time may be helpful to the nurse when planning health education and return visits. Individuals commonly refer to themselves as morning people or night owls; therefore, patterns of retiring and arising provide clues. Patterns of sleep and rest in conjunction with subjective reports of physical and mental well-being help determine appropriate interventions. The nurse is performing an initial antepartal assessment on a woman who has missed two periods. Assessment of this woman for alcohol consumption is best determined by the: - Correct Answer-T-ACE test. Women have different patterns of alcohol consumption and different thresholds for problem drinking than men. Instruments such as the CAGE detect alcohol dependence and would not be a sensitive enough measure for some women, in particular pregnant women, who are less likely than men to be alcohol dependent. The T-ACE instrument provides a measure of alcohol intake patterns more appropriate for women than that derived from the CAGE test (considered Cutting down on drinking, been Annoyed by criticism of drinking, feeling Guilty about drinking, and using alcohol as an Eye opener). The T-ACE test, developed for use with women, was the first validated screening tool for assessing drinking risk in pregnant women and continues to provide a highly sensitive tool for identifying risk drinking. Screening is a useful strategy in health-promotion assessment and intervention (see Chapter 9). A pattern of drinking is established using the following questions:T—How many drinks does it Take to make you feel high?A—Have you ever been Annoyed by people criticizing your drinking?C—Have you ever felt you ought to Cut down your drinking?E—Have you ever had a drink first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover?The CAGE test considers data collected from the client on Cutting down on drinking, being Annoyed by criticism of drinking, feeling Guilty about drinking, and using alcohol as an Eye opener.The nonstress test evaluates the fetal heart rate response to fetal movement, which is assessed after the fetus is 20 weeks or more. The protein dipstick is performed at each prenatal visit and measures the amount of protein in the client's urine. Proteinuria is a symptom seen with preeclampsia. Which of the following would represent a disadvantage concerning screening? - Correct Answer-Uncertainties in scientific evidence for normal range. The primary disadvantages of screening stem largely from uncertainties in scientific evidence, which sets normal testing personal health and wellness in the following areas: hand washing or hand hygiene; oral health; growth and development; sun safety and skin cancer prevention; benefits of rest and sleep; ways to prevent vision and the importance of health screenings and check-ups."Regarding vision screening, the 2020 objectives cite preschool children 5 years and under. The choice involving hearing screening for infants no later than 1 month of age is one of the objectives from Healthy People 2010. It is tobacco screening not alcohol screening which has recommended for hospital settings per the Healthy People 2020 screening objectives. Successful implementation of a screening program depends on the availability of appropriate: - Correct Answer- community resources. Implementing a screening program depends on availability of appropriate community resources, such as funds, health care workers, and follow-through including access, treatment sources, and administrative personnel. Transportation, utilization, and staffing are also components of community resources in place to support the program. Screenings are often based in the community with the assistance of a public health nurse, in the work site by an occupational health nurse, and in schools by a school health nurse. Because funding for traditional public health nursing roles is declining, some of the responsibility for screening will fall to nurses in other basic and advanced practice roles. The proportion of a given population with the disease or condition at any one point in time is the definition of: - Correct Answer-prevalence. Prevalence is the proportion of a given population with the disease or condition at any one point in time. It provides the best estimate of whether a person is likely to become ill during a specific period of time. Usually chronic conditions are measured by their prevalence, whereas acute conditions are associated with their incidence. Incidence is the rate of a new population problem and estimates the risk of an individual developing the specific disease or condition during a specific period or over a lifetime. Epidemiology is the study of the distribution and determinants of health-related states in a specific population. Finally, morbidity is defined as a diseased state or disability from any cause. Many preventive care services are provided by nurses in the community setting. Which of the following elements of health promotion and disease prevention are likely to be conducted in the retirement community setting? - Correct Answer--Blood pressure, diabetes, and cholesterol tests -Counseling on quitting smoking, eating healthfully, losing weight, and increasing physical activity -Flu and pneumonia shots The nurse in the retirement community setting can collaborate with other health providers to ensure that preventive services, along with the required education and counseling, are available through primary care or community services. Some of the services provided include blood pressure, diabetes and cholesterol screenings, counseling on quitting smoking, eating healthfully, losing weight and increasing physical activity, counseling about cancer screenings, and administration of flu and pneumonia shots. Nurses would not be providing recommendations about medication changes, but would provide the resident with a referral to the primary care provider. Additionally, physical therapy for rehabilitative purposes would be a tertiary prevention activity. Clinical and community preventive services are vital components of health promotion and disease prevention. What are some of the goals associated with screening? - Correct Answer--Detects risk factors and a disease or condition early. -Reduces costs associated with disease. -Validity -Reproducibility The variables that aid in a screening instrument's evaluation include reliability, validity, and reproducibility, which are a measure of the accuracy of the instrument. Reliability is an assessment of the reproducibility of the test's results when different individuals with the same level of skill perform the test during different periods and under different conditions. The instrument or measure should yield consistent or stabile results over time. Validity reflects the accuracy or truthfulness of the test or instrument itself. Cost-effectiveness and patient comfort are important considerations in determining the use of screening instruments. Disease screening instruments provide accurate measurement outcomes of sensitivity when they: - Correct Answer-identify the person who tests positive as having the disease. Sensitivity measures the proportion of persons with a condition who correctly test positive when screened. Reliability is an assessment of the reproducibility of the test's results when different individuals with the same level of skill perform the test during different periods and under different conditions. Validity measures the test's ability to correctly distinguish between diseased and nondiseased individuals and the accuracy of the test. Specificity measures the test's ability to recognize negative reactions or nondiseased individuals. Any combination of planned experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions is known as: - Correct Answer-health education. Any combination of planned experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions is known as health education. This process involves several key components including the use of teaching-learning strategies. Which of the following interventions can be appropriately applied by the nurse, after clarifying behaviors which the person is willing to change? - Correct Answer--Motivate using personalized messages. -Assess and offer resources to decrease barriers to change. -Assess and increase self-efficacy. After clarifying behaviors that a person is willing to change, the nurse can use the following framework for developing interventions for behavior change: Assess the behavior. Educate about the need for and benefits of change. Motivate using personalized messages. Assess and increase self-efficacy. Assess and offer resources to decrease barriers to change. Assist with goal setting to modify behavior. Practice the skills needed to change behavior. Plan ways to monitor and maintain the behavior change. Theories of health behavior change are at the heart of health education. The theories presented in this section help the nurses to assess an individual's stage in the behavior change process and to develop appropriate teaching plans. The goals of the teaching plans and the strategies selected will differ depending on the factors affecting the individual's readiness to learn and to change.Nurses must never lose sight of the principle of patient autonomy. For that reason choices c and e are incorrect. We don't pressure patients and we don't make care contingent upon compliance. Per the text, choices about health care practices belong to individuals, not health care providers. All competent persons have the right to The communication of health information in a manner which is clear and understandable fosters which of the following? - Correct Answer-Health literacy Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate health decisions." Health literacy includes the ability to read, write, speak, listen, compute, and comprehend, and to apply those skills to health situations. Empowerment is a goal of health education where successful change is fostered in people to promote healthful changes. Health disparities are health differences that adversely affect socially disadvantaged groups. Health education is a process of teaching and learning that encompasses ensuring the understanding of the information delivered. Which of the following statements accurately describe one of the five stages of health-related behavior change according to the Transtheoretical Model (TTM)? - Correct Answer--Small, sporadic changes occur in the planning phase, as the individual is seriously thinking about making a change within the next month. -Maintenance begins 6 months after the action has started and continues indefinitely. The Transtheoretical Model (TTM), or the stages of change model, is useful for determining where a person is in relation to making a behavior change. The TTM proposes that behavior change progresses through five stages regardless of whether the person is quitting or adopting a behavior. The five stages are: Precontemplation: A person is not thinking about or considering quitting or adopting a behavior change within the next 6 months (not intending to make changes). Contemplation: A person is seriously considering making a specific behavior change within the next 6 months (considering a change). Planning or preparation: A person who has made a behavior change is seriously thinking about making a change within the next month (making small or sporadic changes). Action: The person has made a behavior change and it has persisted for a period of 6 months (actively engaged in behavior change). Maintenance: The period beginning 6 months after action has started and continuing indefinitely (sustaining the change over time). A hospital creates a Facebook page for the bariatric surgery program. The owner of the site posts healthy recipes, lifestyle information, and information about upcoming workshops. This is an example of: - Correct Answer-social marketing. Social marketing is defined as "a process that uses marketing principles and techniques to influence priority audience behaviors that will benefit society as well as the individual. The process relies on creating, communicating, delivering, and exchanging offerings that have value for individuals, clients, partners, and society at large." The primary objective of social marketing is to change behavior. Social marketing provides a strategy for reaching members of the group and implementing a service that will satisfy these members as consumers.Social marketing communication reaches beyond the individual level to influence social conditions, policy, legislation, and normative group behavior. Key attributes of a social marketing approach are the offering of benefits and the reduction of barriers to influence the target group's behavior. Social marketers attempt to modify the attractiveness of specific behavioral options to favor one choice over competing alternatives. The systematic approach to understanding and responding to specific audience characteristics makes the messages more appealing. Social marketing strategies could be used in designing programs for health promotion (tobacco use, obesity), injury prevention and knowledge may differ significantly from their own and seek to understand and show respect for these differences. The nurse enters the room of an 82-year-old patient for whom she has not cared previously. The nurse notices that the patient wears a hearing aid. The patient looks up as the nurse approaches the bedside. Which of the following approaches are likely to be effective with an older adult? - Correct Answer--Listen attentively to the patient's story. -Use gestures that reinforce your questions or comments. -Maintain direct eye contact. Ask questions quickly to reduce the patient's fatigue. Approaches for collecting an older-adult assessment include listening patiently, using nonverbal communication when a patient has a hearing deficit, and maintaining patientdirected eye gaze. Leaning forward, not backward, shows interest in what the patient has to say. A patient who visits the surgery clinic 4 weeks after a traumatic amputation of his right leg tells the nurse practitioner that he is worried about his ability to continue to support his family. He tells the nurse he feels that he has let his family down after having an auto accident that led to the loss of his left leg. The nurse listens and then asks the patient, "How do you see yourself now?" On the basis of Gordon's functional health patterns, which pattern does the nurse assess? - Correct Answer-Self-perception-self-concept pattern This is an example of assessment of a patient's feelings about his worth and body image, which is the self-perception- self- concept health pattern. Which type of interview question does the nurse first use when assessing the reason for a patient seeking health care? - Correct Answer-Open-ended The best interview question for initially determining why a patient is seeking health care is by asking an open-ended question that allows the patient to tell his or her story. This is also a more patient-centered approach. Probing questions are asked after data are gathered to seek more in-depth information. Problem-oriented and confirmation are not types of interview questions. When a nurse conducts an assessment, data about a patient often comes from which of the following sources? - Correct Answer--An observation of how a patient turns and moves in bed -The care recommendations of a physical therapist -The results of a diagnostic x-ray film There are many sources of data for an assessment, including the patient through interview, observations, and physical examination; family members or significant others, health care team members such as a physical therapist, the medical record (which includes x-ray film results, and the scientific and medical literature. A nurse assesses a patient who comes to the pulmonary clinic. "I see that it's been over 6 months since you've been here, but your appointment was for every 2 months. Tell me about that. Also I see from your last visit that the doctor recommended routine exercise. Can you tell me how successful you've been in following his plan?" The nurse's assessment covers which of Gordon's functional health patterns? - Correct Answer-Health perception-health management pattern The nurse's assessment covers the health perception- health management pattern, which is a patient's self-report of how he or she manages his or her health and his or her knowledge last month, and your appetite has been poor—correct?" - Correct Answer-2, 4, 1, 5, 3 This follows the correct order for the interview. A nurse makes the following statement during a change-of- shift report to another nurse. "I assessed Mr. Diaz, my 61- year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, and he moves slowly as he transfers to a chair." What can the nurse who is beginning a shift do to validate the previous nurse's assessment findings when she rounds on the patient? - Correct Answer--The nurse asks the patient to rate his pain on a scale of 0 to 10. -The nurse assesses the patient's lower-limb strength. Validation of assessment data is the comparison of data with another source to determine its accuracy. The nurse compares data reported by the previous nurse with data collected directly with the patient, including assessing pain on the rating scale and assessing the patient's lower limb strength. Asking the patient what caused his fall and about past back pain and experience with pain medications would offer the nurse new information about the patient. A nurse is assigned to a 42-year-old mother of 4 who weighs 136.2 kg (300 lbs), has diabetes, and works part time in the kitchen of a restaurant. The patient is facing surgery for gallbladder disease. Which of the following approaches demonstrates the nurse's cultural competence in assessing the patient's health care problems? - Correct Answer-"You have four children; do you have any concerns about going home and caring for them?" This is the only assessment approach that is not biased or does not show judgment about the patient's weight or occupational status. With the other options, the nurse is reacting to the patient on the basis of personal stereotypes and biases. A 72-year-old male patient comes to the health clinic for an annual follow-up. The nurse enters the patient's room and notices him to be diaphoretic, holding his chest and breathing with difficulty. The nurse immediately checks the patient's heart rate and blood pressure and asks him, "Tell me where your pain is." Which of the following assessment approaches does this scenario describe? - Correct Answer-A problem- oriented approach This is an example of a problem-focused approach. The nurse focuses on assessing one body system (cardiovascular) to determine the nature of the patient's pain and other presenting symptoms. A nurse is checking a patient's intravenous line and, while doing so, notices how the patient bathes himself and then sits on the side of the bed independently to put on a new gown. This observation is an example of assessing: - Correct Answer- Patient's level of function. Observing a patient perform activities physical, socially, psychologically, and developmentally assesses his or her level of function. In the case of this question the nurse assesses physical functional level. Observation does not measure willingness to perform self-care but the ability to do so. Observing physical performance of self-hygiene is not a measure of level of consciousness nor does it reveal a patient's values. The nurse asks a patient, "Describe for me a typical night's sleep. What do you do to fall asleep? Do you have difficulty falling or staying asleep? This series of questions would likely occur during which phase of a patient-centered interview? - Correct Answer-Working phase participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you obscured or deleted all patient identifiers? - Correct Answer-No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work Information such as comments and photos on social media is widely distributed and becomes a risk for violation of privacy. People often inadvertently give "clues" or hints to the identity of a person, or people accessing your site could know your actual assignment or put "two and two" together. 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 best describes the role of the nurse in the resolution of ethical dilemmas? - Correct Answer-To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations. A nurse's point of view is essential to full discussion of ethical issues because of the nature of the relationship that nurses develop with patients and the intensity and intimacy of contact with the patient and family. 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? - Correct Answer-Beneficence Beneficence means "doing well" by taking positive actions. It implies that the best interest of the patient (and society) outweighs self-interest. Which of the following properly applies an ethical principle to justify access to health care? - Correct Answer--Access to health care reflects the commitment of society to principles of beneficence and justice. -If low income compromises access to care, respect for autonomy is compromised. -Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. Justice is the ethical principle that justifies the agreement to ensure access to care for all, but it does not necessarily clarify how to resolve issues of limited resources such as money or organs available for transplant. Privilege is not an ethical principle. Nonmaleficence means "first do no harm." A lack of care because of poor access causes harm (i.e., no preventive services, no early detection, no risk reduction) and therefore is ethically troubling. The principal of fidelity implies that we agree to ensure access to care even for people whose beliefs and behaviors may differ from our own, including drug addicts. 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? - Correct Answer-Nurses develop a relationship with the patient that is unique among all professional health care providers. A fundamental goal of this chapter is to promote and nurture the value of the nursing voice in ethical discourse. It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? - Correct Answer--Community values influence definitions of quality, and they are subject to change over time. -Individual experiences influence perceptions of quality in different ways, making consensus difficult. is compromised, respect for autonomy will be hard to maintain. The nurse will be able to care for the patient, but unfortunately her commitment to care does not give her the power to resolve the difficult issue of limited resources. Other concepts are valid but not as relevant to the case. The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? - Correct Answer--Ethics of care pays attention to the environment in which caring occurs. -Ethics of care pays attention to the stories of the people involved in the ethical issue. -Ethics of care focuses only on understanding relationships. Ethic of care focuses on environmental issues affecting care, the narratives of the patients and health care providers, and understanding relationships. The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? - Correct Answer-In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. In increasingly diverse communities, ideas of usefulness have become equally diverse. When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the pain? - Correct Answer-Fidelity Fidelity means keeping promises. Keeping the promise in this case includes not just tending to the clinical need but evaluating the effectiveness of the interventions. Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma? 1. List the actions that could be taken to resolve the dilemma. 2. Agree on a statement of the problem or dilemma that you are trying to resolve. 3. Agree on a plan to evaluate the action over time. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 5. Take time to clarify values and distinguish between facts and opinions—your own and those of others involved. 6. Negotiate a plan. - Correct Answer-4, 5, 2, 1, 6, 3 This is the correct order to determine the dilemma and influencing factors. This process provides opportunities for the nurse and health care team to reflect on personal values and then identify the exact nature of the ethical problem, design a plan, and evaluate the success of the plan. What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct order. 1. Clarify values. 2. Ask the question, Is this an ethical dilemma? 3. Verbalize the problem. 4. Gather information. 5. Identify course of action. 6. Evaluate the plan. 7. Negotiate a plan. - Correct Answer-2, 4, 1, 3, 5, 7, 6 In resolving an ethical dilemma, it first must be determined that an ethical dilemma exists. Then a systematic approach is needed to gather information, clarify values, verbalize the exact problem, identify a plan, negotiate elements of the plan, and evaluate the plan.