PROFESSIONAL CARING AND ETHICAL PRACTICE QUESTIONS WITH ANSWERS, Exams of Nursing

Download PROFESSIONAL CARING AND ETHICAL PRACTICE QUESTIONS WITH ANSWERS and more Exams Nursing in PDF only on Docsity! PROFESSIONAL CARING AND ETHICAL PRACTICE QUESTIONS WITH ANSWERS During a discussion with the physician regarding an order for the patient, the focus of the skilled communication for the nurse is to A. Agree with the physician to avoid a disagreement B. Threaten to initiate the chain of command C. Advocate only for the patient D. Find a solution that achieves the desirable outcome for the patient - ANS: D Skilled communication should have the focus of finding a solution to the situation that achieves the desirable outcome for the patient. The nurse is a patient advocate, but the question centered on a skilled communication interaction with the physician. Agreeing with the physician to avoid a disagreement may lead to harm of the patient. This has been associated with medical errors and is not recommended. The chain of command may be used if the skilled communication does not accomplish its goal of finding an appropriate solution. Threatening to use the chain of command is not representative of a skilled communication. Patient C has been in the ICU for 5 days following a drug overdose. The patient is not responding, exhibits no reflexes but does overbreathe on the ventilator. The physician is continuing to order hemodialysis daily to treat the metabolic acidosis. The nurse car- ing for the patient is frustrated and believes that the physician should talk to the family regarding a DNR status. Which of the following is the most correct statement? A. The nurse is correct and needs to initiate the conversation with the family B. The nurse is experiencing moral distress C. The physician is the final decision maker regarding medical interventions D. This situation should be immediately brought to the ethics committee for review - ANS: B Moral distress occurs when the nurse believes that he or she knows the ethically cor- rect action to take in the situation but a conflicting action is being pursued due to other members of the health care team or family members. There is more than one option to an ethical dilemma; with each option having an equally compelling alternative, the a moral argument can be made for and against each alternative. A discussion or confer- ence with the physician and the family would be indicated before the issue is sent to the ethics committee. The physician does not have final decision making against the patient's or family's wishes. A nurse, being a moral agent, should emphasize which of the following principles? A. Natural law B. Justice C. Paternalism D. Autonomy - ANS: D Autonomy is considered a very important principle when working as a moral agent for the patient or family. The nurse should respect and not interfere with choices and decisions made by the autonomous individual (patient and/or family member). Paternalism is the principle used when physicians overrule family or patient's wishes for the patient's own welfare. This principle is appropriate in certain situations but is not the primary principle of moral agents for patients. Justice is fairness to everyone and is used frequently in cases of scare resources. Natural law means actions are mor- ally right when they are in accordance with the end purpose of human nature and goals. Natural law is higher than man-made laws and is not a commonly used prin- ciple with ethical dilemmas in health care. Patient M is 2 days post-cardiac surgery. He is extubated, weaned off all vasoactive infusions, and has adequate pain control. Mr. M is being assessed for transfer to the progressive care unit. It has been noted that no family has been in to see him following the surgery. He is awake and alert and has been following commands. Which of the following characteristics is the primary concern of the nurse caring for this patient at this time? A. Vulnerability B. Complexity C. Participation in care D. Resource availability - ANS: D Patient M has been weaned from the ventilator, extubated, and off all vasoactive infu- sions. This indicates that he is less vulnerable and complex than immediately following the cardiac surgery. He is awake, alert, and follows commands, so is likely to be able to participate in his own care. He has had no family members visiting him since his surgery. This indicates that the area of concern is resource availability. He has minimal to no personal, psychological supportive resources or social system resources. A nurse, working with the family of a patient in a coma due to intracranial hemorrhage, approaches the family regarding end of life and removal of life support. The family refuses to terminate life support even with the presence of a living will in which the patient stated that the patient did not want to live on life support. Which of the follow- ing ethical principles is commonly used to justify removal of life support in terminally ill patients? D. Tell the family the patient can only eat the food provided by the hospital - ANS: C Family members want to feel involved in caring for the patient and frequently want to bring in meals they have cooked. If the patient is on a special diet and the food they bring does not meet the specifics of the diet, then the most appropriate intervention is to teach the family about the diet. The family can bring food to the patient but the food needs to meet the specifics of the diet. Telling them they cannot bring food can create stress and further feelings of helplessness. Allowing the patient to eat the food that does not meet the diet may worsen the patient's condition and does not facilitate lifestyle changes that may be required after discharge. Informing the physician and setting up a physician/family conference should not be the initial intervention. If the family continues to disregard the request of the staff, even after teaching and reinforc- ing the instructions, then a conference may be considered. A Hispanic woman in the ICU requires immediate surgery and the physician states that he will be there shortly to obtain the consent from the patient. Being aware of cultural differences, the nurse knows Hispanic women typically view their hus- bands as the decision maker. Which of the following would be the most appropriate intervention? A. Call the husband to come to the ICU to meet with the physician and his wife B. Encourage the patient to make her own decisions C. Suggest the physician use a two-doctor signature for the consent form D. Delay the surgery until the conflict can be resolved - ANS: A The nurse is demonstrating patient advocacy by taking the initiative to call the husband and arrange for him to meet with the physician and his wife to discuss the surgery and obtain a consent form. This keeps with the cultural belief system of the patient and family, and facilitates care. Encouraging the patient to make her own decisions may delay the required surgery. A two-doctor signature is not required in this situation. The patient has the legal and ethical right for information about the proposed surgery and the ability to make her own decisions. To delay the surgery while attempting to resolve the conflict may cause complications and poor outcomes if the patient requires immediate surgery. A Japanese male is in the ICU following stroke. It is noted by the nursing staff that his wife is very involved in the patient's care and is not encouraging the patient to do things for himself. On assessment, the nurse discovers that the patient does not value independence but is of the belief that his wife should take care of him. Which of the following is the most appropriate intervention? A. Discuss the issues of the need for independence and self-care with the wife B. Allow the wife to continue to care for the patient C. Ask the wife to limit her visits until the patient has recovered and ready to be transferred D. Notify the physician and set up a physician/family conference - ANS: B Different cultures have different values and beliefs. In American hospitals, indepen- dence and self-care are considered important values. But other cultures may not view this as important and actually place the value on family support and care. Cultural sensitivity includes not imposing our beliefs on other cultures when it is not necessary for recovery. Allowing the wife to continue to care for her husband demonstrates cul- tural sensitivity. Attempting to stop the wife through discussions, limiting visitation, or physician conferences is an attempt to force the values of independence and self- care on the patient and family. A female patient from Saudi Arabia is admitted for acute coronary syndrome. Her hus- band has accompanied her to the ICU and is upset because a male nurse is attempting to perform an assessment. Which of the following is the most appropriate response to the situation? A. Explain to the husband that the male nurse is a professional and it is his assignment B. Call security to de-escalate the situation C. Ask the husband to leave the room while the assessment is being performed D. Change the assignment to a female nurse to accommodate the husband's wishes - ANS: D Changing the assignment to allow a female nurse to care for the patient demonstrates cultural sensitivity and competency. In the Arab culture, female purity and main- taining gender segregation are valued. This belief system involves extreme modesty for women and would require the women to be kept completely covered if a male enters the room. Explaining to the husband about professionalism would not correct the situation of a male exposing the women to perform an assessment. Requiring the husband to leave the room or calling security would escalate the situation and might interfere with patient care and well-being. A patient is brought to the ICU following an MVC. He is requiring a second emegency surgery and a consent form needs to be obtained. His wife has limited English knowledge but their 15-year-old son speaks fluent English. Which of the following is the most appropriate action? A. Allow the son to translate to obtain the consent B. Ask other nurses in the ICU whether they speak the language and could help with the interpretation C. Use the telephone translator services to obtain the consent D. Leave it to the physician to obtain the consent - ANS: C It is recommended that an interpreter be used when obtaining signed consent forms from a patient or family member with limited or no English-language ability. Using the telephone translator is an appropriate response to the situation and would not delay obtaining the consent. A child of the patient may be more fluent in English but should not be used as an interpreter in the health care setting. Exposure of the child to sensitive health care information and role reversal can cause undue stress and adverse effects. Other concerns are the accuracy of the interpretation, especially the medical ter- minology, competency, and the potential conflict of interest that may exist. Competent translators require knowledge of two different languages, medical terminology, and maintain ethical and professional practice standards. Nurses may have some knowl- edge and ability to speak the language but may not be competent in translating for a consent form. Leaving it to the physician may delay the surgery. A patient is ready to be transferred to the floor. She has a history of cardiovascular disease. The patient does not exercise and eats unhealthy food. Which of the following would be the best focus for patient education at this time using the holistic nursing approach? A. Harmful effects of alcohol B. Smoking cessation C. Family support groups D. Lifestyle changes - ANS: D Holistic nursing focus on lifestyle changes, prevention, and overall well-being. The scenario gave the information that the patient does not exercise and eats unhealthy food. This indicates a need for lifestyle changes to improve her health and prevent fur- ther complications of cardiovascular and cerebrovascular disease. Education on smok- ing and alcohol can also benefit patients, but there was no indication in this scenario that the patient was a smoker or used alcohol. Family support groups are important but the focus of this scenario was on the patient. Allowing a patient to make decisions will assist with providing control back to the patient and lowering anxiety. Which of the following would be an appropriate decision to assist with preventing loss of self- control? A. Whether the patient wants to be turned or remain supine B. Which of the family members can visit and for how long C. Whether the patient wants an IV or not D. Whether the patient wants to remain in the ICU or transfer to the progressive care unit - ANS: B Patients in the ICU commonly experience a loss of control that creates anxiety. Once the patient is able to make simple decisions, allow the patient small choices. Give some control back to the patient in appropriate areas. Patients should have the right to make decisions about visitors, who can visit, and for how long. Patients need to be turned to prevent pressure sores. Giving them the choice of which side they would like to be turned to is appropriate, but not whether they want to be turned or not. An IV is also a safety issue. The patient may assist by stating which arm he or she prefers but not whether to A. Reassure the patient that this is a short-term problem B. Administer sedation to calm the patient C. Use a communication board to facilitate communication D. Explain the difficulty of lip reading to the patient - ANS: C Inability to effectively communicate while intubated and mechanically ventilated cre- ates stress and anxiety in the patient. Using sign language, lip reading, or communica- tion boards can facilitate communication with nonverbal patients. Just reassuring the patient or explaining the problem to the patient without attempting to improve the communication just creates more anxiety. Administering a sedative is not indicated in a situation of communication issues. A patient is scheduled for a surgery in the morning. The patient has been "acting out" all day and is becoming hostile. Which of the following would be the most appropriate response by the nurse? A. "I will have to restrain you if you continue being so hostile." B. "The physician will be in soon, so you need to be calmer to talk with him." C. "What are you feeling right now?" D. "Tell me why you are so angry." - ANS: C Asking an open-ended question allows for exploration of possible meaning behind the patient's behavior. Threatening to restrain the patient or bargaining in regard to the physician's visit are inappropriate responses to acting-out behavior of the patient. Asking the patient to tell you why he or she is angry can put the patient on the defen- sive and does not facilitate exploration of his or her feelings. A group of night nurses have noticed that lab draws ordered for 2:00 a.m. interrupts sleep patterns. Which is the best strategy for addressing this issue? A. Refuse to obtain routine labs at 2:00 a.m. B. Assemble a work group to research best practice and determine the best policy C. Perform a survey of nursing opinions regarding the current policy D. Request physicians to develop a committee to address the problem - ANS: B The first step to determining best practice is to be aware of the problem. In this situa- tion, the problem identified was sleep disruption of critical care patients to obtain labs. The next step is to assemble a work group to research current literature and studies regarding the formulated problem. Once the best practice is identified, then present- ing a plan for changing current practice is received better than just refusing to follow a particular practice. Obtaining other nurses' opinions is not basing the practice on research. This is not a situation or time in which the physicians should be requested to form committees to institute change. A patient experiences a near-death experience and wants to talk to the nurse about the experience. What is the best response by the nurse? A. Encourage the patient to talk about her experiences and listen actively B. Explain to the patient the hallucinations are due to the pain medications C. Reorient the patient to the actual events of the resuscitation D. Tell the patient it is important to talk to her family about the issue - ANS: A Allowing the patient time to talk about an experience helps the patient to work through thoughts and emotions regarding the event. The nurse should listen actively to the patient. Downplaying a patient's experience as a hallucination or attempting to reori- ent the patient to the actual events is not beneficial to the patient and may actually be counterproductive. Referring the patient to talk to her family instead of the nurse may cause the patient to lose trust in the health care provider. A preceptor observes that the new orientee is performing a task using a different method than the preceptor has used. What is the appropriate response by the preceptor? A. Tell the orientee he is doing it incorrectly and needs to perform the task as taught by the preceptor B. Survey other nurses in the unit on their method of performing the task C. Perform a literature review to determine whether the orientee's method is appropriate D. Ignore the difference and assume the orientee is aware of the correct method - ANS: C Professionalism includes mentoring others as well as being mentored. The preceptor is mentoring and teaching the orientee but can learn from the orientee as well. If there is a difference in methods for performing a procedure, perform a literature review to determine best practice. There is more then one way to do some procedures and one way is not always the best way. Stating that the orientee is wrong, without appropriate research, does not acknowledge the nurse as having a base of knowledge and skills. Surveying other nurses can be done in certain circumstances but is not the best answer in this scenario. Ignoring the identified problem does not allow for growth in either the preceptor or orientee. During visitation, the nurse observes the wife of the patient is just standing at the patient's bed. She is not talking to him or touching him. What would be the most appropriate response by the nurse? A. Recognize the wife's discomfort and do not force her to touch the patient B. Encourage the wife to touch the patient and talk to him C. Notify the physician of a potential conflict of interest with the wife D. Ask the physician for a psychological consult to work with the wife - ANS: B Patients may be able to hear even if they are not responding or appear to be oriented. Families frequently do not know what to say to the patient or what to talk about at the bedside. Some families just stand at bedside and are afraid to touch their loved ones because of all of the lines and tubes. ICU nurses can encourage them to talk to the patient directly and touch their loved ones. This behavior does not indicate a conflict of interest in the wife making decisions for the patient. It is a common response and does not require psychological workup. What has been found to be the most common reason for a medication or treatment error? A. New drugs B. Inadequate resource available to nurses C. Lack of knowledge D. Communication problem - ANS: D Most medication or procedure errors relate back to poor communication and an ineffec- tive relationship among health care providers. Health care providers need to improve working relationships and communicate on a more professional level. Outbursts and disruptive behavior may prevent a nurse from calling a physician to report patient changes or question an order. This may lead to medication or patient care errors. Resources are typically available in the ICU, including drug resource websites or books. New drugs can also be looked up and reviewed before being administered. Lack of knowledge can contribute to medication errors, but the most common reason is communication problems. Laughter has been found to have which positive effect? A. Improve patient's spirituality B. Lower risk of strokes C. Decrease pain D. Reorient patient - ANS: C Laughter has been found to lower pain even up to 15 minutes after laughing. It has been reported by oncology patients to be the best self-prescribed pain management. Laughter increases the release of endorphins, the body's endogenous opioid. Laughter has not been found to lower the risk of strokes or affect patient orientation. Spirituality is a person's sense of belonging and belief in a higher being. Laughter has not been shown to affect spirituality. low level of health literacy. Health literacy is the ability of the person to understand basic health information. Observing the person looking through the literature provided does not ensure the person can read or comprehend the literature. The nurse should read the information in addition to providing it in a written format. Preparing the educational material at the fifth- to eighth-grade reading level still does not assure that the person can read. While teaching the patient to perform a dressing change, which of the following evalu- ations will determine the effectiveness of the learning? A. Do not ask for a demonstration if it embarrasses the patient B. Patient states the steps of performing a dressing change C. Patient states his wife can do the dressing change D. Patient demonstrates critical elements of the dressing change - ANS: D When teaching a psychomotor skill, following verbal and written instructions regard- ing the steps, the patient needs to perform the skill so knowledge can be evaluated. Critical elements of the skill need to be identified and those need to be demonstrated by the patient when performing the skill. Just stating the steps of a skill does not dem- onstrate proficiency in actually performing the skill. Stating that the wife can do the dressing change does not evaluate any learning, either of the patient or wife. Learning a new skill can be difficult and requires encouragement by the nurse; avoid embarrass- ing the patient but do not avoid a return-demonstration for fear of embarrassing the patient. Learning has to be evaluated. A family is requesting to stay at the bedside during resuscitation of their loved one. Which of the following is a benefit of family presence during resuscitation? A. Family member will see that everything was done for their loved one B. Staff will try harder to resuscitate the patient C. Resuscitation time will be shorter with the family member present D. Physician will interact with staff better during the resuscitation - ANS: A Family presence during resuscitation has shown benefit for the family. One of the com- monly expressed benefits is the family member is able to see everything that could be done for their loved one was done, instead of being on the other side of the door not knowing what was happening. Family presence should not make the staff try harder, improve physician interactions, or the resuscitation time shorter (which may not be a benefit in many cases). Which of the following is a component of family-oriented palliative care after the death of the patient? A. Preparing the body B. Funeral arrangements C. Bereavement care D. Family conferences - ANS: C Family-oriented palliative care is centered around four major cornerstones—open visi- tation, family conferences, family presence during resuscitation, and bereavement care. After the death of a loved one, support of the family should be provided. Providing information about funeral arrangements may be a component of support but will depend on the family's past experiences. Bereavement care may include allowing the family time at the patient's bedside after death. Family conferences are a part of pallia- tive care while the patient is alive. During a family conference, which of the following statements is the best way to intro- duce bad news and the poor prognosis to the family? A. "Your sister has a very poor prognosis, do you want us to do everything for her?" B. "Your sister's blood pressure is a problem. It is very low and she is already on the maximal amount of support but it is still low." C. "What are your feelings about removing life support?" D. "We would like to call the organ donation team to come evaluate your sister for organ retrieval." - ANS: B Introduce the bad news by identifying the symptoms that are indicating a poor prognosis. It gives family a chance to see what the health care professionals are already seeing. Then, if the need arises to talk about withdrawal of life support, the family is more prepared for the conversation. Asking whether they want "everything done" for their loved one sets up a "yes" answer. Clarifying what "everything" means and ensuring care is still provided although they will not be resuscitated is more appropriate. When discussing the issue of withdrawal, a better question is to ask what the patient would have wanted, not what the family's feelings are about it. Even if a patient is brain dead or a potential organ donor, the focus of the family conference is poor prognosis. Organ donor organizations typically will initiate the conversation about organ donation with the family. At the end of life, pain management is an important aspect of patient care. The prin- ciple of double effect typically refers to which of the following situations? A. Disagreement between family members in regards to removal of life support B. Stopping tube feeds but maintaining IV hydration C. Removal of life support even if the patient is awake D. Administration of opioids for pain even though they may cause respiratory depression - ANS: D The principle of double effect is commonly applied to the administration of opioids for pain management at the end of life. The principle refers to an action having two effects, one good and one bad. Providing analgesics controls pain but opioids can cause respiratory depression. If the primary goal is to control pain, even though the patient develops respiratory depression, this is ethically okay. Disagreements between family members in decision making and stopping tube feeds while maintaining hydration are not considered a double effect. Life support may be removed even if a person is awake. Removal of life support can be considered to have a good and bad effect but the hint in the question is the sentence regarding pain management. A physician orders a medication that the ICU nurse feels may be contraindicated. Which of the following would be the most appropriate initial action of the nurse? A. Refuse to administer the medication B. Notify the charge nurse and supervisor of the order C. Call and discuss the medication order with the ordering physician D. Administer the medication as ordered - ANS: C Discussing the order with the ordering physician typically will allow the physician to explain the justification of the order. It is the most appropriate first response when questioning an order. If this does not clear up the issue regarding the order, then fol- lowing the hospital protocol for using the chain of command should be initiated. This may include notifying the charge nurse and supervisor. If the ICU nurse still feels that the order may harm the patient after discussing it with the physician, refusing to administer the medication is an appropriate action. Administering a medication when it may be harmful to the patient is not appropriate without further discussion and additional steps. Orders have been received to get a bariatric patient out of bed and sitting in a chair. The patient weights 450 pounds. The chair in the ICU for patients has a weight limit of 400 pounds. Which of the following would be the most appropriate response by the nurse? A. Discuss purchasing chairs for bariatric patients with the management B. Obtain an order to get a specialty bed company to bring a bariatric chair C. Refuse to get the patient out of bed because of the weight of the patient D. Use the chair available since there is only a 50-pound difference - ANS: B Obtaining a bariatric chair that has an appropriate weight limit would be the best response of the nurse. Refusing to get the patient out of bed would not benefit the patient. The nurse needs to be an advocate for the patient. Discussing the need to pur- chase chairs for bariatric patients is a good response but will not benefit this patient at this particular time. Using a chair that is not approved for the patient's weight