Preview Extract
Chapter 4
1. A patient cries quietly while undergoing a painful treatment. The nurse realizes the treatment is painful; however, it is necessary for the patient’s healing and recovery. Which ethical principle does this situation exemplify?
1. Nonmaleficence
2. Paternalism
3. Veracity
4. Respect for others
Answer: Nonmaleficence
Rationale:
Even though the principle of nonmaleficence states that a person should do no harm, the focus of the projected treatment or procedure is on the consequences of the benefits to the patient and not on the harm that occurs at the time of the intervention. Paternalism allows one to make decisions for another. Veracity is the concept that individuals should always tell the truth. Respect for others acknowledges the right of individuals to make decisions and to live by those decisions.
2. The health care team is confronted with an ethical dilemma surrounding one patient and the types of care available. The team decides to apply ethical principles to determine the best course of action for this patient. This is an example of which type of ethical theory?
1. Principlism
2. Deontological
3. Teleological
4. Utilitarianism
Answer: Principlism
Rationale:
Principlism incorporates existing ethical principles and attempts to resolve conflicts by applying one or more of the principles. Deontological theories derive norms and rules from the duties human beings owe to one another by virtue of commitments made and roles assumed. Teleological theories derive norms or rules for conduct from the consequences of actions. Utilitarianism is another term for teleological and can be divided into “rule” and “act” utilitarianism.
3. A patient asks the nurse to promise him that nothing bad will happen to him while he is under anesthesia for a surgical procedure. The patient is creating a conflict in which of the following ethical principles of the nurse?
1. Fidelity
2. Respect for others
3. Paternalism
4. Veracity
Answer: Fidelity
Rationale:
Fidelity means keeping one’s promises or commitments. The patient is putting the “nurse in the middle” of a potentially conflicting situation. The nurse cannot promise that nothing bad will happen to the patient during anesthesia. Respect for others acknowledges the right of individuals to make decisions and to live by these decisions. Paternalism allows one person to make decisions for another. Veracity is the concept that one should always tell the truth.
4. A health care provider is reviewing the steps taken to address an ethical issue with a patient. Within which of the following steps of the MORAL model is this health care provider working?
1. Look back and evaluate.
2. Massage the dilemma.
3. Outline the options.
4. Act by applying the selected option.
Answer: Look back and evaluate.
Rationale:
The health care provider is looking back and evaluating. This is the process of reviewing and reexamining whether desired outcomes were attained and whether new options need to be implemented. Massage the dilemma means that the issues are identified. Outline the options means the options are fully examined, including those that are less realistic. Act by applying the selected option refers to implementation of the chosen option to resolve the dilemma.
5. The health care team is making a list of the ways to resolve the issue of whether or not to continue life support for a patient. The step of the MORAL model that the team is currently engaged in would be:
1. Outline the options.
2. Apply the chosen option.
3. Resolve the dilemma.
4. Massage the dilemma.
Answer: Outline the options.
Rationale:
The second step in the MORAL model is outline the options, where the members of the health care team make a list of all ways to resolve the ethical dilemma of continuing life support. Applying the chosen option means the action chosen would be implemented. Resolve the dilemma is the third step in which ethical principles are applied to each of the identified options. Massage the dilemma is the first step in the model and is where all of the issues are identified.
6. The family of a terminally ill patient tells the nurse that a certain level of care is to be provided to the patient. The health care staff is questioning the value of providing the care and believes something else should be done. Which of the following should be done first for this situation?
1. Massage the dilemma.
2. Outline the options.
3. Resolve the dilemma.
4. Apply an option to resolve the dilemma.
Answer: Massage the dilemma.
Rationale:
A new health-care-related issue has surfaced. The family wants one course of action, and the health care professionals want another. The ethical issue needs to be massaged, identified, and defined before the options can be outlined. The team is not prepared to resolve the dilemma or apply any solutions until the actual dilemma is defined.
7. A patient is having a difficult time deciding whether or not to accept an experimental treatment for a health problem. The health care team is planning to discuss this patient’s issue at the next committee meeting. The committee structure that would support this patient’s dilemma is the:
1. Autonomy model.
2. Patient benefit model.
3. Social justice model.
4. Accountability model.
Answer: Autonomy model.
Rationale:
The autonomy model supports ethical decision making for the competent patient. The patient benefit model facilitates decision making for the incompetent patient. The social justice model considers broad social issues that may arise within an organization. The accountability model is not an identified ethics committee structure.
8. A patient, agreeing to receive care for a terminal illness, is experiencing the side effect of confusion from the treatment. If the health care providers follow the patient benefit model of ethical care, which of the following would be done?
1. Determine if the patient would want to be confused and then either proceed or stop the treatment.
2. Continue with the treatment because the patient made the decision.
3. Continue the treatment because other patients might find out that the hospital does not provide required care.
4. Find health care providers willing to provide the care even though the patient is confused.
Answer: Determine if the patient would want to be confused and then either proceed or stop the treatment.
Rationale:
The patient benefit model uses substituted judgment, which takes into consideration what the patient would want done if capable of making the decision. The staff should determine if the patient would want to be confused and then either proceed or stop the treatment. Continuing with the treatment does not take into consideration the patient’s change in mental status and is a decision that would be made if following the autonomy model. Continuing with the treatment because of other patients’ questioning the hospital’s ability to provide care would be an outcome from implementing the social justice model. Finding health care providers willing to provide the care even though the patient is confused is not an example of an ethics committee decision.
9. While providing care to a patient, an ethical issue is discovered. The nurse, recalling a similar situation from attending ethical grand rounds, provides an intervention that resolves the dilemma without further action required. Which of the following types of ethical committee structure helped the nurse and patient resolve the ethical dilemma?
1. Social justice model
2. Blend of autonomy and patient benefit models
3. Autonomy model
4. Patient benefit model
Answer: Social justice model
Rationale:
The social justice model considers broad social issues, and many ethics committees hold ethical grand rounds based on this structure. In ethical grand rounds, broad issues are reviewed and discussed, which helps nurses make quick and competent decisions about the same issue in the future. There is no evidence to suggest that the patient was incapable of making a decision, which the patient benefit model would support. The autonomy model facilitates decision making for a competent patient; however, in this situation, the nurse used information gained from an ethical grand rounds program.
10. The nurse received an update from the state board of nursing about a new continuing education requirement. Which of the following should the nurse do with this information?
1. Plan to learn more about the requirement to be in compliance.
2. Nothing. It is only from the board of nursing.
3. Contact the American Nurses Association about the requirement.
4. Ask a health care provider if the requirement is necessary to nursing practice.
Answer: Plan to learn more about the requirement to be in compliance.
Rationale:
The state board of nursing is an example of an administrative law agency. Administrative laws are enacted through the decisions and rules of administrative agencies, which are specific governing bodies charged with implementing selected legislation. The nurse practice act is an example of statutory law. Statutory laws are those rules and regulations enacted by the legislative branch of the government. When statutory laws are enacted, administrative agencies are given the authority to implement the specific intentions of the statutes, creating rules and regulations that enforce the statutory law. The nurse needs to plan to learn more about the requirement. The nurse should not ignore the notice. The nurse does not need to contact the American Nurses Association or ask a health care provider if the requirement is necessary.
11. A nurse is found to have a chemical-dependency issue. This information is to be communicated to the:
1. State board of nursing.
2. American Nurses Association.
3. Police.
4. School of nursing from which the nurse graduated.
Answer: State board of nursing.
Rationale:
The state board of nursing should be notified because the act may also include information on how to help nurses affected by addictions. The American Nurses Association is not going to provide help for nurses with addictions. The police should not be notified unless the nurse participated in some illegal activity. The school of nursing from which the nurse graduated does not need to be informed of the nurse’s chemical-dependency issue.
12. A patient says that he doesn’t want the nurse to remove the PICC line from his arm because the last time he had one, the doctor told him that it was something that only a doctor can do. Which of the following would be the most appropriate response to this patient?
1. “The nurse practice act for this state includes this skill as a nursing activity and I have been trained on the correct way to remove it.”
2. “I will get the doctor.”
3. “Are you refusing to have the PICC line removed?”
4. “I can talk you through removing it yourself.”
Answer: “The nurse practice act for this state includes this skill as a nursing activity and I have been trained on the correct way to remove it.”
Rationale:
The nurse has had an expansion of her role and has been trained on the activity. The correct response is to explain that the activity is covered within the nurse practice act and the nurse has been found competent to perform the activity. It is not necessary for the nurse to get the doctor, nor should the nurse confront the patient by assuming the patient refuses to have the line removed. Talking the patient through the procedure to remove the line himself is not a viable safe option.
13. A patient is telling the nurse manager that she believes a wrongful act occurred when she was given the wrong medication. The law to address this issue would be considered:
1. Tort.
2. Common.
3. Civil.
4. Criminal.
Answer: Tort.
Rationale:
A tort is a wrongful act committed against another person or the person’s property. These wrongful acts result in an injury or harm, thereby constituting the basis for a claim by the injured party. Although some torts are crimes punishable by imprisonment, the primary aim of tort law is to provide relief for the damages incurred and to deter others from committing the same harms. The injured person may sue for an injunction to prevent the continuation of the tortuous conduct or for monetary damages. Common law is derived from principles rather than rules and regulations. Common law is based on justice, reason, and common sense. It represents law made by judges through decisions in specific cases. Civil law begins with abstract rules, which judges must then apply to cases. Criminal law is public law that involves the prosecution by the government of a person for an act that has been classified as a crime.
14. A patient’s personal health information was provided to another individual without the patient’s permission. The nurse realizes this breach of information would be addressed by which of the following types of laws?
1. Tort
2. Civil
3. Common
4. Contract
Answer: Tort
Rationale:
A tort is a wrongful act committed against another person or the person’s property. An example of a tort action is a breach of confidentiality. Civil law is defined as laws made from abstract rules and applied to situations. Common law is a system of law derived from the decisions of judges. Contract law addresses the issues about agreements made between two parties.
15. A patient tells the nurse that he had money in the top drawer of his bedside table that is now missing. He is phoning his attorney and plans to press charges. The nurse realizes this patient is planning to implement which of the following types of law?
1. Criminal
2. Tort
3. Common
4. Contract
Answer: Criminal
Rationale:
Criminal law involves the prosecution by the government of a person for an act that has been classified as a crime. The patient is claiming that money was stolen, which is a crime. A tort is a wrongful act committed against another person or the person’s property. The primary aim of tort law is to provide relief for damages. Common law is a system of law that is derived from judges’ decisions. Contract law is a way to govern a promise or agreement that has been made between two parties.
16. A patient leaves the hospital without receiving his medication prescriptions and discharge instructions, which causes the patient to sustain physical harm. The hospital should be concerned about which of the following elements of malpractice?
1. Injury
2. Duty
3. Breach of duty
4. Causation
Answer: Injury
Rationale:
Injury means that actual harm results to the patient. An example of this would be failing to provide patient education and discharge planning. Duty means care is provided according to what a prudent nurse would have done. Breach of duty is not giving the care that should be given to a patient. Causation means the patient was harmed because proper care was not given.
17. A patient with an elevated blood glucose level was given 100 units of regular insulin when the order was written for the patient to receive 10.0 units of regular insulin. The patient’s blood glucose level dropped to 40 mg/dl, requiring additional medical intervention to stabilize. The inappropriate amount of insulin this patient received would be considered as which element of malpractice?
1. Causation
2. Breach of duty
3. Foreseeability of harm
4. Duty
Answer: Causation
Rationale:
Causation means that a direct relationship exists between the failure to meet the standard of care and an injury. The patient is harmed because proper care is not given. In this situation, the patient received 10 times the prescribed amount of insulin, which dropped the blood glucose level down to 40 mg/dl, a dangerously low level. The patient then needed additional medical intervention to stabilize. Duty owed the patient is care that any prudent nurse would have done. The nature of the duty represents the minimum requirements that define acceptable or standard care. Breach of duty would be not giving the care that should be given under the circumstances. Foreseeability of harm means the nurse needed to have access to information about whether the possibility of harm exists.
18. A patient has proven that a hospital employee was negligent when providing care. The nurse realizes that the outcome of this decision would result in which of the following?
1. Damages
2. Injury
3. Causation
4. Foreseeability of harm
Answer: Damages
Rationale:
Damages is the final step in the elements of malpractice. The patient must prove that financial harm occurred while hospitalized. Injury is the fifth element of malpractice and means that physical injury occurred and not psychological or transient injury. Causation is the fourth element of malpractice and means that an action or lack of action directly caused harm. Foreseeability of harm is the third element of malpractice and means that certain events may reasonably be expected to cause specific results.
19. The parents of a stillborn baby are suing the hospital for malpractice. Which of the following standards would most likely be consulted for this case?
1. Neonatal Nursing: Scope and Standards of Practice
2. Home Health Nursing: Scope and Standards of Practice
3. Public Health Nursing: Scope and Standards of Practice
4. Scope and Standards of Practice for Nursing Professional Development
Answer: Neonatal Nursing: Scope and Standards of Practice
Rationale:
Several sources can be used to determine the applicable standard of care. The American Nurses Association, as well as a cadre of specialty organizations, publishes standards for nursing practice. The overall framework of these external standards is the nursing process. Additional standards have been published that describe nursing care for a variety of patient populations and in selected nursing settings. Since this situation is about a baby, the standards about home health, public health, and professional nursing development would not apply.
20. The nurse is not sure which approach to take when providing one aspect of care to a patient. Which of the following should the nurse do?
1. Check the organization’s procedure manual to find out the standard of practice for the care.
2. Search for a magazine article that discusses the aspect of care.
3. As the health care provider what should be done about the care.
4. Document that the patient refused the one aspect of care.
Answer: Check the organization’s procedure manual to find out the standard of practice for the care.
Rationale:
Standards of care are established by reviewing the organization’s policy and procedure manual. Searching for a magazine article about the aspect of care might be done but it may not coincide with the organization’s policy and procedure manual. The nurse should not ask the health care provider what should be done about the care. The nurse should not falsely document that the patient refused one aspect of care.
21. The nurse is considering moving into the role of providing care to terminally ill patients. Which of the following scope and standards of practice would the nurse review to learn the most information about the care provided to these types of patients?
1. Hospice and Palliative Nursing
2. Pain Management Nursing
3. Radiology Nursing
4. Home Health Nursing
Answer: Hospice and Palliative Nursing
Rationale:
The American Nurses Association has published many different types of scopes and standards for nursing practice. The one that would be the most applicable to the care of a terminally ill patient would the standards to address Hospice and Palliative Nursing. Pain Management might provide information as well as Home Health Nursing. Radiology Nursing is the one that would provide the least amount of information.
22. A patient comes into a small community hospital emergency department with a severely lacerated hand. After appropriate treatment, the patient receives nursing care based upon documented standards of care so that the hand will function well with minimal scarring. This standard of practice would be considered a(n):
1. National norm.
2. Internal standard.
3. External standard.
4. Regional norm.
Answer: National norm
Rationale:
National standards of care are based on reasonableness and are the average degree of skill, care, and diligence exercised by members of the same profession. Such national standards mean that nurses in all settings, urban and rural, must meet the same standards when caring for patients in clinical settings. National standards of care have slowly replaced the previously used regional or locality standard of care, which allowed the standard of care to be viewed from the perspective of care within a given geographical area or “similar community.” The only way of knowing if this practice is an internal standard would be to review the community hospital’s policy and procedure manual. The only way of knowing if this practice is an external standard would be to review published materials regarding the care of the patient with a severely lacerated hand.
23. A patient asks the nurse why bottled water is being used to flush her wound when she was told to use tap water at home. The nurse realizes this patient is describing which of the following?
1. A regional standard of care
2. A national standard of care
3. An infection control measure
4. A cost containment measure
Answer: A regional standard of care
Rationale:
Regional standards of care are those standards viewed from a given geographical area or similar community. The patient using tap water to flush a wound was most likely a regional standard of care. A national standard is that which is done by nurses in all settings. Using tap water would not be an infection control measure. There is no way of knowing if the patient needed to use tap water as a cost containment measure.
24. The nursing staff from a community hospital is attending a conference to learn how to use a closed chest tube collection device instead of the previously used glass bottle with 500 cc of sterile water. The nurse realizes this conference ensures that all nurses will practice chest tube care according to:
1. National standards of care.
2. The Joint Commission provision of care accreditation standards.
3. Cost-effective methods.
4. National Patient Safety goals.
Answer: National standards of care.
Rationale:
National standards of care are based on reasonableness and are the average degree of skill, care, and diligence exercised by members of the same profession. Educational programs make it easier for all individuals of a profession to learn the standards so that all patients receive the highest quality of care, regardless of location. The Joint Commission’s provisions of care standards and the National Patient Safety goals do not specifically address chest tube care. The closed chest tube collection device may or may not be a cost-effective method.
25. A patient claims that family members had access to his medical record and believes that he has had a breach of confidentiality. This breach would be considered a part of:
1. Invasion of privacy
2. Assault
3. Battery
4. Defamation of character
Answer: Invasion of privacy
Rationale:
An example of a breach of confidentiality is the invasion of privacy that is considered a quasi-intentional tort. Assault and battery are examples of intentional torts. Defamation of character is a quasi-intentional tort with the intention of harming another person’s reputation.
26. The nurse who tells the patient that she is discharged but not allowed to leave the hospital yet and takes the patient’s purse is at risk for which of the following intentional torts?
1. False imprisonment
2. Defamation of character
3. Invasion of privacy
4. Breach of confidentiality
Answer: False imprisonment
Rationale:
False imprisonment is the unjustified detention of a person without the legal right to confine the person and may occur if the act is directed at the patient’s possessions such as a purse. Defamation of character is harming another’s reputation by diminishing the esteem, respect, or goodwill that others have for that person. Invasion of privacy is a violation of a person’s right to protection against unwarranted interference into their personal life. Breach of confidentiality is a type of invasion of privacy that has to do with information within the patient’s medical record.
27. A patient, who is a local elected public official, is admitted with a chemical dependency. The nurse tells a visitor that the patient is a cocaine user. Which of the following has the nurse done?
1. Invaded the patient’s privacy
2. Breached the patient’s confidentiality
3. Assaulted the patient
4. Provided battery to the patient
Answer: Invaded the patient’s privacy
Rationale:
Invasion of privacy is a violation of a person’s right to protection against unreasonable and unwarranted interference with his personal life. An example of this is disclosure of medical facts to persons not entitled to those facts. Breaching the patient’s confidentiality would be providing information that is included in the patient’s medical record. Assault means the patient was touched in an offensive, insulting, or physically injurious manner. Battery is the actual contact with another person or the person’s property.
28. A patient consents to having a cardiac catheterization and willingly permits the nurse to draw blood and measure vital signs before the procedure. The patient’s permitting the actions of the nurse would be considered as which of the following?
1. Implied consent
2. Informed consent
3. Emergency doctrine
4. Acceptance
Answer: Implied consent
Rationale:
Implied consent is consent that may be inferred by the patient’s conduct or that may legally be presumed in emergency situations. Many patients hold out their arm and roll up their sleeve when the nurse approaches with a stethoscope and blood pressure cuff. This is an example of implied consent because a reasonable person would infer by the patient’s action that the patient is consenting to the procedure. Informed consent means the patient received information needed to make a knowledgeable decision about a medical procedure or treatment; there is no information in the scenario about the patient’s receiving the information. Emergency doctrine is when consent for treatment is implied and delaying care would result in the loss of life or limb. Acceptance is not a concept of consent.
29. A patient is in the operating room holding area and tells the nurse that he changed his mind and does not want the procedure. Which of the following should the nurse do?
1. Contact the surgeon and implement steps to cancel the procedure.
2. Explain to the patient that he has already made his decision and cannot change his mind.
3. Ask the surgeon to explain to the patient why he needs the surgery.
4. Document that the preoperative anesthesia has made the patient confused.
Answer: Contact the surgeon and implement steps to cancel the procedure.
Rationale:
Informed consent includes the patient having the right to refuse treatment even after the procedure or therapy has started. The nurse should contact the surgeon and implement steps to cancel the procedure. The nurse should not tell the patient that he cannot change his mind, nor should the surgeon be called to persuade the patient to continue with the procedure. The nurse should not falsely document that the preoperative anesthesia has made the patient confused.
30. A patient questions why his leg is being shaved if he is scheduled to have open-heart surgery. Which of the following should the nurse do in this situation?
1. Contact the health care provider because the patient is not completely informed about the procedure.
2. Explain that the leg veins will be used for the surgery.
3. Tell the patient that the doctor wrote an order to shave his leg.
4. Document that the patient refused to have his leg prepped prior to surgery.
Answer: Contact the health care provider because the patient is not completely informed about the procedure.
Rationale:
The nurse has the responsibility to contact the health care provider because it was obvious that the patient does not understand everything about the open-heart surgery procedure. The nurse should not supplement information provided, nor should the nurse state that the health care provider wrote the order to have the leg shaved. The nurse should also not document that the patient refused to have his leg prepped prior to surgery, but should contact the surgeon to provide additional information so the patient can provide informed consent.
31. The nurse is providing care to a patient who has a history of suing health care providers. Which of the following can the nurse do to reduce the risk of a lawsuit?
1. Establish communication and trust.
2. Spend as little amount of time with the patient as possible.
3. Delegate care activities to an unlicensed assistant.
4. Switch the assignment with another nurse.
Answer: Establish communication and trust.
Rationale:
One of the most fundamental aspects of malpractice law involves relationships. For a duty to be owed the patient, one must first establish that a nurse–patient relationship exists. This may be accomplished by showing that a reliance relationship exists: One person (the patient) is depending on another person (the nurse) for competent, quality nursing care. The core of any reliance relationship is trust and communication. Establishing rapport with a patient, informing patients honestly and openly of all aspects of their care, and allowing patients to make decisions for themselves have always been credited to nurses as one means of preventing potential liability. Nursing is a caring profession; part of caring is maintaining communications and ensuring that trust is established and continues throughout the interactions between the nurse and the patient. The nurse should not reduce the amount of time spent with the patient nor delegate activities to an unlicensed assistant. The nurse should also not switch the assignment with another nurse.
32. A patient tells the nurse that she does not want to take a particular medication but does not want to tell the doctor because “he will be angry with me.” Which of the following should the nurse do to help this patient?
1. Encourage the patient to speak to the health care provider on her own behalf.
2. Tell the patient that the doctor does not need to know.
3. Offer to give the information to the doctor.
4. Tell the patient that if she does not take the medication, she might have more troubles in the future.
Answer: Encourage the patient to speak to the health care provider on her own behalf.
Rationale:
Encouraging the patient to speak to the health care provider on her own behalf is an example of the values-based decision model of advocacy. The nurse should not encourage the withholding of the information from the health care provider. The nurse should not offer to tell the health care provider for the patient. The nurse should also not threaten the patient by saying if she does not take the medication she might have more troubles in the future.
33. A patient who fell when being transferred from the bed to a chair tells the nurse that he does not plan to contact an attorney because the nurse told him to do the transfer one way and he insisted on doing it another and realizes that it was his fault that he fell. This is an example of which of the following?
1. Trust and communication between the nurse and patient
2. Preventative communication
3. Implied consent
4. Informed consent
Answer: Trust and communication between the nurse and patient
Rationale:
The core of any reliance relationship is trust and communication. Establishing rapport with a patient, informing patients honestly and openly of all aspects of their care, and allowing patients to make decisions for themselves is one way to prevent potential liability. There is no such concept as preventative communication. Implied consent means a patient permits an action based upon the patient’s conduct or behavior. Informed consent means a patient has been provided with all necessary information so as to make a decision about a plan of treatment or care.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
