Issues in Nursing Practice

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. After working a 12-hour shift, the nurse is asked to work part of the next shift due to short staffing. Which obligation to work should the nurse use to guide the response to this request?
a. Justice
b. Welfare
c. Moral
d. Legal
____ 2. The family of a patient who has been diagnosed with cancer does not want the patient to be told about the diagnosis. The patient asks the nurse, “Do I have cancer?” Which ethical principles should the nurse consider when resolving this situation?
a. Autonomy and veracity
b. Beneficence and justice
c. Welfare rights and moral obligations
d. Nonmaleficence and legal obligations
____ 3. A patient tells the nurse that the Patient’s Bill of Rights gives patients the legal right to read their medical information. Which of these responses would be appropriate for the nurse to make?
a. “I’ll ask your physician if you can read the record.”
b. ”Are you concerned about the care you are receiving?”
c. ”I’ll stay here with you while you read it in case you have any questions.”
d. ”Let me check with the charge nurse first.”
____ 4. The nurse assigned to care for a patient who has HIV accepts the patient assignment despite believing that the patient’s condition is a punishment from God. With which ethical principle is this nurse’s behavior associated?
a. Justice
b. Veracity
c. Beneficence
d. Nonmaleficence
____ 5. While planning patient care, the nurse considers what needs to be done to limit any liability. Which action should the nurse take to minimize liability when providing patient care?
a. Ensure patients’ rights.
b. Follow verbal orders.
c. Follow directions exactly as given.
d. Verify employer’s liability insurance.
____ 6. A patient is identified to participate in a new drug study, but does not understand the drug or the study. Which ethical principle should the nurse use to prevent the patient from participating in the study?
a. Veracity
b. Autonomy
c. Nonmaleficence
d. Standard of Best Interest
____ 7. The nurse educator is preparing a seminar that focuses on the impact of technology on patient care. Which effect of technology on ethical decision making should the educator include in this seminar?
a. Ethical situations remain similar to what they have always been in health care.
b. Nurses have fewer ethical decisions, because computers now make many decisions.
c. Ethical dilemmas have become more complex owing to technologies that prolong life.
d. Nurses can postpone ethical decisions, because technology allows patients to live longer.
____ 8. The nurse is concerned about a patient’s ability to make decisions about a proposed treatment plan. Which patient characteristic is causing the nurse to have this concern?
a. Lower socioeconomic status
b. Authoritarian family relationship
c. Past experience with hospitalization
d. Lack of information about treatment
____ 9. A patient has a living will and gives it to the nurse to follow. The patient says, “Do not tell my family about the living will.” Which action should the nurse take?
a. Send a copy of the living will to medical records.
b. Assure the patient that the nurse will not tell anyone.
c. Encourage the patient to discuss the living will with the family.
d. Return the living will to the patient until the family is informed.
____ 10. The nurse is caring for an 80-year-old patient. Which statement made by the nurse conveys dignity and respect to the patient?
a. “Honey, I have your medications.”
b. “I have your medications for you, dear.”
c. “I have your medications for you.”
d. “It’s time for us to take our medications.”
____ 11. The charge nurse is concerned that an HCP is breaching a patient’s confidentiality. What did the charge nurse observe to come to this conclusion?
a. A physician asking a nurse if a friend has cancer
b. Use of patient initials on nurse’s assignment worksheet
c. A nurse asking an unknown physician for identification
d. A nurse reviewing charts of assigned patients for orders
____ 12. The nurse is reviewing information on the state board of nursing website prior to renewing a state license. Which type of law is guiding this nurse’s actions?
a. Tort
b. Civil
c. Moral
d. Administrative
____ 13. While providing wound care, the nurse skips a step and does not cleanse the wound before applying a new sterile dressing. What action did this nurse make?
a. Crime
b. Summons
c. Malpractice
d. Respondeat superior
____ 14. The nurse is served with a summons relating to the care of a patient. Which action should the nurse take first?
a. Notify employer immediately.
b. Answer summons after 30 days.
c. Acknowledge liability promptly.
d. Seek legal counsel after 30 days.
____ 15. The nurse is concerned that a nursing assistant is violating a patient’s rights. What action did the nursing assistant make to cause the nurse to come to this conclusion?
a. Telling the patient to bathe right now
b. Identifying name and title to the patient
c. Knocking before entering the patient’s room
d. Asking the patient which beverage is preferred
____ 16. The nurse is deciding whether or not to obtain personal liability insurance, even though the organization has insurance for each employee. What must the nurse do to ensure the organization’s liability insurance provides adequate coverage against liability?
a. Follow institutional policies.
b. Have premiums payroll-deducted.
c. Understand the state’s tort laws.
d. Provide professional nursing care.
____ 17. The nurse is concerned about a patient filing a civil liability suit. What should the nurse expect to occur if a civil liability suit is planned?
a. Receive a summons
b. Receive a copy of the complaint
c. Respondeat superior determination
d. Receive a notice that a complaint was filed with a court
____ 18. A patient decides to not to have a hysterectomy, even though it is recommended by the physician. The nurse disagrees and says that it should be done, because the patient has already had children; the nurse leaves to get the consent form for the surgery. Which ethical principle is the nurse demonstrating with this patient?
a. Autonomy
b. Paternalism
c. Beneficence
d. Nonmaleficence
____ 19. During a patient care conference, the HCPs are reviewing potential outcomes based on individual interventions. Which bioethical theory is being demonstrated during this care conference?
a. Religion
b. Deontology
c. Theological
d. Utilitarianism
____ 20. The ethical decision-making process is being used for a patient regarding the use of life support measures. What action should the nurse take as the final step in this decision-making process?
a. Evaluate the outcomes.
b. Implement the decision.
c. Clarify the values of all the participants.
d. Determine which action has the strongest ethical support.
____ 21. The nurse educator is preparing an in-service program to review laws applicable for patient care. Which law should the educator include that was established to protect a patient’s medical and personal information?
a. Medicare
b. Patients’ Bill of Rights
c. Department of Health and Human Services regulations
d. Health Insurance Portability and Accountability Act (HIPAA)
____ 22. While standing in the lunchroom, the nurse recognizes friends of a patient who was recently transferred to critical care. The nurse approaches them and offers to take them to the patient’s care area. What action is this nurse demonstrating?
a. Defamation
b. Compassion
c. False Imprisonment
d. Disclosure of Confidential Information
____ 23. Before leaving a patient’s room, the nurse says that pain medication will be provided within 15 minutes. The nurse returns in 10 minutes with the pain medication. Which ethical principle did the nurse demonstrate?
a. Justice
b. Fidelity
c. Veracity
d. Beneficence
____ 24. The nurse manager actively listens to the nursing staff and encourages the staff to be accountable for all patient care. Which leadership style is this manager demonstrating?
a. Coaching
b. Utilitarian
c. Autonomy
d. Democratic
____ 25. The nursing staff is meeting to discuss a patient’s desire for all life support measures, even though the patient has end-stage renal disease. Once a list of all possible actions is generated, what should the staff do next?
a. List the stakeholders.
b. Determine the best action.
c. Gather important information.
d. Identify positive and negative consequences.
____ 26. A patient with malnutrition refuses to ingest animal protein products, because it is against religious teachings. What should the nurse do to support this patient’s beliefs while ensuring the patient’s health status?
a. Explain the animal protein is the best source of nutrition for the patient’s needs at this time.
b. Talk with a dietitian about sources of non-animal–based protein to include in the patient’s diet.
c. Suggest to the physician that the patient is going against medical advice and should be discharged.
d. Schedule the organization’s clergy to meet with the patient to discuss interpretation of religious teachings.
____ 27. The nurse is informed of several victims of gang violence being brought by ambulance to the emergency department. Which injury should the nurse prepare to report to the authorities?
a. Fractures
b. Abrasions
c. Lacerations
d. Gunshot wounds
____ 28. A health care administrator is reviewing material submitted to the legislature on tort reform. What should the administrator explain to nurse leaders about this legislation?
a. Limits organizational liability for damages
b. Requires continuing education for all caregivers
c. Expects all staff to have read organizational policies before completing procedures
d. Expects all staff to have malpractice or liability insurance
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 29. The nurse is performing a procedure while caring for a patient and unintentionally eliminates a step in the procedure. What may result from the nurse’s action? (Select all that apply.)
a. Negligence
b. Breach of duty
c. Unintentional tort
d. Assault and battery
e. Civil liability for employer
____ 30. The nurse is preparing to delegate a task to unlicensed assistive personnel (UAP). Which actions should the nurse take in compliance with The National Council of State Boards of Nursing’s (NCSBN) rights of delegation? (Select all that apply.)
a. Right day
b. Right place
c. Right person
d. Right supervision
e. Right circumstances
f. Right communication
____ 31. A nurse is working on a medical unit in a hospital undergoing a Joint Commission review. The investigator asks the nurse to explain “never events.” What examples should the nurse use to explain these kinds of events? (Select all that apply.)
a. Surgery on the wrong body part
b. Paralyzed leg after falling from a bed
c. Death from falling out of bed
d. Having to restart an intravenous (IV) infusion
e. Canceling surgery because blood work is not safe
____ 32. The LPN is working in a senior center and is approached by a participant who asks the nurse, “Can you help me understand my Medicare benefits?” What should the nurse include in a response to this patient? (Select all that apply.)
a. Medicare is a payment system for the working poor.
b. Medicare Part B covers outpatient services and has a monthly cost.
c. Medicare is a federally funded program for individuals 65 and over.
d. Prescription drug coverage for those with Medicare is available.
e. Medicare Part A covers inpatient hospital care and is free to those who qualify for Social Security.
____ 33. The nurse is planning to prepare medications for assigned patients. Which actions should the nurse take to ensure a safe environment while preparing the medications? (Select all that apply.)
a. Find a laboratory value for a physician as requested.
b. Place a “no interruption sign” on the door of the medication room.
c. Answer a patient’s call-light after checking the medication administration record.
d. Listen to information provided by the charge nurse about a newly admitted patient.
e. Ask coworkers to provide you with time to concentrate while preparing medication.

Chapter 3. Issues in Nursing Practice
Answer Section

MULTIPLE CHOICE

1. ANS: C
Morals are standards set by our own conscience, and they guide a person’s decision to work. A. Justice is the ethical principle of fairness and equality. B. D. Welfare and legal rights are guaranteed by laws.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

2. ANS: A
A. In health care, autonomy refers to individuals who are considered capable and competent making health care decisions for themselves. Veracity is the virtue of truthfulness that requires health care providers (HCPs) whenever possible to tell the truth and not intentionally deceive or mislead patients. B. Beneficence is considering and offering treatments that are likely to provide relief. Justice is the ethical principle of fairness and equality. C. Welfare rights are guaranteed by laws. Morals are standards set by our own conscience. D. Nonmaleficence is doing no harm. Legal rights are guaranteed by laws.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

3. ANS: C
The content of the medical record is considered the property of the patient. According to HIPAA, the patient has the right to read the medical information. The patient, however, might not understand everything that is written in the record. The best response would be for the nurse to stay with the patient while the record is being read in the event the patient does not understand the information in the record. A. The nurse does not need to ask the physician if the record can be read by the patient. B. Asking if the patient is concerned about care is a defensive response and does not address the patient’s request to read the medical record. D. The nurse does not need to ask the charge nurse if the patient can read the medical record.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

4. ANS: A
Justice is the ethical principle of fairness and equality. B. Veracity is the virtue of truthfulness. C. Beneficence is considering and offering treatments that are likely to provide relief. D. Nonmaleficence is doing no harm.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

5. ANS: A
A. To provide quality care and limit liability, the nurse should understand and provide care according to the patients’ rights. B. C. Directions that are controversial, given verbally, concern situations of high liability, or involve a discrepancy between the direction and standard policy should be questioned. D. Having insurance does not limit liability. Insurance provides liability coverage and may be offered by some employers but not all.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

6. ANS: C
C. The principle of nonmaleficence requires a nurse to protect from harm those who cannot protect themselves such as the mentally incompetent or the unconscious. A. Veracity is the virtue of truthfulness. B. Autonomy refers to individuals who are considered capable and competent making health care decisions for themselves. D. The best interest standard involves the determination of what action is best for the patient. This is usually for patients who are unconscious or medically incompetent and cannot make decisions for themselves. Family members together with HCPs usually make the best-interest determination.

PTS: 1 DIF: Difficult
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

7. ANS: C
C. Today’s sophisticated technology and complex treatments have resulted in more complex ethical issues that caregivers must consider in decision making. A. Ethical decisions have become more complex because of technology. Technology can prolong decisions regarding life-or-death actions. B. Computers have not affected the nurse’s decision making regarding ethical issues. D. Because of technology, life-or-death decisions are more complicated.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

8. ANS: D
D. Autonomy refers to individuals who are considered capable and competent making health care decisions for themselves, but to do so, individuals must first have the information to make the decision. A. B. C. These choices could influence the patient’s decisions but not as greatly as information about the treatment plan.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

9. ANS: C
C. The second step in the ethical decision-making model is to clarify the values of all the participants involved in a patient’s care. This would include the patient’s family, and it is best that the patient discusses the will with the family. A. B. D. The other options do not support this clarification or ensure that the patient’s wishes will be known or followed if the living will is not placed in the patient’s medical record.

PTS: 1 DIF: Difficult
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

10. ANS: C
C. This statement demonstrates respect by valuing the patient and his or her feelings as a unique individual. A. B. Terms of endearment do not convey respect, especially to older adults, and should not be used. D. Speaking in the third person plural is a form of talking down to the patient and does not demonstrate dignity or respect.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

11. ANS: A
A. Nurses are obligated to discuss the patient only under circumstances in which it is necessary to deliver high-quality health care according to Health Insurance Portability and Accountability Act (HIPAA). B, C, and D are not breaches of confidentiality.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

12. ANS: D
D. State nursing practice laws and the attendant nursing regulations establish the parameters within which nurses must practice and are referred to as administrative laws. A, B, and C are laws that are not associated with nursing licensure.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

13. ANS: C
C. Malpractice is a breach of duty that arises from the relationship between the patient and the health care worker. A. A crime is an action taken by an individual against society. B. A summons is a notice to defendants that they are being sued. D. Respondeat superior means that an employer may also become liable for the acts or omissions of its employees.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

14. ANS: A
A. Nurses served with a summons relating to work should notify their employers and ensure the summons is answered. B. D. If the employer does not answer the summons, the nurse must seek legal counsel to answer the summons within the specified time—20 to 30 days. C. If the nurse fails to answer the summons and complaint, a default judgment may be made, which is acknowledgment of liability.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

15. ANS: A
A. Not allowing patients to have a choice in their care would violate patients’ rights. B. C. D. Knocking before entering a patient’s room, introducing oneself, and allowing patient input are examples of ensuring patients’ rights.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

16. ANS: A
A. Employer’s liability insurance will provide liability coverage when the employee follows the employer’s work policies. B, C, and D do not determine liability coverage.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

17. ANS: D
D. A civil liability suit begins with the filing of a complaint with a court. A, B, and C are actions that may be taken after a suit is filed.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

18. ANS: B
B. Making a care decision for a patient without regard for the patient’s preferences is paternalism. A. Autonomy refers to individuals making health care decisions for themselves. C. Beneficence is considering and offering treatments that are likely to provide relief. D. Nonmaleficence is doing no harm.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

19. ANS: D
D. In utilitarian theory, actions are judged by their consequences, so outcomes are the most important elements to consider in ethical decision making. A. Religious teachings are key concepts for ethical decision making for some individuals. B. Deontology requires actions not to be judged only in terms of their consequences. C. Theological perspectives include the many religious traditions represented in our culture.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

20. ANS: A
A. Evaluation of outcomes is the final step in the ethical decision-making process. Evaluation helps us to learn from success or failure and gain knowledge for the next ethical dilemma. B, C, and D are steps that occur before the evaluation phase, within the ethical decision-making process.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

21. ANS: D
D. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) creates civil and criminal liability for health care workers who wrongfully disclose an individual’s health information. A. Medicare is a nationally sponsored health insurance coverage plan. B and C do not establish liability for disclosure of health information.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

22. ANS: D
D. The wrongful release of confidential information is an intentional tort. A. Defamation is the wrongful injury to another’s reputation. B. Compassion is a central virtue that allows the nurse to identify with another’s pain or suffering. D. False imprisonment is the unlawful restriction of a person’s freedom.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

23. ANS: B
B. Fidelity is the obligation to be faithful to commitments made to self and others. In health care, fidelity includes faithfulness or loyalty to agreements and responsibilities accepted as part of the practice of nursing. It also means not promising a patient something that one cannot deliver or cannot control. A. Justice is based on fairness and equality. C. Veracity is to tell the truth and not intentionally deceive or mislead patients. D. Beneficence means actions taken and treatments provided will benefit a person and promote welfare.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

24. ANS: A
A. Active listening and accountability are characteristics of the coaching leadership style. B. Utilitarian is a theory of ethical behavior. C. Autonomy is an ethical principle. D. In democratic leadership, participation is encouraged in determining goals and in planning for their achievement.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

25. ANS: D
D. After developing a list of all possible actions, identify the positive and negative consequences for each. A. Identifying the stakeholders occurs earlier in the process. B. Determining the best action occurs after each action is analyzed for positive and negative consequences. C. Gathering important information occurs earlier in the process.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

26. ANS: B
B. Religious teachings are key concepts of ethical decision making for some people, and many consider these teachings a divine source of values and morals. One of the difficulties with religious traditions is that it is not simply the official church teaching that is involved, but the individual member’s interpretation of that teaching. Assessment of the importance of this dimension of the patient’s life is important in an ethical analysis. Since the patient will not consume animal-based protein, the nurse should support the patient’s needs by discussing alternative sources of protein with the dietitian. A. There are other sources of protein besides animal-based products. C. The patient is not going against medical advice in this situation. D. This would be challenging the patient to defend personal interpretation of religious teachings.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

27. ANS: D
D. Maintaining confidentiality of personal health information is an expectation when providing patient care unless it compromises mandatory reporting such as the reporting of gunshot wounds. A. B. C. There are no regulations about the mandatory reporting of fractures, abrasions, and lacerations.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

28. ANS: A
A. Tort reform legislation is directed at limiting liability for health care professionals and institutions. B. C. D. Having liability insurance, reading policies, and continuing education can help reduce a nurse’s liability, but are not part of legislative reform.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

MULTIPLE RESPONSE

29. ANS: A, B, C, E
A. B. C. E. An unintentional tort is known as negligence. Negligence occurs when injury results from the failure of the wrongdoer to exercise care. This failure to follow due care in the protection of the person injured is a breach of duty. The institution that employs the worker may become liable for the acts or omissions of its employees. D. Assault and battery involve threatened or real touching or bodily harm. This did not occur in this situation.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

30. ANS: B, C, D, E, F
B. C. D. E. F. The NCSBN identifies the five rights of delegation as the right task, person, circumstances, supervision, and communication. A. The right day is not an identified right to follow when delegating.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

31. ANS: A, B, C
A. B. C. The Joint Commission considers “never events” to be sentinel events. Examples of these events include surgery on the wrong body part, loss of body function from a fall, or a death after a fall. D. E. Having to restart an IV infusion and canceling surgery are not considered sentinel events.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

32. ANS: B, C, D, E
B. C. D. E. Medicare is run by the U.S. government and currently covers all individuals age 65 and over. Several Medicare plan options are offered: Original Medicare, Medicare Health Plans, Medigap policies, and prescription drug coverage for everyone with Medicare. There are two parts of coverage in the original Medicare plan. Part A covers inpatient hospital care, skilled nursing facilities, hospice services, and some home care. There is no premium or deductible for Part A. Part B is medical insurance that covers physician costs, outpatient services, some home care, supplies, and other things not covered by Part A. Some preventive services may also be covered. A monthly premium and yearly deductible are paid in exchange for Part B coverage. Medicare Part D is prescription drug coverage. A. Medicare is not a payment system for the working poor. This best describes Medicaid.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

33. ANS: B, E
B. E. Efforts to reduce medication errors include identifying “no interruption” zones and asking coworkers for time to concentrate while preparing medications. A. C. D. Finding laboratory values, answering a call-light, and listening to the charge nurse provide information are all distractions that could lead to medication errors.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application