Nuft 202 Final exam

Question 1

Accountability is

Answer 1

refers to the ability to answer for ones actions
Health care institutions also exercise this by monitoring individual and institutional compliance with national standards established by agencies such as The Joint Commission TJC.

Question 2

Advocacy

Answer 2

the support of a particular cause.

Nurses do this to ensure the health, safety, and rights of a patient are being met.

Question 3

Autonomy

Answer 3

freedom from external control or influence; independence

Question 4

Beneficence

Answer 4

refers to taking positive actions to help others.

The agreement to act with beneficence implies that the best interests of the patient remain more important than self interest

doing good to others including moral obligation.

Question 5

Casuistry

Answer 5

case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an “intimate understanding of particular situations”

For instance, the casuist might conclude that a person is wrong to lie in legal testimony under oath, but might argue that lying actually is the best moral choice if the lie saves a life

Question 6

Code of Ethics

Answer 6

a set of guiding principles that all members of a profession accept.

a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.

Question 7

confidentiality

Answer 7

the act of holding information in confidence, not to be released to unauthorized individuals.

Protection and safety of patient information

Question 8

Consequentialism

Answer 8

an ethical system that determines the level of goodness or evil from the effect or result of an act

Main emphasis is on the outcome or consequence of action

Question 9

Deontology

Answer 9

defines actions as right or wrong on the basis of their “right-making characteristics” such as fidelity to promises, truthfulness and justice.

The deontological explains that an act that is not good morally can still lead to something good.

Question 10

Ethics

Answer 10

the study of conduct and character

Question 11

Ethics of Care

Answer 11

Strives to address issues beyond individual relationships by raising ethical concerns about the structures within which individual caring occurs (structures such as hospitals or universities)

Question 12

Fidelity

Answer 12

refers to the agreement to keep promises by following through on your action and interventions

Question 13

Justice

Answer 13

refers to fairness

the term is most often used in discussion about access to health care resources, including the just distribution of scarce resources

Question 14

Nonmaleficence

Answer 14

the avoidance of harm or hurt

Examples of nonmaleficence in nursing include holding a medication due to adverse reactions or taking steps to ensure a safe work environment.

Question 15

Responsibility

Answer 15

a willingness to respect one’s professional obligations and to follow through

Ex. It is the nurses responsibility to report Missing narcotics.

Question 16

Teleology

Answer 16

Looking at the end result to do good. Thinking about what will happen if we don’t restrain this patient.

from the Greek word telos, meaning “end,” or the study of ends or final causes.

In healthcare, teleological care is a philosophy of care built around the root idea of an end.

their violent behavior, applying a restraint can be an ethical teleological action.

Question 17

Utilitarianism

Answer 17

idea that the goal of society should be to bring about the greatest happiness for the greatest number of people

measures the effect that an act will have

The utilitarian says that an act is right (moral) if it is useful in “bringing about a desirable or good end.

In this example let us imagine that: A hospital with limited capacity to deal with Covid-19 patients has to decide between admitting a 20 year old patient, who is fit and well, and a 75 year old patient, who has a history of heart disease, to their last available ventilator.

Question 18

Values

Answer 18

a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior

Question 19

The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn’t have health insurance or enough cash. Even though several ethical principles are at work in this case, list the principles from highest to lowest priority.
1. Accountability: You as the nurse are accountable for the well- being of this patient.
2. Respect for autonomy: This patient’s autonomy will be vio- lated if he does not receive the liver transplant.
3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant.
4. Justice: The greatest question in this situation is how to deter- mine the just distribution of resources.

Answer 19

4,2,3,1

Question 20

Fill in the Blank. The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the prin- ciple of ________?

Answer 20

Nonmaleficence

Question 21

A child’s immunization may cause discomfort during administra- tion, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation?
1. Fidelity
2. Beneficence
3. Nonmaleficence
4. Respect for autonomy

Answer 21

2

Question 22

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 iden- tify 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?
1. Fidelity
2. Beneficence
3. Nonmaleficence
4. Respect for autonomy

Answer 22

1. Fidelity

Question 23

A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy?
1. Seeking out the nursing supervisor to talk with the patient
2. Documenting patient fears in the medical record in a timely
manner
3. Working to change the hospital environment
4. Assessing the patient’s point of view and preparing to articu-
late it

Answer 23

Answer: 4

Question 24

The application of utilitarianism does not always resolve an ethical
dilemma. Which of the following statements best explains why?
1. Utilitarianism refers to usefulness and therefore eliminates the
need to talk about spiritual values.
2. In a diverse community it can be difficult to find agreement
on a definition of usefulness, the focus of utilitarianism.
3. Even when agreement about a definition of usefulness exists in
a community, laws prohibit an application of utilitarianism.
4. Difficult ethical decisions cannot be resolved by talking about
the usefulness of a procedure.

Answer 24

Answer 2

Question 25

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? (Select all that apply.) 1. Ethics of care pays attention to the environment in which caring occurs. 2. Ethics of care pays attention to the stories of the people involved in the ethical issue. 3. Ethics of care is used only in nursing practice. 4. Ethics of care focuses only on the code of ethics for nurses 5. Ethics of care focuses only on understanding relationships.

Answer 25

Answer: 1,2,5

Question 26

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? 1. Nurses understand the principle of autonomy to guide respect for a patient's self-worth. 2. Nurses have a scope of practice that encourages their presence during ethical discussions. 3. Nurses develop a relationship with the patient that is unique among all professional health care providers. 4. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

Answer 26

Answer: 3

Question 27

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.

Answer 27

Answer: 4,5,2,1,6,3

Question 28

The ANA code of nursing ethics articulates that the nurse "pro- motes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principle, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you obscured or deleted all patient identifiers? 1. Yes, because patient privacy would not be violated since patient identifiers were removed 2. Yes, because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3. 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 4. No, because the principle of justice requires you to allocate resources fairly

Answer 28

Answer: 3

Question 29

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

Answer 29

Answer: 2,4,1,3,5,7,6,

Question 30

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? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations. 2. To study the literature on current research about the possible clinical interventions available for the patient in question. 3. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion. 4. To allow the patient and the physician to resolve the dilemma on the basis of ethical principles without regard to personally held values or opinions.

Answer 30

Answer: 1

Question 31

It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (Select all that apply.) 1. Average income varies in different regions of the country. 2. Community values influence definitions of quality, and they are subject to change over time. 3. Individual experiences influence perceptions of quality in dif- ferent ways, making consensus difficult. 4. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 5. Statistical analysis is difficult to apply when the outcome cannot be quantified. 6. Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.

Answer 31

Answer: 2,3,4,5

Question 32

Which of the following properly applies an ethical principle to justify access to health care? (Select all that apply.) 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability. 6. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

Answer 32

ANS: 1,2,4

Question 33

Match the examples with the professional nursing code of ethics: 1. You see an open medical record on the computer and close it so no one else can read the record without proper access. 2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication. a. Advocacy b. Responsibility c. Accountability d. Confidentiality

Answer 33

ANS: 1d, 2c, 3a, 4b

Question 34

What are the steps in the process of ethical decision-making?

Answer 34

Step one: ask, is this an ethical problem? Step two gather information that is relevant to the case Step three identify the ethical elements in the problem and examine your values Step four the problem Identify possible courses of action

Question 35

DAR notes

Answer 35

Incorporates, data, action and response The DAR notes address patient concerns, such as a sign or symptom, condition, nursing diagnosis, behavior, significant event, or change in condition

Question 36

PIE note

Answer 36

A pie note has a specific nursing focus. P: problem or dx I: interventions that will be used to address the problem E: evaluation -evaluate if patient is able to teach back and verbalize the given knowledge

Question 37

Soap notes

Answer 37

Identifies interprofessional problems

Question 38

Narrative documentation

Answer 38

Is the format traditionally used by nurses and healthcare providers to record patient assessment, clinical decisions, and care provided; it consist of a story like format to document information.

Question 39

ACA

Answer 39

The Patient Protection and Affordable Care Act (PPACA) was passed in 2010 Its name was later changed to the Affordable Care Act (ACA) ACA intended to reduce overall medical costs by (1) providing tax credits, (2) increasing insurance company accountability for premiums and rate increases, and (3) increasing the number of choices available to patients to select insurers that best meet their needs. In addition, the ACA increased access to health care. Patients now receive recommended preventive services such as screenings for cancer, blood pressure, and diabetes without having to pay copays or deductibles.

Question 40

The ACA is characterized by four themes embedded in nursing practice what are they?

Answer 40

(1) consumer rights and protections, (2) affordable health care coverage, (3) increased access to care, and (4) quality of care that meets the needs of patients.

Question 41

Criminal laws protect who or what?

Answer 41

society and provide punishment for crimes, which are defined by municipal, state, and federal legislation

Question 42

Administrative law, or regulatory law is

Answer 42

Defines expectations of civil and criminal laws. For example, a nurse practice act, as a civil statutory law, states that you have a duty to care for your patients.

Question 43

Nurse practice acts are

Answer 43

civil state laws that define nursing and the standards nurses must meet within individual states. Your state's nurse practice act defines a nurse's scope of practice, the educational requirements you must have to be a nurse, and how to obtain licensure as a nurse in your state (Oyeleye, 2019; Pozgar, 2020). Nurse practice acts also distinguish nursing from other health professions

Question 44

Constitutional law is derived from

Answer 44

federal and state constitutions. For example, in the United States a constitutional right afforded to every citizen is the right to refuse treatment (Furrow et al., 2018). As a nurse, you must understand the rights of your patients to refuse treatment even when you may not agree with their decisions.

Question 45

Statutory law is derived from

Answer 45

statutes passed by the U.S. Congress and state legislatures. These laws are either civil or criminal.

Question 46

Civil laws protect

Answer 46

the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur

Question 47

Common law originates from

Answer 47

decisions that were made in the absence of law. For example, the right to privacy is implied in the U.S. Constitution.

Question 48

Case law describes

Answer 48

decisions made in legal cases that were resolved in courts. After a case is presented to a judge or jury, there is a report of the issue, facts, findings, and subsequent decision that was made to resolve the issue.

Question 49

DVT

Answer 49

Deep vein, thrombosis, a blood clot in a deep vein, usually in the legs 

Question 50

 warfarin

Answer 50

An anticoagulant medication used to prevent and treat blood clots

Question 51

Heparin

Answer 51

An anticoagulant medication used to prevent blood clots

Question 52

PIE NOTE

Answer 52

A nursing note, format, focusing on problem, and intervention, and evaluation

Question 53

Charting by exception

Answer 53

 a documentation system, where only significant findings or exceptions to normal are documented 

Question 54

SBAR/ISBAR

Answer 54

A framework for narrative, notes and verbal reporting, when exceptions occur, including situation, background, assessment, and recommendation

Question 55

Electronic health record (EHR)

Answer 55

A digital version of the patient’s paper chart containing all medical history, diagnosis, medication, treatment, plans, immunization dates, allergies, radiology, images, and laboratory test results

Question 56

Incident report

Answer 56

A report completed whenever an incident occurs, used to identify system and individual human issues needing improvement

Question 57

Acuity rating system

Answer 57

A system used to determine the hours of Care and number staff required for a group of patients based on their individual acuity levels

Question 58

Clinical decisions, support system (CD SS)

Answer 58

A computer program that aids and supports clinical decision-making by providing tailored recommendations, based on patient data and care guidelines

Question 59

Nursing informatics

Answer 59

 the specialty that integrates nursing science, computer, science, and information, science to manage and communicate data, information, knowledge, and wisdom in nursing and informatics practice.

Question 60

Misdemeanor

Answer 60

A crime that causes injury, but does not inflict serious harm. Under criminal law Example: parking in a non-parking zone is a violation of traffic laws usually has a penalty of a monetary fine, for feature, or brief imprisonment. 

Question 61

Felony

Answer 61

Under criminal law A serious offense, that results in significant harm to another person or society in general Carries penalties of monetary restitution, imprisonment for greater than one year, or death Example: misuse of controlled substance, or practicing without a license

Question 62

Standards of care

Answer 62

Legal guidelines for defining nursing practice, and identifying the minimum acceptable nursing care comes from ANA  Set by state and federal laws that govern where nurses work 

Question 63

Americans with disability act, ( ADA)

Answer 63

A federal statutory issue in nursing practice that protects rights of people with physical or mental disabilities Prohibits, discrimination and insurance equal opportunity for people with disabilities and employment, state and local government services, public accommodations, commercial facilities, and transportation 

Question 64

Emergency medical treatment and active labor act (EMTALA)

Answer 64

The federal statutory issue in nursing practice that states when a patient presents to an ED, they must be treated, regardless of them having insurance or not

Question 65

Mental health parody act (MH PA)

Answer 65

 Strengthen mental health services, requires health insurance, companies to provide equal, covered for mental health and substance-abuse treatment

Question 66

Advanced directives

Answer 66

Living will (written document that direct treatment in accordance with a patient wishes in the event of terminal illness or vegetative state) Example, healthcare, proxies, or adorable, power of attorney for healthcare

Question 67

Durable, power of attorney

Answer 67

In advanced directive, illegal document that designates a person, or people of one’s choosing to make healthcare decisions, when a patient is no longer able to make decisions on his or her own behalf

Question 68

Uniform anatomical, gift act

Answer 68

Federal statutory issue in nursing practice allows an individual at least 18 years of age the right to make an organ donation donors need to make the gift in writing with their signature

Question 69

 health information, technology act (HITECH)

Answer 69

A federal statutory issue in nursing practice that expand principles extended under HIPAA, especially when the security breach of PHI occurs nurses must ensure that patient PHI is not in advertently conveyed on social media, and that protected data are not disclosed other than as permitted by the patient

Question 70

Restraints

Answer 70

Reduces the use of all types of restraint in healthcare settings Can be used only:  One) only to ensure the physical safety of the patient or other patients Two) when less restrictive interventions are not successful Three) only on the written order of the healthcare professional typically two hours or less

Question 71

What are some state statutory issues in nursing practice?

Answer 71

Licensure good Samaritan laws, public health laws, the uniform determination of death act autopsy death with dignity or physician assisted suicide

Question 72

Good Samaritan laws

Answer 72

A state statutory issue in nursing practice enacted in some states to protect healthcare professionals from liability and rendering emergency aid, unless there is proven, willful wrong or gross negligence Offers legal immunity if a nurse helps at the scene of an accident

Question 73

Public healthcare

Answer 73

Estate statutory issue in nursing practice that protects the population, advocates for the rights of people, regulate self-care and healthcare financing, and insure, professional accountability for care provided nurses are mandatory reporters of suspected abuse or neglect a patient

Question 74

Autopsy

Answer 74

Is the statutory issue a nursing practice postmortem exam, sometimes requested by the patient or patient’s family when a patient’s death is not subject to medical examiner review, consent must be obtained

Question 75

Death with dignity or physician assisted suicide

Answer 75

A State statutory issue in nursing practice free statute : Oregon, death with dignity act (1994) Incompetent individual with a terminal disease, can make an oral and written request for meds to end his or her life in a humane and dignified manner, ANA believes that nurses participation violates the code of ethics for nurses

Question 76

Civil and common law issues in nursing practice include:

Answer 76

Torts (intentional, quasi-intentional, unintentional)

Question 77

Torts

Answer 77

Civil and common law issues in nursing practice that includes that civil, wrongful act or omissions, made against a person or property can be determined to be: Intentional Quasi – intentional Unintentional

Question 78

Quasi – intentional tort

Answer 78

Type of tort Lack of intent, but volitional, action and direct causation occur Example invasion of privacy and defamation of character

Question 79

Defamation of character

Answer 79

Type of quasi – intentional tort The publication of fall statements that result in damage to a persons reputation Examples: slander, libel

Question 80

Slander

Answer 80

Type of defamation of character occurs when one speaks falsely about another

Question 81

Libel

Answer 81

Type of defamation of character, the written defamation of character

Question 82

Unintentional tort

Answer 82

Type of tort Ex negligence malpractice

Question 83

L.E.A.R.N stands for

Answer 83

Mnemonic for cross cultural communication means: L: listen (listen to the patient’s perception of the problem) Explain: Convey your own perceptions of the health condition, keeping in mind that patients may understand health or illness differently, based on culture or ethnic background Acknowledge: Be respectful when discussing the differences between their views and your own. Point out areas of agreement as well as difference, Recommend: Develop and propose a treatment plan to the patient and their family. Negotiate: Reach an agreement on the treatment plan in partnership with the patient and family, incorporating culturally relevant approaches that fit with the patient’s perceptions of health and healing.

Question 84

Campinha- Bacotes model

Answer 84

a widely used cultural competency model that uses the acronym ASKED to assist professionals and caretakers with making sure they can provide adequate service. Cultural awareness Cultural skills Cultural knowledge Cultural encounters Cultural desire

Question 85

Kleinman’s Explanatory model

Answer 85

The explanatory model includes the client's beliefs about their illness, the personal and social meaning they attach to their disorder, expectations about what will happen to them and what the provider will do, and their own therapeutic goals. 1.What do you call your problem? What name does it have? 2.What do you think caused your problem? 3. Why do you think it started when it did? 4. What does your sickness do to you? How does it work? 5. How severe is it? Will it have a short or long course? 6. What do you fear most about your disorder? 7. What are the chief problems that your sickness has caused for you? 8. What kind of treatment do you think you should receive? What are the most important results you hope to receive from treatment?

Question 86

What for criteria are necessary to establish nursing malpractice?

Answer 86

1) the nurse owed a duty of care to the patient 2) the nurse did not carry out or breached the duty 3) the patient was injured 4) the nurses failure to carry out the duty caused the injury If an injury did not occur, and the nurse carried out the duty, no malpractice occurred.

Question 87

Feminist Ethics

Answer 87

Looks at relationships, especially relationships in which power is unequal, or in which a point of view has become ignored or invisible Noting the limitations of deontology and utilitarianism, scholars who focused on differences between men and women, especially women's points of view, developed a critique of conventional ethical philosophies. Called feminist ethics, this view holds that the natural caring for others is the basis for moral behavior; it places an emphasis on caring relationships and a strong sense of responsibility

Question 88

Ethics of care

Answer 88

Ethics of Care emphasizes the role of feelings The ethics of care offers an alternative view to utilitarianism and deontology. Similar to feminist ethics, care-based ethics focuses on understanding relationships, personal narratives, and the context in which ethical problems arise. Unlike feminist ethics, ethics of care emphasizes the role of the decision maker in the situation.

Question 89

Quality of life remains?

Answer 89

Deeply individual (not social) and difficult to predict. Quality of life is not just a measurable entity, but he shared responsibility. Quality of life measures may take into account the age of the patient, the patient’s ability to live independently, his or her ability to contribute to society in a gainful way, and other nuanced measures of quality. 

Question 90

What are the steps to resolve an ethical dilemma?

Answer 90

1) Ask the question: is this an ethical problem? 2) Gather as much information as possible that is relevant to the case. 3) Examine and determine your values about the issue. 4) Verbalize and name the problem. 5) Consider possible courses of action. 6) Negotiate the outcome by creating an implementing a plan of action. 7) Evaluate the action.

Question 91

Discharge plan includes:

Answer 91

Actual time of discharge, mode of transportation, and who accompanied the patient for discharge summary information

Question 92

Information, in-home care medical record includes:

Answer 92

Patient assessment, referral and intake forms, interprofessional plan of care, a list of medications and reports to third-party payers