Professional Caring & Ethical Practice

Question 1

A severly septic 13-year-old girl is scheduled for an elective late term abortion this morning. A nurse with strong antiabortion beliefs is the individual on the unit most qualified to care for this child. The nurse expresses reluctance to accept this assignment. This is an example 
A. collaboration
B. response to diversity
C. moral distress
D. moral agency

Answer 1

C. moral distress

Question 2

A 10-year-old child with a terminal diagnosis tells her ICU nurse she only wants palliative care. Her mother supports this decision but her father is vehemently opposed. The most appropriate nursing response to this dilemma is to
A. explain that a mother’s wishes have legal precedence
B. ask the father to speak privately with the mother
C. contact the patient advocate to facilitate conflict resolution
D. tell the father a loving parent would honor a child’s wishes

Answer 2

C. contact the patient advocate to facilitate conflict resolution

Question 3

The attending physicial and family members have agreed to extubate an unconscious, terminally ill child and initiate comfort care measure that will include large doses of narcotics. The patient's nurse has never done this before and feels uncomfortable about the fine line between comfort care and euthanasia. Who is the best resource to provide more information to this nurse?
A. A pain service provider
B. The hospital attorney
C. A pastoral care representative
D. The hosptial's ethics team

Answer 3

D. The hosptial’s ethics team

Question 4

The parent of a 4-year-old child wishes to remain in the room during a central line insertion procedure. What is the appropriate response?
A. Explain the procedure, mask the parent, and identify an appropraite location.
B. Describe how painful and unpleasant the procedure is to observe.
C. Inform the parent that most physicians do permit visitors during procedures.
D. State that it is not in the child’s best interest to have visitors during procedures.

Answer 4

A. Explain the procedure, mask the parent, and identify an appropraite location.

Question 5

A child with a lengthy postoperative stay requests that the family dog be allowed to visit. The most appropriate nursing response is
A. “I’ll call the pet therapsit and arrange for a therapy dog to visit.”
B. “Research shows that animals spread diseases in hospitals.”
C. “I will contact the social worker to make arrangements with your family so your dog can visit.”
D. “Your physician is opposed to animals anywhere around open wounds.”

Answer 5

C. “I will contact the social worker to make arrangements with your family so your dog can visit.”

Question 6

A child with vertebral fractures was admitted to the PICU following a fall. The patient’s preadmission medication regimen includes several daily doses of hydrocodone for osteosarcoma pain. The child is now receiving morphine sulfate, 1-2 mg IV every 3 hours, but still describes the pain as 8/10. How can the nurse best address the patient’s pain?
A. Contact the physician and request an order to increase morphine frequency.
B. Ask family members to bring in home medications
C. Suggest an anesthesia consultation for epidural placement.
D. Consult a pharmacist to identify ways to meet both chronic and acute pain needs.

Answer 6

D. Consult a pharmacist to identify ways to meet both chronic and acute pain needs.

Question 7

The parents of a chronically ill child in cardiac arrest wish to remain in the room while medical personnel work to resuscitate their child. The most appropriate nursing response is to
A. advise the parents that witnessing resuscitation is too traumatic to permit observation
B. identify a staff member to answer questions and show the parents where to stand in the room.
C. ask the attending physician for permission for the parents to remain in the room
D. inform the parents that visitor presence during resuscitation is against hospital policy

Answer 7

B. identify a staff member to answer questions and show the parents where to stand in the room.

Question 8

The nurses in a PICU have examined the evidence and would like to introduce a new hemodynamic monitoring device. Crucial representatives on the product implementation team are
A. key physicians, respiratory therapists, and purchasing
B. purchasing, staff nurses, and hospital administration
C. staff nurses, key physicians, and clinical engineers
D. key physician,s clinical engineers, and purchasing personnel.

Answer 8

C. staff nurses, key physicians, and clinical engineers

Question 9

An orientee has made a significant error. In the break room, staff members are gossiping about the event. Upon overhearing the conversation the preceptor should respond
A. “let me tell you what she was about to do before I jumped in and put a stop to it.”
B. “this isn’t the first mistake. I’m going to ask our manager to fire her.”
C. “she just doesn’t seem to get it. I’m fed up and I let her know it.”
D. “I have reviewed the event with my orientee and I’d like it if you didn’t discuss it further.”

Answer 9

D. “I have reviewed the event with my orientee and I’d like it if you didn’t discuss it further.”

Question 10

A nurse in a surgical PICU proposes implementing an 11 AM to 11 PM shift to address staffing needs related to afternoon postoperative admissions. Key stakeholders who need to be involved in this discussion are the
A. surgeons, unit manager, and operating room schedulers
B. union representative, unit practice council, and surgeons
C. all of the staff nurses, charge nurses, and the staffing office
D. unit practice council, unit manager, and charge nurses

Answer 10

D. unit practice council, unit manager, and charge nurses

Question 11

A terminally ill oncology patient in the PICU is experiencing progressive respiratory distress. All treatment options have been exhausted. The child’s parents express their desire to meet with health care personnel to discuss natural death. Key team members to involve in a family meeting include
A. the PICU charge nurse, oncologist, and discharge planner
B. the nurse, an ethics team member, and the resident phyisican,
C. the oncologist, PICU intensivist, social worker, and nurse
D. the PICU manager, the bedside nurse, and PICU intensivist

Answer 11

C. the oncologist, PICU intensivist, social worker, and nurse

Question 12

An adverse event occurred during the use of a piece of patient care equipment. The child’s condition has now stabilized and prognosis appear to be unaffected. The most appropriate action at this time is to
A. ask the risk management team to talk to the patient and family about the event.
B. investigate all of the factors that contributed to the event to identify the root cause.
C. initiate disciplinary action against the employee who used the device.
D. immediately remove the product from service to prevent further injuries.

Answer 12

B. investigate all of the factors that contributed to the event to identify the root cause.

Question 13

To reduce costs, hospital administrators have insisted that all PICU patients transferring to an acute care floor leave the unit by noon. To meet this goal, a systems thinking strategy would be to
A. require that transfer orders be written the night before transfer.
B. provide financial incentives to physicians who meet a timely discharge quota.
C. hire a consultant to identify alternative areas where cutbacks could be made.
D. meet with acute care staff nurses and explore barriers to timely discharge for both units.

Answer 13

D. meet with acute care staff nurses and explore barriers to timely discharge for both units.

Question 14

A critically ill child’s parents are members of a religious sect that strongly believes in burning incense and candles at the bedside. The child is on a high flow oxygen mask. A respectful way to respond to this cultural practice is to
A. consult with the spiritual leader to identify a safe and respectful compromise
B. explain the lighting a candle could result in flash burns on the child
C. ask the fire marshal to explain to family members why an open flame is not permitted.
D. state that it is against hospital policy to have open flames in a patient room

Answer 14

A. consult with the spiritual leader to identify a safe and respectful compromise

Question 15

Health care workers have inadvertently violated a child’s cultural modesty norms. The child and family members are very agitated and are disrupting care in the unit. An appropriate response by the health care team would be to
A. call security for a show of force and visitor removal
B. involve the patient advocate to diffuse the situation
C. restrict the number of people who may visit the patient
D. explain that modesty violations are unavoidable in an ICU

Answer 15

B. involve the patient advocate to diffuse the situation

Question 16

In a PICU that serves a large Asian population many parents have requested acupuncture therapy for a child’s pain management. Several nurses would like to develop a policy to implement the practice on their unit. What is the appropriate first step?
A. Contact other hospitals in the community and ask about their policies.
B. Arrange for an acupuncturist to present several inservice sessions.
C. Explore the evidence regarding acupuncture efficacy for pain relief.
D. Identify key stakeholders to be involved in policy development.

Answer 16

C. Explore the evidence regarding acupuncture efficacy for pain relief.

Question 17

Three PICU nurses have reutnred from a national conference very excited about a new product. The first step in validating the information garnered from the sales representative is to
A. review the scientific literature
B. arrange for a product demonstration
C. visit a facility where the product is in use.
D. develop a clinical research protocol

Answer 17

A. review the scientific literature

Question 18

A 2-year-old child was admitted to the PICU 3 days ago following an anaphylactic reaction to peanut butter. In preparation for discharge, the nurse reviews information with family members regarding epinephrine autoinjector use. Which of the following statements by the child's caregiver indicates appropriate parental understanding of drug indications. "If he has another reaction, I will use the autoinjector
A. only if he can't breathe."
B. and immediately call 911."
C. if Benadryl doesn't work."
D. and see if he gets better."

Answer 18

B. and immediately call 911.”

Question 19

A 5-year-old patient newly diagnosed with type 1 diabetes is admitted in diabetic ketoacidosis. This child will require home insulin injections and capillary blood glucose testing for glycemic control. The child’s mother states “there is no way I can stick my son; I faint every time I see a needle.” The appropraite nursing response to this parent’s concerns is,
A. “Everybody feels this way. You’ll get used to it over time.”
B. “If you don’t learn to do this, your son will die.”
C. “The needles are really small and don’t hurt that much.”
D. “I will ask the diabetes nurse educator to come talk with you.”

Answer 19

D. “I will ask the diabetes nurse educator to come talk with you.”

Question 20

A 23-year-old newly graduated nurse has been hired to work in a PICU. Which of the following preceptors would most likely be the best fit?
A. A 26-year-old nurse with excellent technical ability and inconsistent communication skills
B. A 28-year-old nurse with 3 years of crical care experience, known for an ability to explain complex concepts
C. A nurse with 30 years of experience and an inflexible teaching and practice style.
D. A nurse with 12 years of experience and excellent skills whose English is often difficult to understand.

Answer 20

B. A 28-year-old nurse with 3 years of crical care experience, known for an ability to explain complex concepts

Question 21

A 5-year-old child will be discharged with a new colostomy. The child's parents are overwhelmed by the notion of colostomy care. Which member of the health care team should the nurse contact to address their concerns. 
A. Pastoral care provider
B. Social worker
C. Enterostomal therapist
D. Attending surgeoun

Answer 21

C. Enterostomal therapist