UNIT E

Question 1

Which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups?

a. Interdependence
b. Present orientation
c. Flexible perception of time
d. Direct confrontation to solve problems

Answer 1

ANS: D
Directly confronting problems is a highly valued approach in the American culture but not part of many other cultures in which harmony and restraint are valued. American nurses sometimes mistakenly think that all patients should take direct action. Patients with other values will be unable to meet this culturally inappropriate outcome. Present orientation, interdependence, and a flexible perception of time are not valued in Western culture. These views are more predominant in other cultures. See relationship to audience response question.

Question 2

A psychiatric nurse leads a medication education group for Hispanic patients. This nurse holds a Western worldview and uses pamphlets as teaching tools. Groups are short and concise. After the group, the patients are most likely to believe

a. the nurse was uncaring.
b. the session was effective.
c. the teaching was efficient.
d. they were treated respectfully.

Answer 2

ANS: A
Hispanic individuals usually value relationship behaviors. Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task.

Question 3

To provide culturally competent care, the nurse should

a. accurately interpret the thinking of individual patients.
b. predict how a patient may perceive treatment interventions.
c. formulate interventions to reduce the patient’s ethnocentrism.
d. identify strategies that fit within the cultural context of the patient.

Answer 3

ANS: D
The correct answer is the most global response. Cultural competence requires ongoing effort. Culture is dynamic, diversified, and changing. The nurse must be prepared to gain cultural knowledge and determine nursing care measures that patients find acceptable and helpful. Interpreting the thinking of individual patients does not ensure culturally competent care. Reducing a patient’s ethnocentrism may not be a desired outcome.

Question 4

A black patient, originally from Haiti, has a diagnosis of major depressive disorder. A colleague tells the nurse, “This patient often looks down and is reluctant to share feelings. However, I’ve observed the patient spontaneously interacting with other black patients.” Select the nurse’s best response.

a. “Black patients depend on the church for support. Have you consulted the patient’s pastor?”
b. “Encourage the patient to talk in a group setting. It will be less intimidating than one-to-one interaction.”
c. “Don’t take it personally. Black patients often have a resentful attitude that takes a long time to overcome.”
d. “The patient may have difficulty communicating in English. Have you considered using a cultural broker?”

Answer 4

ANS: D
Society expects a culturally diverse patient to accommodate and use English. Feelings are
abstract, which requires a greater command of the language. This may be especially difficult during episodes of high stress or mental illness. Cultural brokers can be helpful with language and helping the nurse to understand the Haitian worldview and cultural nuances.

Question 5

A Haitian patient diagnosed with major depressive disorder tells the nurse, “There’s nothing you can do. This is a punishment. The only thing I can do is see a healer.” The culturally aware nurse assesses that the patient

a. has delusions of persecution.
b. has likely been misdiagnosed with depression.
c. may believe the distress is the result of a curse or spell.
d. feels hopeless and helpless related to an unidentified cause.

Answer 5

ANS: C
Individuals of African American or Caribbean cultures who have a fatalistic attitude about illness may believe they are being punished for wrongdoing or are victims of witchcraft or voodoo. They may be reticent to share information about curses with therapists. No data are present in the scenario to support delusions. Misdiagnosis more often labels a patient with depression as having schizophrenia.

Question 6

A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient, who was recently discharged from U.S. Marine Corps, arrives at 0945. Which analysis best explains this behavior?
a. The patient wants to lead the group and give directions to others.
b. The patient wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The patient does not want to be late.
d. The behavior indicates feelings of self-importance that the patient wants others to
appreciate.

Answer 6

ANS: C
Culture is more than ethnicity and social norms; it includes religious, geographic, socioeconomic, occupational, ability- or disability-related, and sexual orientation-related beliefs and behaviors. In this instance, the patient’s military experience represents an aspect of the patient’s behavior. The military culture values timeliness. The distracters represent misinterpretation of the patient’s behavior and have no bearing on the situation.

Question 7

A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives
at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at
all. What understanding will improve the nurse’s planning? These patients are
a. members of cultural groups that have a different view of time.
b. immature and irresponsible in health care matters.
c. acting-out feelings of anger toward the system.
d. displaying passive-aggressive tendencies.

Answer 7

ANS: A
Hispanic Americans and Native Americans traditionally treat time in a way unlike the Western culture. They tend to be present-oriented; that is, they value the current interaction more than what is to be done in the future. If engaged in an activity, for example, they may simply continue the activity and appear later for an appointment. Understanding this, the nurse can avoid feelings of frustration and anger when the nurse’s future orientation comes into conflict with the patient’s present orientation.

Question 8

The sibling of an Asian American patient tells the nurse, “My sister needs help for pain. She cries from the hurt.” Which understanding by the nurse will contribute to culturally competent care for this patient? Persons of an Asian American heritage

a. often express emotional distress with physical symptoms.
b. will probably respond best to a therapist who is impersonal.
c. will require prolonged treatment to stabilize these symptoms.
d. should be given direct information about the diagnosis and prognosis.

Answer 8

ANS: A
Asian Americans commonly express psychological distress as a physical problem. The patient may believe psychological problems are caused by a physical imbalance. Treatment will likely be short. The patient will probably respond best to a therapist who is perceived as giving. Asian Americans usually have strong family ties and value hope more than truth.

Question 9

Which communication strategy would be most effective for a nurse to use during an assessment interview with an adult Native American patient?
a. Open and friendly; ask direct questions; touch the patient’s arm or hand
occasionally for reassurance.
b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional
face to express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.

Answer 9

ANS: C
Native American culture stresses living in harmony with nature. Cooperative, sharing styles rather than competitive or intrusive approaches are preferred; thus, the more passive style described would be best received. The other options would be more effective to use with patients of a Western orientation.

Question 10

A Native American patient sadly describes a difficult childhood. The patient abused alcohol as a teenager but stopped 10 years ago. The patient now says, “I feel stupid and good for nothing. I don’t help my people.” How should the treatment team focus planning for this patient?

a. Psychopharmacological and somatic therapies should be central techniques.
b. Apply a psychoanalytical approach, focused on childhood trauma.
c. Depression and alcohol abuse should be treated concurrently.
d. Use a holistic approach, including mind, body, and spirit.

Answer 10

ANS: D
Native Americans, because of their beliefs in the interrelatedness of parts and about being in harmony with nature, respond best to a holistic approach. No data are present to support dual diagnosis, because the patient has resolved the problem of excessive alcohol use. Psychopharmacological and somatic therapies may be part of the treatment, but the focus should be more holistic. Psychoanalysis is a long-term expensive therapy; cognitive therapy might be a better choice.

Question 11

A Native American patient describes a difficult childhood and dropping out of high school. The patient abused alcohol as a teenager to escape feelings of isolation but stopped 10 years ago. The patient now says, “I feel stupid. I’ve never had a good job. I don’t help my people.” Which nursing diagnosis applies?

a. Risk for other-directed violence
b. Chronic low self-esteem
c. Deficient knowledge
d. Social isolation

Answer 11

ANS: B
The patient has given several indications of chronic low self-esteem. Forming a positive self-image is often difficult for Native American individuals because these indigenous people must blend together both American and Native American worldviews. No defining characteristics are present for the other nursing diagnoses.

Question 12

Which viewpoint of an Asian American family will most affect decision making about care?

a. The father is the authority figure.
b. The mother is head of the household.
c. Women should make their own decisions.
d. Emotional communication styles are desirable.

Answer 12

ANS: A
Asian American families traditionally place the father in the position of power as the head of the household. Mothers, as well as other women, are usually subservient to fathers in these cultures. Asian Americans are more likely to be reserved.

Question 13

Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian American patient diagnosed with a mental illness?

a. Encouraging the family to attend community support groups
b. Involving the patient’s family to assist with activities of daily living
c. Providing educational pamphlets to explain the patient’s mental illness
d. Restricting homemade herbal remedies the family brings to the hospital

Answer 13

ANS: B
The Asian community values the family in caring for each other. The Asian community uses traditional medicines and healers, including herbs for mental symptoms. The Asian community describes illness in somatic terms. The Asian community attaches a stigma to mental illness, so interfacing with the community would not be appealing.

Question 14

A nurse speaks with family members of a Chinese American parent recently diagnosed with major depressive disorder. Which comment by the nurse will the family find most comforting? “The nursing staff will

a. take good care of your parent.”
b. pray with your parent several times a day.”
c. teach your parent important self-care strategies.”
d. educate your parent about safety information regarding medication.”

Answer 14

ANS: A
Chinese Americans hold an Eastern (balance) worldview. Persons who are ill or need health care are vulnerable and need protection. The family will find comfort in a nurse’s statement that good care will be provided. The distracters apply to persons with a Western or indigenous worldview.

Question 15

A patient in the emergency department shows a variety of psychiatrical symptoms, including restlessness and anxiety. The patient says, “I feel sad because evil spirits have overtaken my mind.” Which worldview is most applicable to this individual?

a. Eastern/balance
b. Southern/holistic
c. Western/scientific
d. Indigenous/harmony

Answer 15

ANS: D
Persons of an indigenous worldview believe disease results from a lack of personal, interpersonal, environmental, or spiritual harmony and that evil spirits exist. The holism of body–mind–spirit is a key component of this view. If one believes an evil spirit has taken control, distress results. Western and Eastern worldviews do not embrace spirits. See relationship to audience response question.

Question 16

A nurse prepares to teach important medication information to a patient of Mexican heritage. How should the nurse manage the teaching environment?

a. Stand very close to the patient while teaching.
b. Maintain direct eye contact with the patient while teaching.
c. Maintain a neutral emotional tone during the teaching session.
d. Sit 4 feet or more from the patient during the teaching session.

Answer 16

ANS: A
Latin American cultures use close personal space, closer than many other minority groups.Standing very close to the patient frequently indicates acceptance. Direct eye contact should not be prolonged with this patient. Persons of this cultural heritage have high emotionality.

Question 17

A Chinese American patient diagnosed with an anxiety disorder says, “My problems began when my energy became imbalanced.” The nurse asks for the patient’s ideas about how to treat the imbalance. Which comment would the nurse expect from this patient?

a. “My family will bring special foods to help me get well.”
b. “I hope my health care provider will prescribe some medication to help me.”
c. “I think I would benefit from talking to other patients with a similar problem.”
d. “I would like to have a native healer perform a ceremony to balance my energy.”

Answer 17

ANS: A
The concept of energy imbalance as a source of illness is an explanatory model familiar to Asian cultures. A source of healing is dietary change to include either “hot” or “cold” foods to correct the imbalance. “Hot” and “cold” in this case do not refer to thermal properties of the foods. Medication would not be a treatment suggested by a patient with an Eastern worldview. Someone from an indigenous culture may suggest rituals. Group discussion of mental illness would not be appealing to a Chinese American.

Question 18

An experienced psychiatric nurse plans to begin a new job in a community-based medication clinic. The clinic sees culturally diverse patients. Which action should the nurse take first to prepare for this position?

a. Investigate cultural differences in patients’ responses to psychotropic medications.
b. Contact the clinical nurse specialist for guidelines regarding cultural competence.
c. Examine the literature on various health beliefs of members of diverse cultures.
d. Complete an online continuing education offering about psychopharmacology.

Answer 18

ANS: A
An experienced nurse working on a mental health inpatient unit would be familiar with the action and side effects of most commonly prescribed psychotropic medications. However, because the clinic serves a culturally diverse population, reviewing cultural differences in patients’ responses to these medications is helpful and vital to patient safety. The distracters identify actions the nurse would take later.

Question 19

A psychoeducational session will discuss medication management for a culturally diverse group of patients. Group participants are predominantly members of minority cultures. Of the four staff nurses below, which nurse should lead this group?

a. Very young registered nurse
b. Older, mature registered nurse
c. Newly licensed registered nurse
d. A registered nurse who is very thin

Answer 19

ANS: B
Persons of minority cultures value age and wisdom. Persons with a Western worldview tend to value youth. An older, mature registered nurse would be the most credible leader of this group. The nurse’s size has no bearing on credibility.

Question 20

A nurse wants to engage an interpreter for a severely anxious 21-year-old male who immigrated to the United States 2 years ago. Of the four interpreters below who are available and fluent in the patient’s language, which one should the nurse call?

a. 65-year-old female professional interpreter
b. 24-year-old male professional interpreter
c. A member of the patient’s family
d. The patient’s best friend

Answer 20

ANS: B
A professional interpreter will be most effective because he/she will be able to interpret both
language and culture. When an interpreter is engaged, the interpreter should be matched to
the patient as closely as possible in gender, age, social status, and religion. Interpreters
should not be relatives or friends of the patient. The stigma of mental illness may prevent
the openness needed during the encounter.

Question 21

A patient who has been hospitalized for 3 days with a serious mental illness says, “I’ve got to get out of here and back to my job. I get 60 to 80 messages a day, and I’m getting behind on my email correspondence.” What is this patient’s perspective about health and illness?

a. Fateful, magical
b. Eastern, holistic
c. Western, biomedical
d. Harmonious, religious

Answer 21

ANS: C
The Western biomedical perspective holds the belief that sick people should be as independent and self-reliant as possible. Self-care is encouraged; one gets better by “getting up and getting going.” An ability to function at a high level is valued. See relationship to audience response question.

Question 22

A white patient of German descent rocks back and forth, grimaces, and rubs both temples. What is the nurse’s best action?

a. Assess the patient for extrapyramidal symptoms.
b. Sit beside the patient and rock in sync.
c. Offer to pray with the patient.
d. Assess the patient for pain.

Answer 22

ANS: D
This patient of German descent would hold a Western worldview and be stoic about pain. This patient will keep pain as silent as possible and be reluctant to disclose pain unless the nurse actively assesses for it. The patient’s nonverbal communication suggests pain rather than EPS (extrapyramidal symptoms). The patient would probably not respond positively to prayer or the nurse’s rocking behavior.

Question 23

A Vietnamese patient’s family reports that the patient has wind illness. Which menu selection will be most helpful for this patient?

a. Iced tea
b. Ice cream
c. Warm broth
d. Gelatin dessert

Answer 23

ANS: C
Wind illness is a culture-bound syndrome found in the Chinese and Vietnamese population.
It is characterized by a fear of cold, wind, or drafts. It is treated by keeping very warm and avoiding foods, drinks, and herbs that are cold. Warm broth would be most in sync with the patient’s culture and provide the most comfort. The distracters are cold foods.

Question 24

A Mexican American patient puts a picture of the Virgin Mary on the bedside table. What is the nurse’s best action?

a. Move the picture so it is beside a window.
b. Send the picture to the business office safe.
c. Leave the picture where the patient placed it.
d. Send the picture home with the patient’s family.

Answer 24

ANS: C
Cultural heritage is expressed through language, works of art, music, dance, customs, traditions, diet, and expressions of spirituality. This patient’s prominent placement of the picture is an example of expression of cultural heritage and spirituality. The nurse should not move it unless the patient’s safety is jeopardized.

Question 25

A nurse begins work in an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after

a. identifying culture-bound issues.
b. implementing scientifically proven interventions.
c. correcting inferior health practices of the population.
d. exploring commonly held beliefs and values of the population.

Answer 25

ANS: D
Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture. The other options have little to do with cultural competence or represent only a portion of the answer.

Question 26

A nurse cares for a first-generation American whose family emigrated from Germany. Which worldview about the source of knowledge would this patient likely have?

a. Knowledge is acquired through use of affective or feeling senses.
b. Science is the foundation of knowledge and proves something exists.
c. Knowledge develops by striving for transcendence of the mind and body.
d. Knowledge evolves from an individual’s relationship with a supreme being.

Answer 26

ANS: B
The European-American perspective of acquiring knowledge evolves from science. The distracters describe the beliefs of other cultural groups. See relationship to audience response question.

Question 27

The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?
a. Patients of different cultural groups may metabolize medications at different rates.
b. Metabolism of psychotropic medication is consistent among various cultural
groups.
c. Differences in hepatic enzymes will influence the rate of elimination of
psychotropic medications.
d. It is important to provide patients with oral and written literature about their
psychotropic medications.

Answer 27

ANS: A
Cytochrome enzyme systems, which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs. Renal function influences elimination of psychotropic medication; hepatic function influences metabolism rates. Information about medication is important but does not apply to pharmacokinetics.

Question 28

A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine

a. if the patient’s immunizations are current.
b. the patient’s religious preferences.
c. the patient’s specific ethnic group.
d. whether an interpreter is needed.

Answer 28

ANS: D
The assessment depends on communication. The nurse should first determine whether an interpreter is needed. The other information can be subsequently assessed.

Question 29

Which questions should the nurse ask to determine an individual’s worldview? (Select all that apply.)

a. What is more important: the needs of an individual or the needs of a community?
b. How would you describe an ideal relationship between individuals?
c. How long have you lived at your present residence?
d. Of what importance are possessions in your life?
e. Do you speak any foreign languages?

Answer 29

ANS: A, B, D
The answers provide information about cultural values related to the importance of individuality, material possessions, relational connectedness, community needs versus individual needs, and interconnectedness between humans and nature. These will assist the nurse to determine a patient’s worldview. Other follow-up questions are needed to validate findings.

Question 30

Why is the study of culture so important for psychiatric nurses in the United States? (Select all that apply.)
a. Psychiatric nurses often practice in other countries.
b. Psychiatric nurses must advocate for the traditions of the Western culture.
c. Cultural competence helps protect patients from prejudice and discrimination.
d. Patients should receive information about their illness and treatment in terms they
understand.
e. Psychiatric nurses often interface with patients and their significant others over a long period of time.

Answer 30

ANS: C, D, E
One purpose of cultural competence is for the psychiatric nurse to relate and explain information about the patient’s illness and treatment in an understandable way, incorporating the patient’s own beliefs and values. A fundamental aspect of nursing practice is advocacy. Cultural competence promotes recognition of prejudices in care, such as stigma and misdiagnosis. Psychiatric nurses often interface with patients and families over years and in community settings.

Question 31

The nurse should be particularly alert to expression of psychological distress through physical symptoms among patients whose cultural beliefs include (Select all that apply)

a. mental illness reflects badly on the family.
b. mental illness shows moral weakness.
c. intergenerational conflict is common.
d. the mind, body, and spirit are merged.
e. food choices influence one’s health.

Answer 31

ANS: A, B, D
Physical symptoms are seen as more acceptable in cultural groups in which interdependence
and harmony of the group are emphasized. Mental illness is often perceived as reflecting a
failure of the entire family. In groups in which mental illness is seen as a moral weakness
and both the individual and family are stigmatized, somatization of mental distress is better
accepted. In groups in which mind, body, and spirit are holistically perceived, somatization of psychological distress is common. Somatization and food are not commonly related. Intergenerational conflict has not been noted as a risk factor for somatization.

Question 32

A nurse is educating an adult patient on patient rights, according to the American Hospital Association. The teaching has been effective when the adult states that the patient’s rights include
a.
“choice of diet to be eaten during hospitalization.”
b.
“considerate and respectful care from all care providers.”
c.
“medical care regardless of ability to pay.”
d.
“information from nurses about diagnosis and prognosis.”

Answer 32

ANS: B
When you are a patient in the hospital, you have the right to receive considerate and respectful care. The American Hospital Association published a Patient’s Bill of Rights, which is now revised and called the Patient Care Partnership. This document reflects acknowledgment of patients’ rights to participate in their health care and was developed as a response to consumer criticism of paternalistic provider care. The statements detail the patient’s rights with corresponding provider responsibilities. This document reflects the increasing emphasis on patient autonomy in health care and defines the limits of provider influence and control. It does not contain information on diets, nursing diagnosis, or the ability to pay for medical care.

Question 33

A nurse manager is teaching the purpose of the nurse’s Code of Ethics to a group of high school students. Which statement by one of the students indicates that the teaching has been effective? The purpose of the nurse’s Code of Ethics is
a.
“to assist in clarifying the individual nurse’s personal values and goals.”
b.
“to differentiate between moral and immoral acts.”
c.
“to guide the behavior of the professional nurse.”
d.
“to identify acts that are legal for the nurse to perform.”

Answer 33

ANS: C
The American Nurses Association (ANA) Code of Ethics (2015) is a statement to society that outlines the values, concerns, and goals of the profession. It should be compatible with the values and goals of each nurse. It does not outline moral or immoral acts or make statements regarding legal aspects of nursing.

Question 34

Which statement best describes the Code of Ethics of the American Nurses Association?
a.
A moral statement of accountability for practicing nurses and for student nurses
b.
A legal document describing the responsibilities of the nurse
c.
A statement regarding nursing care that outlines principles for the hospital to use to evaluate quality of care
d.
A document that is used as a guide for the nurse to consider in the decision-making process in legal situations

Answer 34

ANS: A
The Code of Ethics is a moral statement of accountability for practicing nurses and for student nurses. It is a statement to society that outlines the values, concerns, and goals of the profession, thereby addressing accountability. The code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse–patient relationship entails. It lacks legal enforceability and is not a legal document like licensure laws.

Question 35

Which ethical principle is applied when the nurse acts to safeguard the patient and the public by reporting poor nursing practice?
a.
Autonomy
b.
Fidelity
c.
Justice
d.
Veracity

Answer 35

ANS: D
Veracity—the duty to tell the truth—is represented in this situation. Autonomy is the right of the patient to make an informed decision. Fidelity means to act in a way that is loyal, such as keeping information private and confidential. Justice requires the nurse to treat all patients fairly without regard to age, socioeconomic status, or other variables.

Question 36

What ethical principle is implemented, or supported, when the nurse encourages a patient to be involved in planning and implementing self-care?
a.
Autonomy
b.
Fidelity
c.
Justice
d.
Veracity

Answer 36

ANS: A
A patient’s right to self-determination implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity is the duty to tell the truth.

Question 37

The ethical principle of autonomy is not applicable in which patient situation?
a.
The patient does not speak or understand the English language.
b.
The patient is unaware of who or where he or she is.
c.
The patient has been in a long-term care facility for 10 years.
d.
The patient has values that conflict with the caregiver’s values.

Answer 37

ANS: B
This principle assumes rational thinking on the part of the patient, and being unaware of who and where one is, is not indicative of the ethical principle of autonomy. Autonomy is a patient’s right to self-determination that implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. In the other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist.

Question 38

A nurse is educating a nurse aide on patient confidentiality. The nurse believes the teaching to be effective when the nurse aide states that confidentiality will be maintained by a nurse who believes in and values the ethical principle of
a.
veracity.
b.
autonomy.
c.
justice.
d.
fidelity.

Answer 38

ANS: D
Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity means to tell the truth. Autonomy involves the patient making an informed decision and implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables.

Question 39

A patient who has a terminal illness wants to be able to take a prescription medication to end life when suffering becomes unbearable. The patient asks the nurse for advice. Operating from a deontological point of reference, what action does the nurse take?
a.
Advises the patient about local providers willing to participate
b.
Assesses the patient for more information about the situation
c.
Determines what kind of insurance the patient has before acting
d.
Tells the patient that he/she cannot participate in this action

Answer 39

ANS: D
Deontology is rule-bound and inflexible, obtaining moral authority from absolutes revealed by God. To preserve the sanctity of life, the nurse cannot participate in this situation. Advising the patient of providers to see is working from a teleological viewpoint because the end (patient death) might be seen as outweighing the means (helping the patient find a provider to provide a lethal prescription of drugs). Assessing the situation to see how the patient is affected (versus how some other patient would be affected) is situational. Determining financial status is not related to a specific philosophical outlook but might violate the principle of justice.

Question 40

The nurse is very busy caring for a large caseload. An adult patient mentions that by having slow mobility, “people just do things for me rather than allowing me to do as much as possible on my own.” To solve the dilemma of needing to conserve time versus supporting the patient’s involvement in self-care, what principle may help the nurse?
a.
Veracity
b.
Fidelity
c.
Justice
d.
Autonomy

Answer 40

ANS: D
Autonomy implies the freedom to have choices and make decisions about one’s own care without interference. Just because this patient is slow does not mean he/she cannot make choices and participate in self-care. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Veracity is the duty to tell the truth. Fidelity involves keeping information confidential and maintaining privacy and trust.

Question 41

What element in health care is most responsible for the ethical dilemma of whether health care is a privilege or a right?
a.
Cost
b.
Technology
c.
Consumerism
d.
Worker shortage

Answer 41

ANS: A
Variables of the justice principle involve the allocation of scarce or expensive health care resources. The following questions are a few examples illustrating this principle: What kind of access to health care should illegal immigrants receive—preventive care or only more costly emergency care? How should the health care of children be allocated? Should all children receive the same health care regardless of ability to pay?

Question 42

Advance directives such as the health care proxy and living will support what ethical principle?
a.
Veracity
b.
Advocacy
c.
Beneficence
d.
Autonomy

Answer 42

ANS: D
Autonomy implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Veracity is the duty to tell the truth. Beneficence is the duty to actively do good for patients. Speaking out on behalf of the patient is an essential part of the advocacy role of the nurse.

Question 43

A nurse is learning about the ANA Code of Ethics. Which action by the nurse would be unethical, according to the ANA Code of Ethics?
a.
Joining unions or bargaining units
b.
Engaging in lobbying related to health care issues
c.
Reporting an incompetent or impaired colleague
d.
Refusing to care for a patient who is diagnosed as HIV positive

Answer 43

ANS: D
ANA Code Provision 1: “The nurse practices with compassion and respect for the inherent dignity, worth, and uniqueness attributes of every person.” Nurses have the right to engage in collective bargaining and lobbying for health care issues. Nurses have a legal responsibility based on the Nurse Practice Act in their states to report an incompetent or impaired colleague.

Question 44

Which action by the nurse shows an understanding of the ethical principle of autonomy?
a.
Allowing a patient the right to make decisions regarding his health care
b.
Making decisions for the patient regarding her care
c.
Disregarding the patient’s decisions because they are not “normal”
d.
Consulting the attending physician to make decisions for the patient

Answer 44

ANS: A
The nurse shows understanding of the ethical principle of autonomy by allowing patients the right to make their own health care decisions even if the nurse does not agree with their decisions. It is not up to the nurse or the attending physician to make health care decisions for patients.

Question 45

The nurse is educating a coworker on the ethical principle of beneficence. The nurse judges the teaching to be effective when her coworker states
a.
“Beneficence involves allowing patient to make their own health care decisions.”
b.
“Beneficence is the duty to actively do good for patients.”
c.
“Beneficence is the duty to do no harm.”
d.
“Beneficence involves treating all patients equally.”

Answer 45

ANS: B
Beneficence is the ethical principle of actively doing good for patients. Allowing patients to make their own health care decisions is autonomy. Doing no harm to the patient is nonmaleficence. Justice involves treating all patients equally.

Question 46

What action can the nurse take to uphold the ethical principle of fidelity?
a.
Report unscrupulous billing practices.
b.
Disclose the results of an HIV test to a patient’s family.
c.
Make health care decisions for a patient.
d.
Accept an assignment that is unsafe.

Answer 46

ANS: A
The nurse can uphold the ethical principle of fidelity by reporting unscrupulous billing practices. Disclosing the results of an HIV test to a patient’s family would violate fidelity. Making health care decisions would violate autonomy. Accepting an assignment that is unsafe violates nonmaleficence.

Question 47

A nurse is caring for a patient who has just been diagnosed with cancer. The patient’s family has requested that the patient not be told at this time because it would be devastating. The patient asks the nurse if the diagnosis is cancer. If the nurse were to uphold the ethical principle of veracity, what would the response be?
a.
“No, you do not have cancer.”
b.
“The physician is unsure of your diagnosis at this time.”
c.
“Yes, that is the diagnosis. Let me call the doctor so that we can have a discussion.”
d.
“Yes, but your family told me that I could not talk to you about the diagnosis.”

Answer 47

ANS: C
If the nurse were to uphold the ethical principle of veracity, the nurse would inform the patient of the diagnosis and involve the physician in the discussion. The nurse should not lie to the patient or withhold information at the family’s request; the patient has a right to know information regarding his/her health care.

Question 48

A nurse is educating a group of nursing students on the deontological model of ethical reasoning. The nurse determines that the teaching has been effective when a student states
a.
“All life is worthy of respect.”
b.
“Abortions are ethical.”
c.
“Euthanasia is acceptable in certain situations.”
d.
“Lying is acceptable if it benefits the patient.”

Answer 48

ANS: A
The deontological model of ethical reasoning states that all life is worthy of respect. Abortions and euthanasia are never acceptable because they violate the duty to respect the sanctity of all life. Lying is never acceptable because it violates the duty to tell the truth.

Question 49

A nurse is educating nursing students on the teleological model of ethical reasoning. The nurse judges that the education has been effective when a student states which of the following?
a.
“Abortion is acceptable because it results in fewer unwanted babies.”
b.
“Abortion is never acceptable because it violates the sanctity of life.”
c.
“Euthanasia is never acceptable because it violates the sanctity of life.”
d.
“The rights on individuals should not be sacrificed for the good of the majority.”

Answer 49

ANS: A
The teleological model of ethical reasoning is interpreted as meaning “the end justifies the means.” The rights of some individuals may be sacrificed for the majority. Therefore, abortion may be acceptable because it results in fewer unwanted babies. Euthanasia may be acceptable because it results in decreased suffering.

Question 50

A nurse and a patient are discussing the patient’s wishes regarding resuscitation. The patient decides that resuscitation is not wanted under any circumstances. What action can the nurse take to identify the ethical issues of the situation?
a.
Encourage the patient to discuss his/her wishes with his/her family.
b.
Encourage the patient to change his/her mind.
c.
Coerce the patient into changing his/her mind by calling the physician to the bedside.
d.
Continue to treat the patient as a “full code.”

Answer 50

ANS: A
When identifying the ethical issues of the situation, the nurse should encourage the patient to share his/her wishes with his/her family. It is not the position of the nurse to try to change the patient’s mind or force him/her to remain a “full code.” The nurse should respect the patient’s wishes and document them accordingly.

Question 51

A patient with cancer has decided to end treatment and is discussing end-of-life care with the family. The nurse notices that the attending physician has just ordered another dose of chemotherapy. What would be the best action for the nurse to take as an advocate for the patient?
a.
Send the order to the pharmacy so that the chemotherapy can be prepared.
b.
Call the attending physician, and request a meeting so that there can be open communication between the physician and the patient and family.
c.
Tell the patient that because the chemotherapy has been ordered, it must be given.
d.
Request a meeting with the attending physician and the patient and family so the attending physician can convince the patient to receive the chemotherapy.

Answer 51

ANS: B
As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to the pharmacy, try to convince the patient to receive chemotherapy, or tell the patient that the drug must be given because it was already ordered.

Question 52

A young woman has come to the hospital requesting medication to induce an abortion. The nurse assigned finds it too hard to provide care to this patient because it violates the nurse’s ethical principles. Which action would be the best for the nurse to take?
a.
Continue to provide care for the patient but refuse to administer the medication.
b.
Administer the medication because the doctor ordered it.
c.
Find another nurse to provide care for the patient.
d.
Try to talk the patient out of taking the medication.

Answer 52

ANS: C
To ensure care for the patient without violating the nurse’s ethical principles, the nurse should find another nurse to care for the patient. Because the patient has rights, it would be inappropriate to try to talk the patient out of receiving the medication or to deny the patient’s access to the medication.

Question 53

A nurse is caring for a young patient recovering from a traumatic car crash. The patient has lost a lot of blood and is in need of a blood transfusion. The patient states, “I’m a Jehovah’s Witness,” and will not accept the blood. The nurse knows the patient will likely not survive without the blood. What action should the nurse take?
a.
Administer the blood anyway; the patient will die without it.
b.
Try to talk the family into signing the consent for the blood.
c.
Call the physician and report the patient’s decision.
d.
Stop all care for the patient to respect his/her wishes.

Answer 53

ANS: C
The nurse should immediately call the physician to report the patient’s decision. The nurse should not administer the blood against the patient’s wishes or try to talk the family into signing the consent. The nurse should continue all care for the patient except administration of the blood.

Question 54

The nurse has an adequate understanding of ethical issues regarding transplantation when stating which of the following?
a.
“There are few Americans on the transplantation list.”
b.
“Everyone on the transplantation list receives the organ he/she needs.”
c.
“There is an overabundance of organ donors.”
d.
“Most people on the transplantation list die due to the shortage of organs.”

Answer 54

ANS: D
There are over 122,000 Americans on the transplantation list, and the majority of them will die without a transplant because of the shortage of available organs.

Question 55

A nurse manager is educating a group of staff nurses about genetics and genomics. The nurse manager judges that the teaching has been effective when one of the staff nurses states
a.
“Health outcomes and treatment of disease processes have not increased with the study of genetics and genomics.”
b.
“Only researchers benefit from the study of genetics and genomics.”
c.
“This area of study has nothing to do with nurses.”
d.
“Genetics and genomics have increased the ability of health care professionals to assist patients in improving health outcomes.”

Answer 55

ANS: D
The study of genetics and genomics has increased the ability of health care professionals to assist patients in improving health outcomes. Nurses involved in this area of health care educate patients and provide support and treatments based on the most current research.

Question 56

A nurse is educating students on physician-assisted suicide (PAS). The nurse judges that the teaching has been effective when a student states which of the following? (Select all that apply.)
a.
“PAS does not violate any ethical principles.”
b.
“PAS threatens to destroy the fundamental relationship between physician and patient.”
c.
“PAS does not involve nurses.”
d.
“Quality of life advocates support PAS as an example of personal autonomy and control.”
e.
“Nurses should be aware of the legal and ethical implications of administering legal dosages of medications.”

Answer 56

ANS: B, D, E
The American Medical Association opposes physician-assisted suicide (PAS) because it violates the most basic ethical principle: First, do no harm. Physicians have traditionally cared for living patients, and their opinion is that PAS threatens to destroy this fundamental relationship. On the other hand, quality of life advocates support PAS as an example of personal autonomy and control. Nurses working with physicians involved in PAS should be aware of the legal and ethical implications of administering lethal dosages of medications.

Question 57

Which action by a psychiatric nurse best applies the ethical principle of autonomy?

a. Exploring alternative solutions with the patient, who then makes a choice.
b. Suggesting that two patients who were fighting be restricted to the unit.
c. Intervening when a self-mutilating patient attempts to harm self.
d. Staying with a patient demonstrating a high level of anxiety.

Answer 57

ANS: A
Autonomy is the right to self-determination, that is, to make one’s own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.

Question 58

A nurse finds a psychiatric advance directive in the medical record of a patient currently experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should

a. review the directive with the patient to ensure it is current.
b. ensure that the directive is respected in treatment planning.
c. consider the directive only if there is a cardiac or respiratory arrest.
d. encourage the patient to revise the directive in light of the current health problem.

Answer 58

ANS: B
The nurse has an obligation to honor the right to self-determination. An advanced psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of the directive now apply.

Question 59

Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion

a. reinforces the autonomy of the two patients.
b. violates the civil rights of both patients.
c. represents the intentional tort of battery.
d. correctly places emphasis on safety.

Answer 59

ANS: B
Patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion violates the patient’s autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.

Question 60

In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision.” Which ethical principle most clearly applies to this situation?

a. Beneficence
b. Autonomy
c. Fidelity
d. Justice

Answer 60

ANS: D
The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make one’s own decisions. Fidelity is the observance of loyalty and commitment to the patient.

Question 61

Select the example of a tort.
a. The plan of care for a patient is not completed within 24 hours of the patient’s
admission.
b. A nurse gives a prn dose of an antipsychotic drug to an agitated patient because the
unit is short-staffed.
c. An advanced practice nurse recommends hospitalization for a patient who is
dangerous to self and others.
d. A patient’s admission status changed from involuntary to voluntary after the
patient’s hallucinations subside.

Answer 61

ANS: B
A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus, false imprisonment is a possible charge. The other options do not exemplify torts.

Question 62

What is the legal significance of a nurse’s action when a patient verbally refuses medication and the nurse gives the medication over the patient’s objection? The nurse

a. has been negligent.
b. committed malpractice.
c. fulfilled the standard of care.
d. can be charged with battery.

Answer 62

ANS: D
Battery is an intentional tort in which one individual violates the rights of another through touching without consent. Forcing a patient to take medication after the medication was refused constitutes battery. The charge of battery can be brought against the nurse. The medication may not necessarily harm the patient; harm is a component of malpractice.

Question 63

Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, “I’m getting out of here, and no one can
stop me.” The nurse restrains this patient without a health care provider’s order
and then promptly obtains an order.
b. A patient has been irritating and attention seeking much of the day. A nurse escorts
the patient down the hall saying, “Stay in your room, or you’ll be put in seclusion.”
c. An involuntarily hospitalized patient with suicidal ideation runs out of the
psychiatric unit. The nurse rushes after the patient and convinces the patient to
return to the unit.
d. An involuntarily hospitalized patient with homicidal ideation attempts to leave the
facility. A nurse calls the security team and uses established protocols to prevent
the patient from leaving.

Answer 63

ANS: B
False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. If a patient is not competent (confused), then the nurse should act with beneficence. Patients admitted involuntarily should not be allowed to leave without permission of the treatment team.

Question 64

Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The patient who

a. is noncompliant with the treatment regimen.
b. fraudulently files for bankruptcy.
c. sold and distributed illegal drugs.
d. threatens to harm self and others.

Answer 64

ANS: D
Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization.

Question 65

A nurse prepares to administer a scheduled intramuscular injection of an antipsychotic medication to an outpatient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” Select the nurse’s best action.

a. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary.
b. Stop the medication administration procedure and say to the patient, “Tell me more about the side effects you’ve been having.”
c. Proceed with the injection but explain to the patient that there are medications that will help reduce the unpleasant side effects.
d. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about delaying next month’s dose.”

Answer 65

ANS: B
Patients diagnosed with mental illness retain their civil rights unless there is clear, cogent,
and convincing evidence of dangerousness. The patient in this situation presents no
evidence of dangerousness. The nurse, as an advocate and educator, should seek more
information about the patient’s decision and not force the medication.

Question 66

A nurse is concerned that an agency’s policies are inadequate. Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice?
a. Agency policies do not exempt an individual nurse of responsibility to practice
according to professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and
therefore override other standards of care.
c. Faced with substandard policies, a nurse has a responsibility to inform the
supervisor and discontinue patient care immediately.
d. Interpretation of policies by the judicial system is rendered on an individual basis
and therefore cannot be predicted.

Answer 66

ANS: A
Nurses are professionally bound to uphold standards of practice regardless of lesser standards established by a health care agency or a state. Conversely, if the agency standards are higher than standards of practice, the agency standards must be upheld. The Courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.

Question 67

A newly admitted acutely psychotic patient is a private patient of the medical director and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care?

a. Medical director
b. Hospital
c. Profession
d. Patient

Answer 67

ANS: D
Although the nurse is accountable to the health care provider, the agency, the patient, and the profession, the duty of care is owed to the patient. This duty reflects both legal and ethical standards of nursing practice.

Question 68

Which action by a nurse constitutes a breach of a patient’s right to privacy?

a. Documenting the patient’s daily behavior during hospitalization
b. Releasing information to the patient’s employer without consent
c. Discussing the patient’s history with other staff during care planning
d. Asking family to share information about a patient’s pre-hospitalization behavior

Answer 68

ANS: B
Release of information without patient authorization violates the patient’s right to privacy. The other options are acceptable nursing practices. See relationship to audience response question.

Question 69

An adolescent hospitalized after a violent physical outburst tells the nurse, “I’m going to kill my father, but you can’t tell anyone.” Select the nurse’s best response.

a. “You are right. Federal law requires me to keep clinical information private.”
b. “I am obligated to share that information with the treatment team.”
c. “Those kinds of thoughts will make your hospitalization longer.”
d. “You should share this thought with your psychiatrist.”

Answer 69

ANS: B
Breach of nurse–patient confidentiality does not pose a legal dilemma for nurses in these circumstances because a team approach to delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria. The patient should also know that the team has a duty to warn the father of the risk for harm.

Question 70

A voluntarily hospitalized patient tells the nurse, “Get me the forms for discharge. I want to leave now.” Select the nurse’s best response.

a. “I will get the forms for you right now and bring them to your room.”
b. “Since you signed your consent for treatment, you may leave if you desire.”
c. “I will get them for you, but let’s talk about your decision to leave treatment.”
d. “I cannot give you those forms without your health care provider’s permission.”

Answer 70

ANS: C
A voluntarily admitted patient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patient’s wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. Facilitating discharge without consent is not in the patient’s best interests before exploring the reason for the request.

Question 71

Insurance will not pay for continued private hospitalization of a mentally ill patient. The
family considers transferring the patient to a public hospital but expresses concern that the
patient will not get any treatment if transferred. Select the nurse’s most helpful reply.
a. “By law, treatment must be provided. Hospitalization without treatment violates patients’ rights.”
b. “All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.”
c. “You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety.”
d. “Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable.”

Answer 71

ANS: A
The right to medical and psychiatric treatment is conferred on all patients hospitalized in public mental hospitals under federal law.

Question 72

Which individual diagnosed with mental illness may need emergency or involuntary admission? The individual who

a. resumes using heroin while still taking naltrexone (ReVia).
b. reports hearing angels playing harps during thunderstorms.
c. does not keep an outpatient appointment with the mental health nurse.
d. throws a heavy plate at a waiter at the direction of command hallucinations.

Answer 72

ANS: D
Throwing a heavy plate is likely to harm the waiter and is evidence of dangerousness to others. This behavior meets the criteria for emergency or involuntary hospitalization for mental illness. The behaviors in the other options evidence mental illness but not dangerousness. See related audience response question.

Question 73

A patient in alcohol rehabilitation reveals to the nurse, “I feel terrible guilt for sexually abusing my 6-year-old before I was admitted.” Select the nurse’s most important action.

a. Anonymously report the abuse by phone to the local child protection agency.
b. Reply, “I’m glad you feel comfortable talking to me about it.”
c. File a written report with the agency’s ethics committee.
d. Respect nurse–patient relationship confidentiality.

Answer 73

ANS: A
Laws regarding child abuse reporting discovered by a professional during the suspected abuser’s alcohol or drug treatment differ by state. Federal law supersedes state law and prohibits disclosure without a court order except in instances in which the report can be made anonymously or without identifying the abuser as a patient in an alcohol or drug treatment facility.

Question 74

A family member of a patient with delusions of persecution asks the nurse, “Are there any circumstances under which the treatment team is justified in violating a patient’s right to confidentiality?” The nurse should reply that confidentiality may be breached

a. under no circumstances.
b. at the discretion of the psychiatrist.
c. when questions are asked by law enforcement.
d. if the patient threatens the life of another person.

Answer 74

ANS: D
The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient’s right to confidentiality. The right to confidentiality is not suspended at the discretion of the therapist or for legal investigations.

Question 75

A new antidepressant is prescribed for an elderly patient diagnosed with major depressive disorder, but the dose is more than the usual geriatric dose. The nurse should

a. consult a reliable drug reference.
b. teach the patient about possible side effects and adverse effects.
c. withhold the medication and confer with the health care provider.
d. encourage the patient to increase oral fluids to reduce drug concentration.

Answer 75

ANS: C
The dose of antidepressants for elderly patients is often less than the usual adult dose. The nurse should withhold the medication and consult the health care provider who wrote the order. The nurse’s duty is to practice according to professional standards as well as intervene and protect the patient

Question 76

A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with the correct rationale. The psychiatrist

a. released information without proper authorization.
b. demonstrated the duty to warn and protect.
c. violated the patient’s confidentiality.
d. avoided charges of malpractice.

Answer 76

ANS: B
It is the health care professional’s duty to warn or notify an intended victim after a threat of harm has been made. Informing a potential victim of a threat is a legal responsibility of the health care professional. It is not a violation of confidentiality.

Question 77

A patient experiencing psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation.
a. Patient struck another patient who attempted to leave day room to go to bathroom.
Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these
two patients away from each other for 24 hours.
b. Seclusion ordered by physician at 1415 after command hallucinations told the
patient to hit another patient. Careful monitoring of patient maintained during
period of seclusion.
c. Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for
2 hours without incident. Outcome: Patient calmer and apologized for outburst.
d. Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, “I’ll punch anyone who gets near me,” and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained
from MD at 1430.

Answer 77

ANS: D
Documentation must be specific and detail the key aspects of care. It should demonstrate implementation of the least restrictive alternative. Justification for why a patient was secluded should be recorded, along with interventions attempted in an effort to avoid seclusion. Documentation should include a description of behavior and verbalizations, interventions tried and their outcomes, and the name of the health care provider ordering the use of seclusion.

Question 78

A person in the community asks, “Why aren’t people with mental illness kept in state institutions anymore?” Select the nurse’s best response.

a. “Less restrictive settings are available now to care for individuals with mental
illness. ”
b. “There are fewer persons with mental illness, so less hospital beds are needed.”
c. “Most people with mental illness are still in psychiatric institutions.”
d. “Psychiatric institutions violated patients’ rights.”

Answer 78

ANS: A
The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. The distracters are incorrect and part of the stigma of mental illness.

Question 79

A patient experiencing psychosis asks a psychiatric technician, “What’s the matter with me?” The technician replies, “Nothing is wrong with you. You just need to use some self-control.” The nurse who overheard the exchange should take action based on

a. the technician’s unauthorized disclosure of confidential clinical information.
b. violation of the patient’s right to be treated with dignity and respect.
c. the nurse’s obligation to report caregiver negligence.
d. the patient’s right to social interaction.

Answer 79

ANS: B
Patients have the right to be treated with dignity and respect. The technician’s comment disregards the seriousness of the patient’s illness. The Code of Ethics for Nurses requires intervention. Patient emotional abuse has been demonstrated, not negligence. An interaction with the technician is not an aspect of social interaction. The technician did not disclose clinical information.

Question 80

Which documentation of a patient’s behavior best demonstrates a nurse’s observations?
a. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
b. Calmer; more cooperative. Participated actively in group. No evidence of
psychotic thinking.
c. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others.
d. Wore four layers of clothing. States, “I need protection from evil bacteria trying to pierce my skin.”

Answer 80

ANS: D
The documentation states specific observations of the patient’s appearance and the exact statements made. The other options are vague or subjective statements and can be interpreted in different ways.

Question 81

After leaving work, a nurse realizes documentation of administration of a prn medication was omitted. This off-duty nurse phones the nurse on duty and says, “Please document administration of the medication for me. My password is alpha1.” The nurse receiving the call should

a. fulfill the request promptly.
b. document the caller’s password.
c. refer the matter to the charge nurse to resolve.
d. report the request to the patient’s health care provider.

Answer 81

ANS: C
Fraudulent documentation may be grounds for discipline by the state board of nursing.
Referring the matter to the charge nurse will allow observance of hospital policy while
ensuring that documentation occurs. Notifying the health care provider would be
unnecessary when the charge nurse can resolve the problem. Nurses should not provide passwords to others.

Question 82

Which individual diagnosed with a mental illness may need involuntary hospitalization? An individual
a. who has a panic attack after her child gets lost in a shopping mall.
b. with visions of demons emerging from cemetery plots throughout the community.
c. who takes 38 acetaminophen tablets after the person’s stock portfolio becomes
worthless.
d. diagnosed with major depression who stops taking prescribed antidepressant
medication.

Answer 82

ANS: C
Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary hospitalization also protects other individuals in society. An overdose of acetaminophen indicates dangerousness to self. The behaviors described in the other options are not sufficient to require involuntary hospitalization.

Question 83

An aide in a psychiatric hospital says to the nurse, “We don’t have time every day to help each patient complete a menu selection. Let’s tell dietary to prepare popular choices and send them to our unit.” Select the nurse’s best response.
a. “Thanks for the suggestion, but that idea may not work because so many patients
take MAOI (monoamine oxidase inhibitor) antidepressants.”
b. “Thanks for the idea, but it’s important to treat patients as individuals. Giving
choices is one way we can respect patients’ individuality.”
c. “Thank you for the suggestion, but the patients’ bill of rights requires us to allow
patients to select their own diet.”
d. “Thank you. That is a very good idea. It will make meal preparation easier for the
dietary department.”

Answer 83

ANS: B
The nurse’s response to the aide should recognize patients’ rights to be treated with dignity and respect as well as promote autonomy. This response also shows respect for the aide and fulfills the nurse’s obligation to provide supervision of unlicensed personnel. The incorrect responses have flawed rationale or do not respect patients as individuals.

Question 84

In order to release information to another health care facility or third party regarding a patient diagnosed with a mental illness, the nurse must obtain
a. a signed consent by the patient for release of information stating specific
information to be released.
b. a verbal consent for information release from the patient and the patient’s guardian
or next of kin.
c. permission from members of the health care team who participate in treatment
planning.
d. approval from the attending psychiatrist to authorize the release of information.

Answer 84

ANS: A
Nurses have an obligation to protect patients’ privacy and confidentiality. Clinical information should not be released without the patient’s signed consent for the release.

Question 85

In which situations would a nurse have the duty to intervene and report? (Select all that apply.)

a. A peer has difficulty writing measurable outcomes.
b. A health care provider gives a telephone order for medication.
c. A peer tries to provide patient care in an alcohol-impaired state.
d. A team member violates relationship boundaries with a patient.
e. A patient refuses medication prescribed by a licensed health care provider.

Answer 85

ANS: C, D
Both keyed answers are events that jeopardize patient safety. The distracters describe situations that may be resolved with education or that are acceptable practices.

Question 86

Which actions violate the civil rights of a psychiatric patient? The nurse (Select all that apply)

a. performs mouth checks after overhearing a patient say, “I’ve been spitting out my medication.”
b. begins suicide precautions before a patient is assessed by the health care provider.
c. opens and reads a letter a patient left at the nurse’s station to be mailed.
d. places a patient’s expensive watch in the hospital business office safe.
e. restrains a patient who uses profanity when speaking to the nurse.

Answer 86

ANS: C, E
The patient has the right to send and receive mail without interference. Restraint is not
indicated because a patient uses profanity; there are other less restrictive ways to deal with
this behavior. The other options are examples of good nursing judgment and do not violate
the patient’s civil rights.

Question 87

A nurse is giving a presentation on malpractice. Which statement indicates the nurse understands malpractice?
a.
“The elements of duty, breach of duty, causation, and patient injury must be present for a malpractice claim.”
b.
“Negligent nursing care and failure to follow standards must be present for a malpractice claim.”
c.
“Failure to report, defamation, and discrimination must be present for a malpractice claim.”
d.
“Error in judgment and invasion of privacy must be present for a malpractice claim.”

Answer 87

ANS: A
There are four elements that must be present for a malpractice claim: (1) You must have a duty—there must be a professional nurse–patient relationship. (2) You must have breached a duty that was foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient (4) injury or damages. The other options do not indicate the nurse’s understanding of malpractice.

Question 88

In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, QID. The patient has a long history of gastrointestinal bleeding. What is the best nursing action?
a.
Give the medication.
b.
Withhold the medication, and chart why it was not given.
c.
Call the provider, and question the order in light of the patient’s history.
d.
Ask if the patient is allergic to aspirin.

Answer 88

ANS: C
The nurse should call the provider and question the medication order for aspirin based on the patient’s history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient’s allergies. The nurse would withhold the medication until the provider is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding

Question 89

The nurse enters a patient’s room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated the patient could not leave the hospital until the bill was paid. What is the best nursing action?
a.
Comfort the patient and continue the preparations for discharge.
b.
Call the social worker for a financial evaluation.
c.
Call the family to arrange for the payment.
d.
Cancel the discharge plans and notify the physician of the situation.

Answer 89

ANS: A
The best action is to comfort the patient and continue the discharge preparations. If the patient’s claim is accurate, this could be false imprisonment (wrongfully making someone believe that he/she cannot leave a place). The nurse’s best action is to comfort the patient and continue the discharge preparations. However, this should also be reported to the supervisor. Calling the social worker may be needed if the patient does not have the resources to pay the bill so the social worker can help explore options. Contacting the family is not appropriate.

Question 90

What is a correct statement regarding a nurse who acts beyond the scope of practice?
a.
Demonstrates what a good nurse he/she can be
b.
Provides enriched services to patients who would not otherwise receive them
c.
May make other nurses angry because of the increased expectations created
d.
May be disciplined by the board of nursing

Answer 90

ANS: D
States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse’s ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice.

Question 91

Which error in judgment would be the most serious for the nurse defendant in a legal case?
a.
Discussing the case with the plaintiff
b.
Tampering with the chart
c.
Hiding information from the plaintiff’s attorney
d.
Being discourteous on the witness stand

Answer 91

ANS: B
The patient’s chart is a legal document. Changing or tampering with the chart would be in violation of the standards of practice and the Nurse Practice Act and would not be considered “what a reasonable nurse would do.” The nurse is expected to perform as a reasonable nurse would. If your actions are not those of a reasonable nurse and this causes someone to be injured, you can be sued. Being discourteous on the witness stand may not be professional. It is also not appropriate to discuss the case with the plaintiff or hide information; however, tampering with the chart is a more serious error in judgment.

Question 92

A graduate nurse is preparing to start a first nursing job. What action would be the best legal safeguard for the graduate nurse to take?
a.
Competent practice
b.
A legal contract
c.
A valid license
d.
Following management policies

Answer 92

ANS: A
The best legal safeguard is competent practice. Practicing within the parameters of the state’s Nurse Practice Act, performing care based on established policies and procedures, and performing as a reasonable nurse are the best ways for a nurse to safeguard against legal action. It is important to maintain a current license and follow management policies; however, the best safeguard is being competent. A legal contract is not necessary for all situations and is not necessarily the best legal safeguard.

Question 93

A nurse is providing care to a 6-year-old child with a broken arm. The nurse notices multiple bruises. The child says, “My father got mad because I was bad, and he hit me and broke my arm so that I would remember to be good.” What is the best nursing action?
a.
Chart that the child is a victim of abuse.
b.
Do nothing because the nurse cannot prove the child was abused.
c.
Report the situation to the appropriate authorities.
d.
Ignore what the child said because little children often lie.

Answer 93

ANS: C
States have many statutes that require health care providers to report certain incidences or occurrences. If the provider fails to report as required and a person is injured, there can be negligence per se. It important for nurses to be aware of the reporting statutes in the state in which they are practicing. In most states, it is the law to report evidence of child or adult abuse. It is not appropriate to chart a decision that the child is a victim of abuse but rather to accurately describe injuries and comments that are made. Nurses should listen to what the patient has to say—whether the patient is a child or adult.

Question 94

What would be the most effective way for a nurse to validate informed consent?
a.
Check the chart for a completed and signed consent form.
b.
Determine from the physician what was discussed with the patient.
c.
Ask the family whether the patient understands the procedure.
d.
Ask the patient what he/she understands about the procedure.

Answer 94

ANS: D
Asking the patient (not the family unless the patient is a minor child) what he/she understands about the procedure is an effective way to validate informed consent. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for the procedure to be done. The piece of paper is simply evidence that the informed consent process has been completed. Determining from the physician what was discussed does not guarantee that the patient understands what was explained.

Question 95

What action might be taken on a nurse who commits an infraction of the Nurse Practice Act?
a.
The nurse is subject to discipline by a court of law.
b.
The nurse is subject to discipline by the state board of nursing.
c.
The nurse is subject to discipline by the state nurses association.
d.
The nurse is subject to discipline by the National League for Nursing.

Answer 95

ANS: B
The Nurse Practice Act is regulated and enforced by the state board of nursing. State Nurse Practice Acts regulate nursing by controlling the scope of practice and determining the specific activities for each level of nursing. The National League of Nursing is involved with nursing program accreditation. The local state nurses association does not provide discipline for infractions of the Nurse Practice Act. Only if the infraction is of a criminal nature will the state board of nursing refer the case to the local court of law.

Question 96

The nurse understands “scope of nursing practice” when making which of the following statements?
a.
“The scope of nursing practice includes acts that permit some overlap between nursing and medicine.”
b.
“The scope of nursing practice includes activities that are legally permissible for a nurse to perform in a particular state.”
c.
“The scope of nursing practice are the specific duties the nurse owes to a patient.”
d.
“The scope of nursing practice involves those activities for which a nurse can be held liable for malpractice.”

Answer 96

ANS: B
Defining the scope of nursing practice is part of the responsibility of the state board of nursing. This involves determining the specific activities for each level of nursing and who can perform what functions. The duty that a nurse owes to a patient is part of the professional nurse–patient relationship. Any nursing activity that is outside the scope of nursing practice can be grounds for malpractice or negligence.

Question 97

A student nurse is studying assault and battery. The student interprets assault and battery to include
a.
the nurse, without consent, touched the patient in an offensive, insulting, or injurious way.
b.
the nurse threatened to put the patient in restraints if he or she did not stay in bed.
c.
the nurse said the bill has to be paid before the patient can leave.
d.
the nurse failed to perform an act expected of a reasonable nurse.

Answer 97

ANS: A
Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Permission to do this touching is usually implied when the patient seeks medical care. Using restraints or threatening to use them on competent patients to make them do what you want them to do against their wishes is an example of false imprisonment. Failure to perform an act expected of a reasonable, prudent nurse can constitute negligence.

Question 98

A nurse understands informed consent when making which of the following statements?
a.
“Informed consent is a binding agreement.”
b.
“Informed consent involves filling out a consent form.”
c.
“Informed consent occurs when the patient receives information about a procedure before giving consent.”
d.
“Informed consent is a name for a written legal policy.”

Answer 98

ANS: C
Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for it to be done. Informed consent is not a binding agreement or a written legal policy and is more than just a consent form.

Question 99

Which definition given by the nurse indicates understanding of malpractice?
a.
“Malpractice is a criminal act committed against society.”
b.
“Malpractice means doing something a reasonable person or nurse would not do.”
c.
“Malpractice is an intentional professional act of negligence.”
d.
“Malpractice is a professional act or failure to act that leads to injury of a patient.”

Answer 99

ANS: D
Malpractice may be defined as doing something outside your scope of practice or something that is unsafe for the patient and could cause injury. A criminal act committed against society may be a felony or a misdemeanor. Negligence is the failure to act as an ordinary prudent person when such failure results in harm to another.

Question 100

A nurse tells a patient, “If you don’t stop getting out of that chair, I’m going to put some restraints on you.” What may this nurse be accused of?
a.
False imprisonment
b.
Defamation
c.
Invasion of privacy
d.
Malpractice

Answer 100

ANS: A
Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Use of restraints may also be interpreted as false imprisonment. False imprisonment means making someone wrongfully believe that he/she cannot leave a place. It is often associated with assault and battery claims. Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Malpractice is the improper performance of professional duties, a failure to meet the standards of care that results in harm to another person. Defamation (libel and slander) refers to causing damage to someone else’s reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander. Invasion of privacy applies to several behaviors, such as photographing a procedure and showing it without the patient’s consent, going through a patient’s belongings without consent, or talking about a patient’s private life publicly.

Question 101

During a malpractice suit, how can the standard of “what the wise and prudent nurse would do” best be established?
a.
From the testimony of an expert nurse
b.
By consulting with nursing faculty regarding standards of care
c.
Conferring with a lawyer regarding malpractice parameters
d.
By consulting the standards of The Joint Commission

Answer 101

ANS: A
The most common way to establish the duty owed by a nurse is by the testimony of a registered nurse—usually, but not always, with training and background similar to the nurse being sued. This expert witness will then testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. The Joint Commission standards may reflect on hospital policies and procedures, not the nurse’s practice. A lawyer provides legal advice but cannot attest to the standards of nursing practice that a nurse can. Faculty can be knowledgeable about standards of care, but the testimony of a nurse with similar training and background can determine what the wise and prudent nurse would have done.

Question 102

During a life-threatening emergency, a nurse hurriedly gives the patient a medication by IV push. There is extravasation of medication. Later, necrosis and tissue sloughing take place. The nurse’s behavior may be the basis for what action?
a.
Felony charge
b.
Misdemeanor charge
c.
Tort suit
d.
Defamation suit

Answer 102

ANS: C
Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Civil, as opposed to criminal, actions are also called torts. Remember that civil actions occur when a plaintiff files a lawsuit to receive compensation for damages he/she suffered as a result of a perceived wrong. Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Defamation (libel and slander) refers to causing damage to someone else’s reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander.

Question 103

At the time of admission, a patient gave a history of allergy to penicillin that was duly noted in all critical areas of the patient’s record. While giving medications, a nurse accidentally administered penicillin to this patient. The patient had a severe reaction but recovered. What is the implication of the nurse’s action?
a.
The nurse cannot be sued for malpractice because the patient did not directly inform the nurse of the allergy.
b.
The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice.
c.
The nurse who gave the medication can bring a countersuit against the nurse who took the history.
d.
There is no cause for concern because the action did not result in the patient’s death.

Answer 103

ANS: B
The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. The allergy was clearly documented, so the patient did not have to tell this particular nurse about it; the nurse was responsible for knowing it. There is no justification for the nurse to bring about a countersuit for the nurse who took the medication history because it was clearly noted in all critical areas of the chart. Injury or harm, not death, is the standard for malpractice.

Question 104

In a legal suit, what element is necessary to prove that malpractice has been committed?
a.
Intent
b.
Assault
c.
Injury
d.
Expenses

Answer 104

ANS: C
There are four elements that need to be present in a malpractice case, one of which is patient injury. The patient will have to prove that the specific nursing action caused injury or harm. Intent, assault, and expenses are not included in the elements of malpractice.

Question 105

What action must occur to prove a breach of duty?
a.
Liability testimony of physician
b.
Testimony from state board of nurses
c.
Expert testimony
d.
Testimony of coworkers

Answer 105

ANS: C
The duty of a nurse is to act as a reasonable nurse would under the same or similar circumstances. An expert witness may testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. Testimony from a physician, the state board of nursing, or coworkers does not establish a breach of duty. The state board of nursing provides the statutes and laws that govern nursing practice.

Question 106

What is a significant action a nurse can take to prevent being named in malpractice suits?
a.
Refuse to care for suit-prone patients.
b.
Carry professional liability insurance.
c.
Maintain updated professional knowledge and skills.
d.
Check with a nursing supervisor before undertaking care.

Answer 106

ANS: C
When you become a registered nurse, you will have a license to practice nursing. This license sets certain standards, which you must follow as a nurse in the state. Should you not live up to these standards, your state can take away your ability to practice as a nurse. The best way to maintain those standards to practice professionally is to stay updated on skills and knowledge. Refusing to care for patients does not prevent you from being named in other malpractice suits. Carrying professional liability insurance does not prevent a malpractice suit but may provide assistance and monies in paying out claims. Although it is important to check with a supervisor about questions concerning nursing care, it may not prevent you from being named if you perform a procedure or intervention incorrectly.

Question 107

A nurse places a heating pad on the lower leg of a patient with peripheral vascular disease. When the heating pad is removed, it is apparent that the patient has sustained partial-thickness burns to the area covered by the pad, and the nurse is sued for malpractice. Which statement is true?
a.
All elements are present to find the nurse liable for damages.
b.
Proximate cause cannot be established, so the nurse will not be found liable.
c.
The standard of care in such a situation cannot be established, so the nurse will not be found liable.
d.
No duty to the patient exists, so the nurse will not be held liable.

Answer 107

ANS: A
The nurse had a duty, that duty was breached, the patient suffered harm (partial-thickness burn), and that harm was caused by the nurse’s actions. All four elements for a malpractice suit are present. The other options do not show that all elements are present and are therefore incorrect.

Question 108

A nurse has relocated to another state and wants to find a full-time nursing job. What action should be taken first in order to provide care as a nurse?
a.
Begin applying for jobs at the local hospital.
b.
Contact the board of nursing in the nurse’s new state to obtain licensure.
c.
Begin practicing immediately, as the nurse is still licensed in the other state.
d.
Begin practice on a part-time basis so that a new license is not needed.

Answer 108

ANS: B
The nurse should contact the board of nursing in the state the nurse just moved to in order to determine what needs to be done to obtain licensure to practice in that state. The nurse should not begin practicing without an updated license even on a part-time basis. Each state may require a new license, and the nurse will not be covered by a license issued in another state unless the state is part of the nurse licensure compact. Either way, the nurse will need to contact the board of nursing first.

Question 109

The nurse has an adequate understanding of Nurse Practice Acts when stating which of the following?
a.
“Nurse Practice Acts do not help guide nurses.”
b.
“Nurse Practice Acts describe how to prepare for the NCLEX exam.”
c.
“Nurse Practice Acts describe how and when to renew a nursing license.”
d.
“Nurse Practice Acts provide a list of job openings.”

Answer 109

ANS: C
Nurse Practice Acts are great resources that provide information to nurses, including how and when to renew a nursing license. The Nurse Practice Acts do not describe how to prepare for the NCLEX exam or provide a list of job openings.

Question 110

A nurse wants to avoid malpractice claims. Which action can be taken to greatly reduce the risk of a lawsuit?
a.
Reduce work status to part time.
b.
Implement fall precautions on an older adult patient.
c.
Leave clutter on the floor in patient rooms for housekeeping.
d.
Leave the patient’s bed in the highest position so he/she can look out the window.

Answer 110

ANS: B
To protect oneself from a malpractice claim, the nurse can implement fall precautions on an older adult patient. These include supervising the patient when getting out of bed, keeping the floor clear, and placing the bed in the lowest position. Reducing work status to part time would not guarantee that the nurse wouldn’t be named in a lawsuit.

Question 111

A nurse has just administered a medication when suddenly realizing that more medication was given than was ordered. Which action should the nurse take?
a.
Call the patient’s provider, and report the error.
b.
Say nothing about the medication error, and continue to monitor the patient.
c.
Document the dose that was supposed to be given in the medical record.
d.
Document the amount given in the medical record, but keep the error quiet.

Answer 111

ANS: A
The nurse should call the provider and report the error after assessing the patient’s condition. The nurse should never falsify a document in the medical record or keep the error to him/herself.

Question 112

Which of the following would be considered a criminal action?
a.
A nurse who steals narcotics from the hospital
b.
A nurse who gets into a verbal disagreement with a visitor
c.
A nurse who restrains a patient who is considered a threat to him/herself
d.
A nurse who refuses to allow a visitor onto the unit who appears intoxicated

Answer 112

ANS: A
An example of a criminal action is the nurse who steals narcotics from the hospital. Verbal disagreements, restraining patients who have the potential to harm themselves, and refusing visitors who appear intoxicated are not examples of criminal actions.

Question 113

Which of the following can result in a civil action against the nurse?
a.
Failure to monitor
b.
Enforcing strict compliance with contact precautions against the family’s wishes
c.
Refusing to discuss the patient’s condition with the family per patient request
d.
Assisting the physician in a bedside procedure after obtaining informed consent

Answer 113

ANS: A
Failure to monitor can result in a civil action against the nurse. Enforcing strict compliance with contact precautions against the family’s wishes, refusing to discuss the patient’s medical history with family per the patient’s request, and assisting the physician in a bedside procedure after obtaining informed consent are not examples that could lead to civil action.

Question 114

Which of the following statements by the nurse indicates understanding of legal actions?
a.
“A misdemeanor is a less serious crime resulting in a fine.”
b.
“A felony is a less serious crime that can result in a fine.”
c.
“Civil actions are serious and often result in prison time.”
d.
“The defendant is the victim.”

Answer 114

ANS: A
A misdemeanor is a less serious crime resulting in a fine. A felony is a serious crime that often results in prison time. In court cases, the victim is the plaintiff.

Question 115

Which statement by the nurse indicates understanding of the Nurse Practice Act?
a.
“The Nurse Practice Act defends any action the nurse may take.”
b.
“The Nurse Practice Act defines the scope of practice for each level of licensure.”
c.
“The Nurse Practice Act details pay raises and benefits for nurses.”
d.
“The Nurse Practice Act has language that grants nurses vacation time.”

Answer 115

ANS: B
The Nurse Practice Actdefines the scope of practice for each level of licensure. It is a type of state statutory law and can be obtained from the state board of nursing or online. It does not defend any action the nurse may take, detail pay raises, or discuss vacation time.

Question 116

Which actions take place in organizations to monitor quality improvement? (Select all that apply.)
a.
Evaluation of what nurses are doing for patients
b.
Development of policies and procedures
c.
Employee evaluations
d.
Intermittent monitoring
e.
Continuing education

Answer 116

ANS: A, B, C, E
There are many actions that take place in organizations to monitor quality improvement. These include evaluation of what nurses are doing for patients, development of policies and procedures, employee evaluations, ongoing monitoring, and continuing education.

Question 117

A nurse is completing an incident report. The nurse demonstrates an adequate understanding of the report when refraining from putting which of the following on the form? (Select all that apply.)
a.
Conclusions about the incident
b.
The name of the patient
c.
Blame of others
d.
Judgment
e.
The nurse’s opinion about what happened

Answer 117

ANS: A, C, D, E
The nurse should avoid putting conclusions, blame, judgment, and opinions on the incident report. The nurse should only relay facts. It would be appropriate for the nurse to list the patient’s name.

Question 118

The nurse has an adequate understanding of risk management when stating which of the following? (Select all that apply.)
a.
“Risk management becomes involved when incidents occur.”
b.
“Risk management becomes involved when untoward events occur.”
c.
“Risk management becomes involved to discipline the nurse.”
d.
“Risk managers gather evidence surrounding the event.”
e.
“Risk managers will interview those involved in an event.”

Answer 118

ANS: A, B, D, E
Risk management becomes involved when incidents and untoward events occur. Risk managers gather evidence surrounding the event and interview those involved. Risk management does not become involved to discipline the nurse.

Question 119

A nurse wants to improve cultural competence. What action shows progress toward this goal?
a.
Uses an evidence-based cultural assessment tool
b.
Tries to treat all patients the same
c.
Prioritizes care based on cultural needs
d.
Wants to learn more about other ethnic groups

Answer 119

ANS: A
One action nurses can take to improve cultural competence is to learn how to use cultural assessment tools. The other actions are good steps but do not demonstrate progress to the stated goal as well as using an evidence-based tool.

Question 120

What is an example of a system barrier to cultural competence?
a.
Lack of knowledge regarding kosher diet options on menu
b.
No sinks in every patient room
c.
No privacy curtains in exam rooms
d.
A strict and enforced policy against more than one visitor in the ICU

Answer 120

ANS: D
System barriers are due to the agency’s structure and policies that do not support cultural diversity. A strict and enforced ICU visitor policy, for example, will impact those cultures with a strong emphasis on the extended family. Provider barriers are those such as a nurse may have, including lack of information about a culture. A lack of knowledge about a culturally specific diet is an example. Facility issues such as sinks and privacy curtains are not specifically related to culture but are needed for every patient.

Question 121

Which of the following actions causes health care disparities?
a.
Refusal of treatment
b.
Provider–patient relationships
c.
Trust in the health care system
d.
Provider bias and discrimination

Answer 121

ANS: A
Disparities in health care can include both provider and patient variables. Patient variables are mistrust of the health care system and refusal of treatment.

Question 122

Which of the following actions would have little to no impact in helping resolve health care disparities?
a.
Research on life stressors
b.
Access to basic health care
c.
Increasing diversity of health care workers
d.
Health promotion and wellness programs

Answer 122

ANS: A
Some solutions to help resolve health care disparities include the following: increasing the diversity of health care providers; ensuring that all people have access to affordable, basic health care; promoting wellness and a healthy lifestyle; strengthening provider–patient relationships; increasing cultural competency of health care providers; and conducting research to determine why certain diseases affect minorities so greatly and to discover effective intervention strategies. Research on life stressors does not have an impact on resolving health care disparities.

Question 123

Based on assessment data, the nursing diagnosis for a patient is spiritual distress related to loneliness or social alienation. What would be included in spiritual nursing interventions?
a.
Participate in active listening.
b.
Identify level of functioning.
c.
Assist with activities of daily living.
d.
Evaluate ability to understand events.

Answer 123

ANS: A
Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the patient’s thoughts and feelings, values clarification, sensitive responses to patient beliefs, and developing a trusting relationship. Identifying level of functioning and ADLs addresses basic human needs. Evaluating the ability to understand events is addressing cognitive function.

Question 124

By asking “How has being sick affected your spiritual practices?” the nurse is trying to determine the need in what spiritual dimension?
a.
Sources of hope and strength
b.
Spirit-enhancing practices or rituals
c.
Involvement in spiritual community
d.
Experience of God or transcendence

Answer 124

ANS: B
According to Taylor in Spiritual Care: Nursing Theory, Research, and Practice (2002), asking the following assessment question helps determine the patient’s spirit-enhancing practices or rituals: “How has being sick affected your spiritual practices?” As a testing strategy, note that the answer has the spiritual practices and so does the question. Other questions would assess sources of hope and strength, involvement in the spiritual community, and their experience of God or transcendence.

Question 125

Using a spiritual assessment tool helps the nurse gain more understanding of the patient. What would be the best question to assess a patient’s inner strengths?
a.
What gives your life meaning?
b.
Are you motivated to get well?
c.
What do you do to show love for yourself?
d.
What brings you joy and peace in your life?

Answer 125

ANS: D
Asking what brings joy and peace to a person’s life is an example of a reflective question to help increase the awareness of the inner strengths of a patient’s spiritual process. Such a question assesses a person’s ability to manifest joy. Asking about what gives meaning could address family and career and not necessarily a patient’s inner strength. Asking about motivation and what a person does to show love for him/herself does not encourage reflection on inner strengths but asks a question that could be briefly answered.

Question 126

Determine which of the following situations would be a provider barrier to the nurse developing cultural competence.
a.
A nurse who is unaware of personal biases to other ethnic groups
b.
No family rooms to accommodate a critically ill patient’s family
c.
A nurse who seeks encounters with individuals from other cultures
d.
A health care provider who incorporates alternative therapies in health care

Answer 126

ANS: A
A nurse who is unaware of personal biases to other ethnic groups represents a provider barrier. “No family rooms” is an example of a system barrier. Nurses who seek encounters with individuals from other cultures and who incorporate alternative therapies into health care have a developed sense of cultural competence.

Question 127

A manager is educating a group of nurses on the importance of cultural competence. The manager knows that the teaching has been effective when one of the nurses states
a.
“Cultural competence does not impact patient care.”
b.
“Cultural competence is not important in health care.”
c.
“Lack of cultural competence leads to suboptimal patient outcomes.”
d.
“Lack of cultural competence does not cause active harm to the patient.”

Answer 127

ANS: C
Lack of cultural competence is extremely important in health care because it directly impacts patient care. Lack of cultural competence leads to suboptimal care and can cause active harm to the patient.

Question 128

A nurse has an adequate understanding of the barriers to cultural competence when making which of the following statements?
a.
“Barriers to cultural competence no longer exist in today’s society.”
b.
“The barriers to cultural competence cannot be broken down.”
c.
“Provider barriers include having knowledge about a custom’s culture regarding health care.”
d.
“System barriers exist when an agency’s structure and policies are not designed to support cultural diversity.”

Answer 128

ANS: D
Barriers to cultural competence exist in today’s society and can be broken down with the help of health care providers. Provider barriers include having a lack of knowledge about a custom’s culture regarding health care. System barriers exist when an agency’s structure and policies are not designed to support cultural diversity.

Question 129

A nurse is attending a lecture on health disparities. The education has been effective when the nurse states which of the following?
a.
“Inequalities in income and education are the root of many health disparities.”
b.
“Today, there are no longer inequalities preventing access to health care.”
c.
“Low education and low income levels are related to lower rates of health disparities.”
d.
“Higher income is associated with more health disparities than lower income.”

Answer 129

ANS: A
Inequalities in income and education are the root of many health disparities. Individuals with low education and low income levels often have higher rates of health disparities, and higher income is associated with fewer health disparities.

Question 130

A nurse is working in a disaster area as a volunteer with the local ambulance agency. The nurse is providing care to a Spanish-speaking patient. What actions can be taken to properly care for this patient?
a.
Use gestures to emphasize what he is saying.
b.
Obtain an interpreter.
c.
Provide wound care instructions written in English.
d.
Treat the patient without speaking to her.

Answer 130

ANS: B
The Office of Minority Health and Disaster Preparedness launched an initiative in 2009 to help first responders better manage disaster and crises in diverse populations. The nurse can use this initiative by obtaining an interpreter and providing wound care instructions written in English. The nurse should not rely on gestures to get his point across or treat the patient without speaking to her.

Question 131

A nurse is caring for a patient experiencing spiritual distress. What nursing intervention would be appropriate for this patient?
a.
Asking the patient to reserve prayer for the hospital chaplain
b.
Placing the patient by the nurses’ station because it will be distracting
c.
Developing a trusting relationship with the patient
d.
Allowing the patient’s roommate to have visitors late into the night

Answer 131

ANS: C
It is important that the nurse develop a trusting relationship with the patient, as well as being supportive of the patient’s needs. The nurse should allow the patient a quiet environment that allows time for prayer and meditation.

Question 132

A nurse is caring for a diabetic patient who frequently uses alternative medicine to manage ailments. The patient feels nauseous and requests ginger tea. What should the nurse be aware of before giving the patient ginger tea?
a.
Nothing; natural remedies do not cause unwanted side effects.
b.
Ginger can cause blood glucose levels to decrease.
c.
Ginger causes blood glucose levels to rise.
d.
Ginger can cause a diabetic patient to become more nauseous.

Answer 132

ANS: B
Nurses should be aware of natural remedies and their interactions because more patients turn to these remedies as opposed to medication for management of ailments. In this scenario, the nurse should be aware of the fact that ginger can cause blood glucose levels to decrease, possibly causing harm to the diabetic patient.

Question 133

A nurse manager is looking for ways to improve the cultural competency of unit staff. Which action would help the manager accomplish this?
a.
Propose voluntary cultural competence training.
b.
Hire bicultural clinical and administrative staff.
c.
Hire staff from the same ethnic background.
d.
Avoid issues pertaining to cultural competence.

Answer 133

ANS: B
The nurse manager can improve the staff’s cultural competence by hiring bicultural clinical and administrative staff to improve education, care delivery, and outcomes. The nurse manager should also propose mandatory cultural competence training and hire staff from different ethnic backgrounds

Question 134

A nurse is educating a patient’s family on holistic nursing. Which statement by a family member leads the nurse to determine that more education is needed?
a.
“Holistic nursing is an attitude.”
b.
“Holistic nursing is a way of being.”
c.
“Holistic nursing focuses on healing the person as a whole.”
d.
“Holistic nursing focuses on healing the system causing the ailment.”

Answer 134

ANS: D
Holistic nursing is an attitude, a way of being, and is focused on healing the person as a whole. It is not focused on the system causing the ailment.

Question 135

A nurse is gathering data on a patient of a different culture. Which action can the nurse take to enhance communication while gathering cultural data?
a.
Ignore the patient’s culture and focus on the reason for hospital admission.
b.
Use hand gestures to get points across to a patient with poor English.
c.
Use closed-ended questions to gather information.
d.
Determine the patient’s level of fluency in English.

Answer 135

ANS: D
The nurse should determine the patient’s level of fluency in English to enhance communication. If needed, the nurse should obtain an interpreter. The nurse should not avoid the patient’s culture during the assessment. Hand gestures should not be used because they could be offensive to the patient. The nurse should use open-ended questions or questions phrased in different ways as a method to gather data.

Question 136

The nurse understands that the following organization believes that cultural competence in nursing is necessary.
a.
Nurse Practice Acts of state boards of nursing
b.
Code of Ethics of the American Nurses Association
c.
Accreditation standards of the National League of Nursing
d.
Accreditation standards of The Joint Commission (TJC)

Answer 136

ANS: B
The American Nurses Association indicates in its Code of Ethics the necessity of the nurse to be sensitive to individual needs. State boards of nursing are involved in the regulation and licensure of nursing practices. The National League of Nursing is involved with accreditation of nursing programs. TJC is involved with hospital accreditation.

Question 137

In what culture are older adults respected and unquestioned?
a.
Asian
b.
African American
c.
Hispanic
d.
Native American

Answer 137

ANS: B
In the African American culture, older family members are respected, and their authority is unquestioned. Native American, Asian, and Hispanic culture do not consider elders unquestionable.

Question 138

The nurse knows that in this culture mental illness can bring shame on the family.
a.
Chinese
b.
Hispanic
c.
Native American
d.
African American

Answer 138

ANS: A
In the Chinese ethnic group, mental illness has a stigma that can bring shame on the family. The other ethnic groups do not have this family-centered view of mental illness.

Question 139

The nurse is creating a plan of care for a patient. Which would be important for the nurse to consider before implementing the plan? (Select all that apply.)
a.
The patient’s lifestyle
b.
The patient’s insurance coverage
c.
The patient’s value system
d.
The patient’s religious beliefs
e.
The patient’s ability to pay for services

Answer 139

ANS: A, C, D
When creating a plan of care for the patient, the nurse should consider the patient’s lifestyle, value system, and religious beliefs.

Question 140

A nurse manager is educating unit staff on cultural competence. The manager knows that the teaching has been effective when one of the staff members states that “cultural competence is (Select all that apply.)
a.
not important in health care.”
b.
accepting and respecting cultural differences.”
c.
demonstrating knowledge of the patient’s culture.”
d.
demonstrating an understanding of the patient’s culture.”
e.
adapting care to be congruent with the patient’s culture.”

Answer 140

ANS: B, C, D, E
Purnell and Paulanka (2009) define cultural competence as accepting and respecting cultural differences, demonstrating knowledge of the patient’s culture, demonstrating an understanding of the patient’s culture, and adapting care to be congruent with the patient’s culture.

Question 141

Which actions by the nurse show cultural competence of Native American culture? (Select all that apply.)
a.
Refuse to allow rituals to be practiced at the bedside.
b.
Allow the family to bring in a medicine man for healing.
c.
Allow the family and patient time for prayer.
d.
Provide space for rituals.
e.
Work hard to gain trust.

Answer 141

ANS: B, C, D, E
The nurse can show culturally competent care of an Native American patient by allowing the family to bring in a medicine man, allowing time for prayer, providing space for rituals, and working hard to gain trust.

Question 142

Which statements by the nurse show understanding of the Vietnamese culture? (Select all that apply.)
a.
“Vietnamese are slow to trust authority figures.”
b.
“Vietnamese have a very patriarchal society.”
c.
“Vietnamese will try home remedies before seeking Western medicine.”
d.
“Vietnamese are often compliant with Western treatment once sought.”
e.
“Vietnamese are generally noncompliant with health care.”

Answer 142

ANS: A, B, C, D
The nurse shows understanding of Vietnamese culture by stating that the Vietnamese are slow to trust authority figures, are a very patriarchal society, will try home remedies before seeking Western medicine, and are often compliant with Western treatment once sought.

Question 143

A nurse is educating a student nurse on African American culture. The nurse judges the teaching to be effective when the student nurse states that African Americans (Select all that apply.)
a.
“have extended family who have a great influence on the patient.”
b.
“honor and respect older family members.”
c.
“have the oldest woman as the decision maker.”
d.
“do not disagree with health care recommendations.”
e.
“don’t always follow up with health care recommendations.”

Answer 143

ANS: A, B, D, E
The teaching has been effective when the student nurse states that African Americans have extended family who have a great influence on the patient, have older family members who are honored and respected, do not disagree with health care recommendations, and don’t always follow up with health care recommendations. The oldest man is the decision maker.

Question 144

The nurse has an adequate understanding of Japanese culture when stating which of the following? (Select all that apply.)
a.
“The Japanese believe that contact with blood, skin diseases, and corpses causes illness.”
b.
“The Japanese believe in healers and herbalists.”
c.
“The Japanese have high regard for physicians.”
d.
“The Japanese tend to not question the care of the physician.”
e.
“The Japanese verbally express pain.”

Answer 144

ANS: A, B, C, D
The nurse has an adequate understanding of Japanese culture when stating that the Japanese believe that contact with blood, skin diseases, and corpses causes illness; have high regard for physicians; and often do not question their care. The Japanese do not express pain, believing that it is a virtue to bear pain.