Nursing Within the Context of Contemporary Health Care

Nursing Within the Context of Contemporary Health Care

Nursing Within the Context of Contemporary Health Care

1. A home care nurse is visiting an older adult who
experienced a brain attack 2 years ago and now has a
sacral pressure ulcer. The nurse identifies that the
patient and spouse both appear unkempt and the
spouse appears tired and irritated. The patient is very
quiet and avoids eye contact. Which nursing action is
most appropriate?

Nursing Within the Context of Contemporary Health Care

1. Explore with the patient and spouse their concerns.
2. Assess the patient for signs of physical abuse and
neglect.
3. Discuss with the patient and spouse additional
resources to help with the patient’s care.
4. Assess the patient’s pressure ulcer and report findings to the primary health-care provider.
2. A patient is admitted to a home health-care program
for palliative care. When completing the admission
interview and nursing assessment the patient empathically states, “I want no intervention to extend my life
other than keeping me comfortable.” When talking
with family members they want the patient to continue chemotherapy. What should the nurse do?
1. Protect the patient’s right to self-determination.
2. Initiate a referral to a psychiatric nurse practitioner.
3. Ask the patient to reconsider chemotherapy for the
sake of the family.
4. Refer family members to the primary health-care
provider to resolve this issue.
3. A nurse is planning patient care based on moral and
ethical principles. Which nursing statement demonstrates an effort to implement the principle of fidelity?
1. “Let’s talk about foods that are healthy and that you
should include in your daily diet.”
2. “I know that you are out of work, so I have arranged
for you to get follow-up care at our out-patient clinic.”
3. “You said that your son wants you to have this surgery. What is important is what you believe is best
for you.”
4. “It’s been half an hour and I am back as I promised
to ensure that the pain medication I gave you is
providing relief.”
4. Which statements are associated with state nurse
practice acts? Select all that apply.
1. Nurse practice acts identify what a
nurse can and cannot do.
2. A purpose of state nurse practice acts
is to regulate the practice of nursing.

Nursing Within the Context of Contemporary Health Care

3. The federal government is the regulating agency responsible for state nurse
practice acts.
4. Student nurses are not obligated to
meet the same standards of care as are
licensed nurses.
5. If a student nurse is involved in a disciplinary action by the state board of
nursing, the student may be prohibited from taking the National Council
Licensure Examination.
5. A nurse is caring for an adult patient who is scheduled
for surgery. Which action is not associated with the
nurse ensuring a valid, legal consent?
1. Observe the patient signing the consent form.
2. Ensure that the patient is signing the consent form
voluntarily.
3. Assess if the patient has the capacity to make an
informed consent.
4. Review with the patient the risks and benefits of the
surgery before the consent is signed.
6. Which situation should the nursing staff refer to the
hospital ethics committee?
1. The adult patient with renal insufficiency who
refuses dialysis
2. The wife who wants her unconscious husband to
have a drug that is available in a phase-three trial
3. The parents of a developmentally disabled adult
who disagree with the health-care decisions of the
court appointed guardian
4. The adult patient recently diagnosed with metastatic cancer who wants hospice care but whose family
wants chemotherapy to be given immediately
34 Unit I Nursing Within the Context of Contemporary Health Care

7. A nurse is implementing care based on moral and
ethical principles. What should the nurse do first to
accomplish a personal professional code of ethics consistent with the American Nurses Association Code of
Ethics for Nurses?
1. Deliver care that preserves and protects patient
autonomy and self-determination.
2. Explore personal values and beliefs because they
affect nursing decisions.
3. Implement culturally competent and sensitive
nursing care to patients.
4. Respect the inherent worth and uniqueness of each
individual patient.
8. Which actions meet obligations regarding the Health
Insurance Portability and Accountability Act
(HIPAA) of 1996? Select all that apply.
1. Allowing patients the right to review
and copy their clinical record
2. Providing access to a patient’s clinical
record to all members of the nursing
team
3. Holding patient rounds in a hallway
out of the hearing range of the patient
being discussed
4. Explaining to a person inquiring
about the condition of a patient
that information about the patient
is confidential
5. Giving medical information about an
unconscious patient to a patient’s
daughter who is the person indicated
in the patient’s proxy directive
Chapter 2 Legal and Ethical Issues 35
9. An older adult is diagnosed with atrial flutter with a
4-to-1 block. The atrial rate is 280 beats/minute and
the ventricular rate is 70 beats/minute. The patient is
admitted to the hospital and transferred to a medical
unit. The patient is being treated with diltiazem
(Cardizem), an antidysrhythmic, as well as continuous
electrocardiogram monitoring. The primary healthcare provider is contemplating performing cardioversion if the patient does not respond favorably to the
antidysrhythmic. Later that evening, the patient reports
feeling strange, so the nurse obtains the patient’s vital
signs and performs a physical assessment. The nurse
concludes that the patient is stable and continues to follow the primary health-care provider’s orders. During
the night, the patient dies. Eventually, the patient’s
cause of death is determined to be a brain attack (cerebral vascular accident, stroke). The risk manager of the
hospital reviews the patient’s clinical record, specifically
the vital signs, nurse progress notes, and electrocardiogram results.