You are on page 1of 28

Import Settings:

Base Settings: Brownstone Default


Information Field: Chapter
Information Field: Client Needs
Information Field: Cognitive Level
Information Field: Difficulty
Information Field: Integrated Process
Information Field: !"ective
Information Field: Page and #eader
#ighest $nswer Letter: %
&ultiple 'eywords in Same Paragraph: No
Chapter: Chapter (): Critical *hin+ing, %thical Decision &a+ing, and the Nursing Process
&ultiple Choice
-. $ nurse is offered a position at a clinic that offers therapeutic a!ortions. *his procedure
contradicts the nurse/s personal !eliefs. *he nurse +nows that she is una!le to care for these
patients o!"ectively. 0hat is the nurse/s ethical o!ligation to these patients1
$2 *he nurse is re3uired !y law to continue service to these patients.
B2 *he nurse should ma+e the choice to decline this position.
C2 *he nurse may discriminate !etween patients and refuse to care for the patient.
D2 *he nurse may e4press his or her opinion and provide another option to terminating the
pregnancy.
$ns: B
Chapter: )
Client Needs: C
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Caring
!"ective: 5
Page and #eader: 67, %thical Nursing Care
Feed!ac+: *o avoid facing ethical dilemmas, nurses can follow certain strategies. For e4ample,
when applying for a "o!, a nurse should as+ 3uestions regarding the patient population. If a nurse
is uncomforta!le with a particular situation, then not accepting the position would !e an option.
*he other answers would !e incorrect !ecause the nurse is only re3uired !y law to provide care
to the patients the clinic accepts, the nurse may not discriminate !etween patients, and the nurse
e4pressing her own opinion and providing another option is inappropriate.
6. $ terminally ill patient you are caring for is complaining of pain. *he physician has ordered a
large dose of narcotic via intravenous infusion. 8ou +now that one of the side effects of this
medicine is respiratory depression. 0hen you assess your patient/s respiratory status, you find
that the rate has decreased from -9 !reaths per minute to -( !reaths per minute. 0hat action
should you ta+e1
$2 Decrease the I: infusion
B2 Stimulate the patient
C2 ;eport the decreased respiratory rate to the physician
D2 $llow the patient to rest comforta!ly
$ns: C
Chapter: )
Client Needs: D<6
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: 5
Page and #eader: 67, %thical Nursing Care
Feed!ac+: %nd<of life issues that often involve ethical dilemmas include pain control, =do not
resuscitate> orders, life<support measures, and administration of food and fluids. *he ris+ of
respiratory depression is not the intent of the action of pain control. ;espiratory depression
should not !e used as an e4cuse to withhold pain medication for a terminally ill patient. *he
patient/s respiratory status should !e carefully monitored and any changes should !e reported to
the physician.
). 0hen a terminally ill patient has re3uested a =do not resuscitate> ?DN;2 order and the family
of the patient is strongly opposed to the patient/s re3uest, what is the responsi!ility of the nurse1
$2 Perform a =slow code> until a decision is made
B2 #onor the re3uest of the patient
C2 Contact a lawyer to intervene
D2 *erminate nursing care until the physician tal+s to the family
$ns: B
Chapter: )
Client Needs: D<-
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Communication and Documentation
!"ective: @
Page and #eader: 67, %thical Nursing Care
Feed!ac+: Discussing the matter with the physician may lead to further communication with the
family, during which the family may reconsider their decision. *he nurse must also honor the
patient/s wishes and continue to provide re3uired nursing care. It is not appropriate for the nurse
to see+ the assistance of a lawyer or to perform a =slow code> in this situation.
@. $ new patient comes to your unit. During admission the patient states, =I have a living will.>
0hat is the correct definition of a living will1
$2 $ legal document that is always honored
B2 $ legal document that specifies the patient/s wishes !efore hospitaliAation
C2 $ legal document that is !inding for the duration of the patient/s life
D2 $ legal document drawn !y the patient/s family to determine DN; status
$ns: B
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Communication and Documentation
!"ective: 5
Page and #eader: 6B, %thical Nursing Care
Feed!ac+: $ living will is one type of advance directive. In most situations, living wills are
limited to situations in which the patient/s medical condition is deemed terminal. *he other
answers are incorrect !ecause living wills are not always honored, they are not !inding for the
duration of the patient/s life, and they are not drawn !y the patient/s family.
5. $ nurse has a duty of nonmaleficence. 0hich of the following would !e considered a
contradiction to that duty?
$2 Provide comfort measures for a terminally ill patient
B2 $ssist the patient with $DLs
C2 ;efuse to administer pain medication as ordered
D2 Provide all information related to procedures
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: )
Page and #eader: 65, %thical Nursing Care
Feed!ac+: *he duty not to inflict as well as prevent and remove harm is termed nonmaleficence.
Providing comfort measures for a terminally ill patient, assisting a patient with $DLs, and
providing information related to procedures would not !e considered a contradiction to the
nurse/s duty of nonmaleficence.
9. 8ou have "ust ta+en report for your shift and you are doing your initial assessment of your
patients. ne of your patients as+s you if there has !een an error made in her medication. 0hich
of the following principles would apply if you give an accurate response1
$2 :eracity
B2 Confidentiality
C2 ;espect
D2 Custice
$ns: $
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Communication and Documentation
!"ective: )
Page and #eader: 69, %thical Nursing Care
Feed!ac+: *he o!ligation to tell the truth and not deceive others is termed veracity. *he other
answers are incorrect !ecause they are not the o!ligation to tell the truth.
D. It is important that the wording of a nursing diagnosis falls within the ta4onomy of nursing.
0hich organiAation is responsi!le for developing the ta4onomy of a nursing diagnosis1
$2 $merican Nurses $ssociation ?$N$2
B2 North $merican Nursing Diagnosis $ssociation ?N$ND$2
C2 National League for Nursing ?NLN2
D2 Coint Commission
$ns: B
Chapter: )
Client Needs: $<-
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: )6, *he Nursing Process
Feed!ac+: North $merican Nursing Diagnosis $ssociation ?N$ND$2 International is the
official organiAation responsi!le for developing the ta4onomy of nursing diagnoses and
formulating nursing diagnoses accepta!le for study. *he $N$, NLN, and Coint Commission are
not charged with the tas+ of developing the ta4onomy of nursing diagnoses.
7. 0hat phase of the nursing process is the nurse in when he determines a medication is
effective and documents this in the patient/s record1
$2 $nalysis
B2 %valuation
C2 $ssessment
D2 Data collection
$ns: B
Chapter: )
Client Needs: D<6
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: D
Page and #eader: )(, *he Nursing Process
Feed!ac+: %valuation, the final step of the nursing process, allows the nurse to determine the
patient/s response to the nursing interventions and the e4tent to which the o!"ectives have !een
achieved. *he other answers are incorrect !ecause they are not the correct phase of the nursing
process.
B. $fter the health history and admission assessment are completed, the nurse esta!lishes a care
plan for the patient. 0hat is the rationale for documenting and planning the patient/s care1
$2 It provides continuity of care.
B2 It creates a teaching log for family.
C2 It verifies staffing.
D2 It provides the patient with information a!out treatments.
$ns: $
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Communication and Documentation
!"ective: 9
Page and #eader: )6, *he Nursing Process
Feed!ac+: *his record provides a means of communication among mem!ers of the health care
team and facilitates coordinated planning and continuity of care. It serves as the legal and
!usiness record for a health care agency and for the professional staff mem!ers who are
responsi!le for the patient/s care. $ care plan is not a teaching log, it does not verify staffing, and
it is not intended to provide the patient with information a!out treatments.
-(. *he nurse is caring for a patient who is com!ative and confused. *he patient has a fractured
hip and is trying to get out of !ed. 0hat is the most appropriate action for the nurse to ta+e1
$2 Leave the patient and get help
B2 !tain a physician/s order to restrain the patient
C2 ;ead the facility/s policy on restraints
D2 rder soft restraints from the storeroom
$ns: B
Chapter: )
Client Needs: $<6
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: @
Page and #eader: 67, %thical Nursing Care
Feed!ac+: It is mandatory in most settings to have a physician/s order !efore restraining a
patient. Before restraints are used, other strategies, such as as+ing family mem!ers to sit with the
patient, or utiliAing a specially trained sitter, should !e tried. *he Coint Commission ?formerly the
Coint Commission on $ccreditation of #ealthcare rganiAations, or CC$#2 and the Centers for
&edicare and &edicaid Services ?C&S2 have designated standards for the use of restraints. $
patient should never !e left alone while the nurse summons assistance. $ll staff mem!ers re3uire
annual instruction on the use of restraints, and the nurse should !e familiar with the facility/s
policy. *his ma+es all other answers incorrect.
--. $ patient admitted with right leg throm!ophle!itis is to !e discharged from an acute<care
facility. *he nurse notes that the patient/s leg is pain<free, without redness or edema. 0hich step
of the nursing process does this reflect1
$2 $ssessment
B2 $nalysis
C2 Implementation
D2 %valuation
$ns: D
Chapter: )
Client Needs: D<@
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: )(, *he Nursing Process
Feed!ac+: *he nursing actions descri!ed constitute evaluation of the e4pected outcomes. *he
findings show that the e4pected outcomes have !een achieved. $ssessment consists of the
patient/s history, physical e4amination, and la!oratory studies. $nalysis consists of considering
assessment information to derive the appropriate nursing diagnosis. Implementation is the phase
of the nursing process where the nurse puts the care plan into action.
-6. During report, a nurse finds that she has !een assigned to care for a patient with $IDS. She
is refusing to care for him !ecause he has $IDS. *he nurse has an o!ligation to this patient under
which legal premise1
$2 Eood Samaritan $ct
B2 Nursing Interventions Classification ?NIC2
C2 Patient Self<Determination $ct
D2 $N$ Code of %thics
$ns: D
Chapter: )
Client Needs: D<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: @
Page and #eader: 67, %thical Nursing Care
Feed!ac+: *he ethical o!ligation to care for all patients is clearly identified in the first statement
of the $N$ Code of %thics for Nurses. *he Eood Samaritan $ct relates to lay people helping
others in need. *he NIC is a standardiAed classification of nursing treatment that includes
independent and colla!orative interventions. *he Patient Self<Determination $ct encourages
people to prepare advance directives in which they indicate their wishes concerning the degree of
supportive care to !e provided if they !ecome incapacitated.
-). $n emergency department nurse is caring for a D<year<old child suspected of having
meningitis. *he patient is to have a lum!ar puncture performed, and the nurse is doing
postprocedure teaching with the child and the mother. *he nurse/s action is an e4ample of which
therapeutic communication techni3ue1
$2 Informing
B2 Suggesting
C2 #umor
D2 Broad openings
$ns: $
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: *eachingFLearning
!"ective: 9
Page and #eader: 67, %thical Nursing Care
Feed!ac+: Informing involves providing information to the patient regarding his care.
Suggesting is the presentation alternative idea for the patient/s consideration relative to pro!lem
solving. #umor is the discharge of energy through the comic en"oyment of the imperfect. Broad
openings encourage the patient to select topics for discussion.
-@. *he nurse, in colla!oration with the patient/s family, is assigning priorities related to the care
of the patient. *he nurse e4plains that when setting priorities it is important to loo+ at the
urgency of specific pro!lems. 0hat provides the !est framewor+ for prioritiAing patient
pro!lems1
$2 $vaila!ility of hospital resources
B2 Family mem!er statements
C2 &aslow/s hierarchy of needs
D2 Nursing s+ill
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: D
Page and #eader: )@, *he Nursing Process
Feed!ac+: &aslow/s hierarchy of needs provides a useful framewor+ for prioritiAing pro!lems,
with the first level given to meeting physical needs of the patient. $vaila!ility of hospital
resources, family mem!er statements, and nursing s+ill do not provide a framewor+ for
prioritiAation of patient pro!lems.
-5. 0hich of the following would !e an e4ample of the nurse practicing fidelity1 *he nurse
$2 regulates visitors.
B2 stays with the patient during his or her death as promised.
C2 withholds information as re3uested.
D2 provides continuity of care.
$ns: B
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Caring
!"ective: )
Page and #eader: 69, %thical Nursing Care
Feed!ac+: Fidelity re3uires the nurse to +eep promises made and to !e faithful to one/s
commitments.
-9. 8ou wor+ in a long<term care facility. ne of your patients is an elderly man who is very
confused. 0hat ethical dilemma is posed when using restraints in a long<term care setting1
$2 It limits personal safety.
B2 It increases confusion.
C2 It threatens autonomy.
D2 It prevents self<directed care.
$ns: C
Chapter: )
Client Needs: $<6
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: @
Page and #eader: 67, %thical Nursing Care
Feed!ac+: Because there are safety ris+s involved when using restraints on elderly confused
patients, this is a common ethical pro!lem in long<term care settings, as well as other health care
settings. ;estraints limit the individual/s autonomy !ecause they are perceived as imprisonment.
;estraints should not limit personal safety. ften restraints increase confusion, and they prevent
self<directed care.
-D. 0hile receiving report on her patients, the nurse learns that a patient with terminal cancer
has granted medical power of attorney to her !rother. 0hat applies to the power of attorney1
$2 $nother individual has !een identified to ma+e decisions on !ehalf of the patient.
B2 It is !inding even if the patient changes his or her mind.
C2 *he named individual is in charge of the patient/s finances.
D2 It is a legal document delegating custody of children to other than the spouse.
$ns: $
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Communication and Documentation
!"ective: 5
Page and #eader: 6B, %thical Nursing Care
Feed!ac+: $ power of attorney is said to !e in effect when a patient has identified another
individual to ma+e decisions on the patient/s !ehalf. *he patient has the right to change her mind.
$ medical power<of<attorney does not give anyone the right to ma+e financial decisions for the
patient nor does it delegate custody of minor children.
-7. Before ma+ing a nursing diagnosis, what must a nurse do1
$2 %sta!lish a plan.
B2 $ssign a positive value to each conse3uence.
C2 Collect and analyAe data.
D2 %valuate the plan of care.
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: 6B, *he Nursing Process
Feed!ac+: In the diagnostic phase of the nursing process, the patient/s nursing pro!lems are
defined through analysis of patient data. %sta!lishing a plan comes after collecting and analyAing
data, evaluating a plan is the last step of the nursing process, and assigning a positive value to
each conse3uence is not done.
-B. 8ou are writing a care plan for a patient newly admitted to your unit. 0hich of these would
!e considered a nursing implementation1
$2 *he patient will am!ulate twice a day.
B2 *he patient appears diaphoretic.
C2 *he patient is at ris+ for aspiration.
D2 &onitor for peripheral edema twice a day.
$ns: D
Chapter: )
Client Needs: D<)
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: 6B, *he Nursing Process
Feed!ac+: Implementation refers to carrying out the plan of nursing care.
6(. *he physician has recommended an amniocentesis for an -7<year<old woman. *he patient is
)@ wee+s/ gestation and does not want this procedure. *he physician is insistent the patient have
the procedure. *he physician arranges for the amniocentesis to !e done. 0hat is this would !e an
e4ample of1
$2 :eracity
B2 Beneficence
C2 Paternalism
D2 $utonomy
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Communication and Documentation
!"ective: )
Page and #eader: 65, %thical Nursing Care
Feed!ac+: Paternalism is the intentional limitation of another/s autonomy. Paternalism e4ists
when the physician decides what is !est for the patient rather than providing the patient with
options and allowing the patient to ma+e an informed decision related to care.
6-. 8ou are admitting a patient to your unit who has "ust come !ac+ from surgery. *he patient/s
hus!and is providing the information you need. During the discussion with the patient/s hus!and,
you discover that the patient has a living will. 0hat applies to a living will1
$2 *he patient is legally una!le to refuse !asic life support.
B2 *he physician may disagree with the patient/s desires for treatment.
C2 *he patient may nullify the living will during the illness.
D2 Power<of<attorney may change while the patient is hospitaliAed.
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Communication and Documentation
!"ective: 5
Page and #eader: 6B, %thical Nursing Care
Feed!ac+: Because living wills are often written when the person is in good health, it is not
unusual for the patient to nullify the living will during illness. $ living will does not ma+e a
patient legally una!le to refuse !asic life support. *he physician may disagree with the patient/s
wishes, !ut he is ethically !ound to carry out those wishes. $ power<of<attorney is not a living
will.
66. 8our patient has a diagnosis of rheumatoid arthritis. 0hile ma+ing the patient/s plan of care,
which nursing diagnosis would !e most applica!le to this patient1
$2 Self<care deficit related to fatigue and "oint stiffness
B2 Ineffective airway clearance related to chronic pain
C2 ;is+ for depression related to !ody image distur!ance
D2 Grinary retention related to chronic pain
$ns: $
Chapter: )
Client Needs: D<-
Cognitive Level: $nalysis
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: 6B, *he Nursing Process
Feed!ac+: Nursing diagnoses are actual or potential pro!lems that can !e managed !y
independent nursing actions. $ll of the other answers are possi!ly correctH the self<care deficit
would !e most applica!le.
6). 8ou are writing a care plan for a 95<year<old patient you have "ust admitted to the hospital.
*he patient has pneumonia and you note decreased air entry to !ilateral lung !ases. 0hat is the
most appropriate nursing diagnosis for this patient1
$2 Ineffective airway clearance related to copious tracheo!ronchial secretions
B2 Pneumonia related to disease process
C2 Poor ventilation related to infection
D2 Immo!ility related to fatigue
$ns: $
Chapter: )
Client Needs: D<@
Cognitive Level: $nalysis
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: D
Page and #eader: 6B, *he Nursing Process
Feed!ac+: Nursing diagnoses are not medical diagnoses or treatments. *he most appropriate
nursing diagnosis for this patient is =ineffective airway clearance related to copious
tracheo!ronchial secretions.>
6@. 8our patient has a diagnosis of pneumonia. 0hich of these would !e classified as part of the
planning phase of the nursing process for a patient diagnosed with pneumonia1
$2 Improve airway patency
B2 Promote fluid inta+e
C2 $dminister fluids
D2 $void overe4ertion
$ns: $
Chapter: )
Client Needs: D<@
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: D
Page and #eader: 6B, *he Nursing Process
Feed!ac+: *he planning phase entails specifying the immediate, intermediate, and long<term
goals of nursing action. *he other answers are incorrect !ecause they are part of the
implementation phase of the nursing process.
65. 8ou are the nurse who is caring for a patient with an allergy to peanuts. 0hat would !e an
immediate goal with a nursing diagnosis of =+nowledge deficit related to the patient/s
administration of an %pi<pen>1
$2 *he patient will demonstrate correct in"ection techni3ue with today/s teaching session.
B2 *he patient will o!serve the nurse demonstrating the in"ection.
C2 *he nurse will teach the patient/s family mem!er to administer the in"ection.
D2 *he patient will return to the clinic in 6 wee+s to demonstrate the in"ection.
$ns: $
Chapter: )
Client Needs: D<)
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: D
Page and #eader: )5, *he Nursing Process
Feed!ac+: Immediate goals are those that can !e reached in a short period of time. $n
appropriate immediate goal for this patient is that the patient will demonstrate correct
administration of the medication on a specified date of today. $nswers B and C are incorrect
!ecause the goal should specify that the patient administer the %pi<pen. $nswer D is not an
immediate goal.
69. &any nursing actions are independent while others are interdependent. $ nurse is
performing an interdependent nursing intervention when he
$2 provides a !ac+ ru! to a restless patient to help her sleep.
B2 provides mouth care.
C2 administers I: fluid.
D2 elevates the head of the !ed.
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: D
Page and #eader: )9, *he Nursing Process
Feed!ac+: $lthough many nursing actions are independent, others are interdependent, such as
carrying out prescri!ed treatments, administering medications and therapies, and colla!orating
with other health care team mem!ers to accomplish specific e4pected outcomes and to monitor
and manage potential complications. Irrigating a wound, administering pain medication, and
administering I: fluids are interdependent nursing actions and re3uire a physician/s order. $n
independent nursing action occurs when the nurse provides a !ac+ ru!, elevates the head of the
!ed, or provides mouth care.
6D. 0hat should the nurse do during the evaluation phase of the nursing process1
$2 #ave patient provide input on 3uality of care
B2 Discontinue surgical sutures
C2 Provide follow<up appointment for postoperative patient
D2 Document improved gas e4change with incentive spirometry use
$ns: D
Chapter: )
Client Needs: D<@
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: D
Page and #eader: )9, *he Nursing Process
Feed!ac+: During the evaluation phase of the nursing process, the nurse determines the patient/s
response to nursing interventions. $n e4ample of this is when the nurse documents whether the
patient/s spirometry use has improved his or her condition. $nswer $ is incorrect !ecause the
patient does not do the evaluation. $nswers B and C are incorrect !ecause they are not
evaluations.
67. 8ou are the charge nurse for this shift. Gpon completing his rounds, a physician prescri!es
restraints for four on the floor. Gpon reviewing the orders, you +now that it is inappropriate to
apply restraints to which of the following patients1
$2 $ postlaryngectomy patient attempting to pull out his tracheostomy tu!e
B2 $ patient in hypovolemic shoc+ trying to pull out his I: catheter
C2 $ patient with urosepsis who is often ringing the call !ell to use the !edside commode
D2 $ paranoid patient who has "ust tried to commit suicide and is refusing restraints
$ns: C
Chapter: )
Client Needs: $<6
Cognitive Level: $nalysis
Difficulty: &oderate
Integrated Process: Communication and Documentation
!"ective: @
Page and #eader: 67, %thical Nursing Care
Feed!ac+: ;estraints should never !e applied for staff convenience. *he patient with urosepsis
who is fre3uently ringing the call !ell is re3uesting assistance to the !edside commode, and this
is appropriate !ehavior that will not result in patient harm. *he situations descri!ed in options $,
B, and D could result in patient harmH therefore, it is appropriate to apply restraints in these
instances.
6B. $ @9<year<old patient has !een diagnosed with cancer. #e has met with the oncologist and is
now weighing his options to undergo chemotherapy or radiation as his treatment. *his patient is
utiliAing which ethical principle in ma+ing his decision1
$2 Beneficence
B2 Confidentiality
C2 $utonomy
D2 Custice
$ns: C
Chapter: )
Client Needs: D<@
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: )
Page and #eader: 69, %thical Nursing Care
Feed!ac+: $utonomy entails the a!ility to ma+e a choice free from e4ternal constraints.
Beneficence is the duty to do good and the active promotion of !enevolent acts. Confidentiality
relates to the concept of privacy. Custice states that li+e cases should !e treated ali+e.
)(. $ @5<year<old patient is part of a research study dealing with management of migraine
headaches. *he patient does not +now whether she is receiving a place!o for pain management.
0hich ethical principle is involved in this situation1
$2 Sanctity of life
B2 Confidentiality
C2 :eracity
D2 Fidelity
$ns: C
Chapter: )
Client Needs: D<6
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: ), @
Page and #eader: 69, %thical Nursing Care
Feed!ac+: *elling the truth ?veracity2 is one of the !asic principles of our culture. *hree ethical
dilemmas in clinical practice that can directly conflict with this principle are the use of place!os
?nonactive su!stances used to for treatment2, not revealing a diagnosis to a patient, and revealing
a diagnosis to persons other than the patient with the diagnosis. $ll involve the issue of trust,
which is an essential element in the nurseIpatient relationship. Sanctity of life is the perspective
that life is the highest good. Confidentiality deals with privacy of the patient. Fidelity is promise
+eeping and the duty to !e faithful to one/s commitments.
)-. *he nursing instructor is e4plaining critical thin+ing to a class of first<semester nursing
students. 0hat would !e the !est e4planation of critical thin+ing the instructor could give1
$2 Information gained from old medical records
B2 %4amination and analysis of information from the family
C2 Information gained from the admission assessment
D2 %4amination and analysis of all availa!le information
$ns: D
Chapter: )
Client Needs: $<-
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6), Critical *hin+ing
Feed!ac+: Critical thin+ing involves reasoning and purposeful, systematic, reflective, rational,
outcome<directed thin+ing !ased on a !ody of +nowledge, as well as e4amination and analysis of
all availa!le information and ideas. 0hile all of these answers are correct, options $, B and C are
not the !est e4planation of critical thin+ing.
)6. 0hich is a characteristic of critical thin+ing1
$2 0illingness to o!serve !ehaviors
B2 Colla!oration with physicians
C2 $!ility to !ase decisions on what has happened in the past
D2 penness to various viewpoints
$ns: D
Chapter: )
Client Needs: $<-
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6), Critical *hin+ing
Feed!ac+: 0illingness and openness to various viewpoints are inherent in critical thin+ing, and
it is also important to reflect on the current situation. ptions $, B, and C are incorrect !ecause
they are not characteristics of critical thin+ing.
&ultiple Selection
)). Critical thin+ing is an integral part of nursing care. 0hat does critical thin+ing do when
applied to nursing1 ?&ar+ all that apply.2
$2 %nhances clinical decision ma+ing
B2 Identifies patient desires
C2 Plans the !est nursing actions to assist the patients in meeting their needs
D2 Eradually develops independent "udgments and decisions
%2 #elps identify patient needs
$ns: $, D, %
Chapter: )
Client Needs: $<-
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6@, Critical *hin+ing
Feed!ac+: Independent "udgments and decisions evolve from a sound +nowledge !ase and the
a!ility to synthesiAe information within the conte4t in which it is presented. Critical thin+ing
enhances clinical decision ma+ing, helping to identify patient needs and the !est nursing actions
that will assist patients in meeting those needs. Critical thin+ing does not identify patient desires
nor does it plan the !est nursing actions to assist patients in meeting their needsH it identifies the
!est nursing actions.
&ultiple Choice
)@. $ nursing student is giving a report on critical thin+ing. *he student says that which of the
following is a part of critical thin+ing1
$2 Planning
B2 &etacognition
C2 Desiring
D2 &etocognition
$ns: B
Chapter: )
Client Needs: B
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6), Critical *hin+ing
Feed!ac+: Critical thin+ing includes metacognition, the e4amination of one/s own reasoning or
thought processes, to help refine thin+ing s+ills.
&ultiple Selection
)5. *he nursing instructor cites a list of s+ills needed in critical thin+ing to her students. 0hat
s+ills would !e included in that list1 ?&ar+ all that apply.2
$2 Self<esteem
B2 Self<regulation
C2 Inference
D2 Self<awareness
%2 Interpretation
$ns: B, C, %
Chapter: )
Client Needs: B
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6), Critical *hin+ing
Feed!ac+: S+ills needed in critical thin+ing include interpretation, analysis, evaluation,
inference, e4planation, and self<regulation. Self<esteem and self<awareness would not !e on the
list !ecause they are not s+ills.
&ultiple Choice
)9. Part of critical thin+ing is determining the significance of data that has !een gathered. 0hat
characteristic of critical thin+ing is used in ma+ing this determination1
$2 $nalysis
B2 Inference
C2 %valuation
D2 Interpretation
$ns: D
Chapter: )
Client Needs: B
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6), Critical *hin+ing
Feed!ac+: Nurses use interpretation to determine the significance of data that are gathered,
analysis to identify patient pro!lems suggested !y the data, and inference to draw conclusions.
%valuation is the process of determining whether outcomes have !een or are !eing met.
)D. $ nurse is admitting a new patient to her unit. *he nurse has as+ed many open<ended
3uestions while gathering information a!out the new patient. 0hat is the nurse doing1
$2 Interpreting what the patient has said
B2 %valuating what the patient has said
C2 $ssessing what the patient has said
D2 :alidating what the patient has said
$ns: D
Chapter: )
Client Needs: B
Cognitive Level: $pplication
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: -
Page and #eader: 6), Critical *hin+ing
Feed!ac+: Critical thin+ers validate the information presented to ma+e sure that it is accurate
?not "ust supposition or opinion2, that it ma+es sense, and that it is !ased on fact and evidence.
*he nurse is not interpreting, evaluating, or assessing the information the patient has given.
)7. Nurses use critical thin+ing every day when going through the nursing process with each
patient they care for. 0hat does critical thin+ing in nursing practice result in1
$2 $ comprehensive plan of care
B2 Identification of the nurse/s goals for the patient
C2 $ colla!orative !asis for assigning care
D2 Identifying interventions to give continuity of care
$ns: D
Chapter: )
Client Needs: $<-
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 6
Page and #eader: 6), Critical *hin+ing
Feed!ac+: Critical thin+ing in nursing practice results in a comprehensive plan of care with
ma4imiAed potential for success. Critical thin+ing does not identify the nurse/s goal for the
patient or interventions aimed at giving continuity of care. Critical thin+ing does not result in a
colla!orative !asis for assigning care.
)B. 8ou are admitting two new patients to your unit. *hey are !oth status post +nee
replacements. 0hat would !e the !est e4planation as to why their care plans may !e different
from each other1
$2 ne patient is male and the other is female.
B2 Patients are viewed as uni3ue and dynamic.
C2 ne patient had a right +nee replaced and the other had a left +nee replaced.
D2 Patients are viewed as dissimilar according to their ages.
$ns: B
Chapter: )
Client Needs: $<-
Cognitive Level: $nalysis
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 6
Page and #eader: 6@, Critical *hin+ing
Feed!ac+: ;egardless of the setting, each patient situation is viewed as uni3ue and dynamic.
@(. $ class of nursing students is in its first semester of nursing school. *he instructor e4plains
that one of the changes they will undergo while in nursing school is learning to =thin+ li+e a
nurse.> 0hat is the newest model of this process1
$2 Critical<thin+ing model
B2 Nursing process model
C2 Clinical "udgment model
D2 $ctive practice model
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: $nalysis
Difficulty: Difficult
Integrated Process: Nursing Process
!"ective: 6
Page and #eader: 6@, Critical *hin+ing
Feed!ac+: *o depict the process of =thin+ing li+e a nurse,> *anner ?6((92 developed a model
+nown as the clinical "udgment model. *he other answers are incorrect !ecause option $ was
developed prior to the clinical "udgment model and neither option B nor option D is a model.
&ultiple Selection
@-. Critical thin+ing is an essential part of nursing in all venues. 0hat is an e4ample of the use
of critical thin+ing in the venue of genetics<related nursing1 ?&ar+ all that apply.2
$2 Notifying individuals and family mem!ers of the results of genetic testing
B2 Providing written report on genetic testing to insurance companies
C2 $ssessing and analyAing family history data for genetic ris+ factors
D2 Identifying individuals and families in need of referral for genetic testing
%2 %nsuring privacy and confidentiality of genetic information
$ns: C, D, %
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Caring
!"ective: 6
Page and #eader: 6@, Critical *hin+ing
Feed!ac+: Nurses use critical thin+ing and decision ma+ing s+ills in providing genetics<related
nursing care when they assess and analyAe family history data for genetic ris+ factors, identify
those individuals and families in need of referral for genetic testing or counseling, and ensure the
privacy and confidentiality of genetic information. Nurses who wor+ in the venue of genetics<
related nursing do not notify family mem!ers of the results of an individual/s genetic testing, and
they do not provide written reports to insurance companies concerning the results of genetic
testing.
@6. Student nurses are providing !asic care for patients on a medical<surgical unit. ne young
student nurse is assigned to care for a D7<year<old male with a diagnosis of $IDS<related
pneumonia. *he man was admitted early that morning and is in need of a !ath and a shampoo.
#e is homeless and undernourished. *he student tells her instructor that she does not want to care
for this patient. 0hat +ey component of critical thin+ing has this student yet to incorporate into
her practice1
$2 Not refusing assignments
B2 Being more respectful of patients
C2 $nalyAing information and situations
D2 0ithholding "udgment
$ns: D
Chapter: )
Client Needs: D<@
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Caring
!"ective: 6
Page and #eader: 6@, Critical *hin+ing
Feed!ac+: 'ey components of critical thin+ing !ehavior are withholding "udgment and !eing
open to options and e4planations from one patient to another in similar circumstances. *he other
options are incorrect !ecause they are not components of critical thin+ing.
@). Nursing students in an ethics class have !een as+ed to define =ethics.> 0hat would !e the
!est definition of ethics1
$2 *he formal, systematic study of moral !eliefs
B2 *he informal, systematic study of moral !eliefs
C2 *he adherence to formal personal values
D2 *he adherence to informal personal values
$ns: $
Chapter: )
Client Needs: D<@
Cognitive Level: Comprehension
Difficulty: %asy
Integrated Process: Nursing Process
!"ective: )
Page and #eader: 65, %thical Nursing Care
Feed!ac+: In essence, ethics is the formal, systematic study of moral !eliefs, whereas morality is
the adherence to informal personal values.
@@. Nurses provide care !ased on the $merican Nurse/s $ssociation Code of %thics. 0hat duty
does this Code of %thics re3uire of nurses1
$2 *o care only for the type of patients they prefer
B2 *o act !ased on the most relevant of several ethical principles
C2 *o care for the patients with whom they are ethically comforta!le
D2 *o always carry out physician orders
$ns: B
Chapter: )
Client Needs: $<-
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 5
Page and #eader: 6D, %thical Nursing Care
Feed!ac+: Nurses have a duty to act !ased on the one relevant principle, or the most relevant of
several ethical principles. *he $N$ Code of %thics does not re3uire nurses to care only for the
patients they prefer or are most comforta!le with. Nor does a nurse always carry out a
physician/s order.
@5. 8our patient has !een admitted for a liver !iopsy !ecause the physician !elieves the patient
may have liver cancer. *he family has told !oth you and the physician that if the patient is
terminal, the family does not want the patient to +now. *he !iopsy results are positive for a very
aggressive form of liver cancer. *he patient as+s you repeatedly what the results of the !iopsy
show. 0hat strategy can you use to give ethical care to this patient1
$2 *ell the patient the results of the !iopsy.
B2 *ell the patient that only the physician +nows the results of the !iopsy.
C2 Communicate the patient/s re3uest for information to the family and the physician.
D2 *ell the patient the !iopsy results are not !ac+ yet.
$ns: C
Chapter: )
Client Needs: $<-
Cognitive Level: Comprehension
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 5
Page and #eader: 67, %thical Nursing Care
Feed!ac+: Strategies nurses could consider include the following: not lying to the patient,
providing all information related to nursing procedures and diagnoses, and communicating the
patient/s re3uests for information to the family and physician. %thically you cannot tell the
patient the results of the !iopsy and you cannot lie to the patient.
@9. *he nurse admits a patient to a research unit that is gathering data on the efficacy of a
specific drug to treat cancer pain. *he patient +nows that place!os are going to !e used for a
specific group of patients in the study population !ut does not +now that he is receiving a
place!o. 0hen is it ethically accepta!le to use place!os1
$2 $nytime in a research study
B2 nly when the patient is unaware of it
C2 0hen it replaces an active drug to show the patient/s symptoms are false
D2 In e4perimental research when the patient +nows place!os are !eing used and is involved in
the decision<ma+ing process
$ns: D
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Caring
!"ective: @
Page and #eader: 67, %thical Nursing Care
Feed!ac+: Place!os may !e used in e4perimental research in which a patient is involved in the
decision<ma+ing process and is aware that place!os are !eing used in the treatment regimen.
Place!os may not ethically !e used anytime the researcher wants to use them, when the patient
does not +now a!out it, or to prove the patient/s symptoms are false.
@D. 0hen the nurse engages in activities that involve potential pro!lems or complications that
are medical in origin, what is the primary nursing focus1
$2 Eiving discharge instructions
B2 Performing initial shift assessments
C2 !serving family dynamics
D2 &onitoring patients for complications
$ns: D
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: )), *he Nursing Process
Feed!ac+: 0hen treating colla!orative pro!lems, a primary nursing focus is monitoring patients
for the onset of complications or changes in the status of e4isting complications. *he primary
nursing focus is not discharge instructions, shift assessments, or family dynamics.
@7. *he nurse caring for a patient who is 6 days post hip<replacement notifies the physician that
the patient/s incision is red around the edges, warm to touch, and seeping a white li3uid with a
foul odor. 0hat type of pro!lem is the nurse dealing with1
$2 Colla!orative pro!lem
B2 Nursing pro!lem
C2 &edical pro!lem
D2 $dministrative pro!lem
$ns: $
Chapter: )
Client Needs: $<-
Cognitive Level: Comprehension
Difficulty: %asy
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: )), *he Nursing Process
Feed!ac+: In addition to nursing diagnoses and their related nursing interventions, nursing
practice involves certain situations and interventions that do not fall within the definition of
nursing diagnoses. *hese activities pertain to potential pro!lems or complications that are
medical in origin and re3uire colla!orative interventions with the physician and other mem!ers
of the health care team. *he other answers are incorrect !ecause the signs and symptoms of
infection are a medical complication that re3uires interventions !y the nurse.
@B. 0hile developing the plan of care for a new patient on the unit, the nurse must identify
e4pected outcomes that are appropriate for the new patient. 0hat is a resource for identifying
these appropriate outcomes1
$2 Community Specific utcomes Classification ?CS2
B2 Nursing<Sensitive utcomes Classification ?NC2
C2 State Specific Nursing utcomes Classification ?SSNC2
D2 Department of #ealth and #uman ;esources utcomes Classification ?##;C2
$ns: B
Chapter: )
Client Needs: $<-
Cognitive Level: 'nowledge
Difficulty: %asy
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: )@, *he Nursing Process
Feed!ac+: ;esources for identifying appropriate e4pected outcomes include the Nursing<
Sensitive utcomes Classification ?NC2 ?Chart )<92 and standard outcome criteria esta!lished
!y health care agencies for people with specific health pro!lems. *he other options are incorrect
!ecause they do not e4ist.
5(. *he nurse has "ust ta+en report on a newly admitted patient who is a -6<year<old female who
is Indian. 0hen planning interventions for this patient, the nurse +nows the interventions must !e
what1 ?&ar+ all that apply.2
$2 $ccepta!le to the patient/s older !rother
B2 $ppropriate to the patient/s age
C2 %thical
D2 $ppropriate to the patient/s culture
%2 Shared !y everyone with the same diagnosis
$ns: B, C, D
Chapter: )
Client Needs: $<-
Cognitive Level: $pplication
Difficulty: &oderate
Integrated Process: Nursing Process
!"ective: 9
Page and #eader: )5, *he Nursing Process
Feed!ac+: Planned interventions should !e ethical and appropriate to the patient/s culture, age,
and gender. Planned interventions do not have to !e accepta!le to the patient/s si!lings nor do
they have to !e shared !y everyone with the same diagnosis.