Management And Ethical Nivel 1

A nurse on the night shift enters the medication room and inadvertently discovers a colleague with a tourniquet wrapped around their upper arm, ready to inject a clear liquid into their antecubital area. Which initial action should the nurse take?

• Call security and have the colleague restrained

• Call the police and file charges against the colleague

• Call the nursing supervisor

• Lock the colleague in the medication room until help is at hand

Answer explanation

Explanation

Choice C is correct. Nurses are required to report colleagues who are suspected of substance abuse, as this jeopardizes the safety of clients and other staff members. The initial action is to report this individual to the nursing supervisor on duty, as this individual can intervene immediately, therefore circumventing harm to clients and other staff members. Following the initial response by the nursing supervisor on duty, the issue will be escalated within the healthcare facility before being relayed to the applicable state board of nursing, which possesses complete jurisdiction to order and supervise the treatment of the impaired nurse.

Choice A is incorrect. Calling security and having the colleague restrained would be appropriate if a disturbance had or is anticipated to occur, but nothing in the above scenario indicates this has or is anticipated to occur. Therefore, calling security and having the colleague restrained is inappropriate and would only inflame the existing situation.

Choice B is incorrect. Although the police may be contacted at some point in the future, this is not the initial action.

Choice D is incorrect. In the absence of posing a significant threat to clients or other staff members, locking the colleague in the medication room "until help is at hand" is grossly inappropriate and potentially criminal behavior by this nurse.

A nurse is caring for a client who is considering becoming an organ donor. Which action by the nurse best facilitates the organ donation process? 

• Providing the client with information about organ donation and addressing any questions or concerns they may have.

• Advising the client to sign an organ donor card and carry it with them at all times.

• Scheduling the client for immediate organ donation surgery upon expressing interest.

• Assisting the client in completing advance directives specifying their wish for organ donation.

Answer explanation

Explanation

Choice A is correct. Before deciding on organ donation, clients need to be well-informed about the process, including the benefits, risks, and implications. The nurse plays a crucial role in providing accurate information, clarifying misconceptions, and addressing any concerns the client may have. This empowers the client to make an informed decision about organ donation based on their values, beliefs, and preferences. It also fosters open communication and trust between the client and the healthcare staff, which is essential for the donation process.

Choice B is incorrect. While signing an organ donor card can indicate the individual's intention to donate their organs, it is not the most effective action for facilitating the organ donation process. Open communication with family members and healthcare providers is necessary to ensure understanding and consent. Merely carrying an organ donor card may not be sufficient to ensure that the client's wishes are understood and honored, especially if family members are unaware or not supportive of the decision.

Choice C is incorrect. Organ donation typically occurs after a thorough evaluation process to determine donor suitability and match recipients based on medical criteria and organ availability. Rushing the process without proper evaluation and consent could jeopardize the safety and success of the donation process and may not align with the client's wishes or medical suitability.

Choice D is incorrect. Advance directives specify an individual's preferences for medical treatment in the event they are unable to communicate their wishes. While specifying the wish for organ donation in advance directives can be helpful, it is not the primary action for facilitating the organ donation process.

A medication error has occurred in the medical ward. After a thorough investigation was performed, the nurse manager posts a memorandum regarding changes in medication administration to be implemented immediately. The nurses on the unit recognized this management style as:

• Autocratic

• Democratic

• Participative

• Laissez-faire

Answer explanation

Explanation

Choice A is correct. In autocratic leadership, decisions are made with little or no staff input. The manager makes all the decisions in the unit.

Choice B is incorrect. In a democratic style of management, staff members are encouraged to participate in the decision-making process whenever possible. The majority of the decisions are made by the group, not the manager in this management style.

Choice C is incorrect. In a participative style of management, problems are identified by the manager and presented to the staff with several solutions. Staff members are encouraged to provide input however, the manager makes the final decision.

Choice D is incorrect. Little direction, structure, or support is provided by the manager in a Laissez-faire type of management. The manager abdicates responsibility and decision-making whenever possible in this type of management.

The nurse is caring for a client who reports having a durable power of attorney. The nurse understands that this type of advance directive

• legally designates their spouse or significant other, allowing them to have a voice in health care treatment options as the client ages.

• designates an individual by the client to assist in medical decision-making who also becomes responsible for all of the client's medical bills.

• legally designates an individual to make medical decisions when the client can no longer do so.

• is a specific designation specifying who can receive and discuss the client's privileged healthcare information

Answer explanation

Explanation

Choice C is correct. A health care proxy is an individual named in a written legal document designated to make medical decisions for the client when the client is no longer able to make decisions for themself. 

Choice A is incorrect. Although a client may designate their spouse or significant other as their health care proxy, an official health care proxy requires the completion of legal paperwork and a copy of the documents to be provided to the hospital or healthcare provider. Without doing so, the significant other or spouse cannot be the legally designated health care proxy.

Choice B is incorrect. Health care proxies make decisions about healthcare. In general, if the health care proxy follows the client's pre-discussed wishes, there are no financial implications for the health care proxy.

Choice D is incorrect. A health care proxy designation and a designation to receive confidential information protected under HIPAA are two distinct designations. 

A client has just been diagnosed with a terminal illness. She decides to execute a living will in the unit and asks the nurse to be the witness of the will. What is the most appropriate response by the nurse?

• “I’m sorry, but under the law, we’re not allowed to witness living wills.”

• “Let me call the doctor. Maybe he can witness it for you.”

• “Your family are the only people that can serve as witnesses.”

• “Let me call the hospital attorney; he needs to be present when you sign your will.”

Answer explanation

Explanation

Choice A is correct. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses.

Choice B is incorrect. This statement is inaccurate. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses.

Choice C is incorrect. This statement is false. Witnesses for the signing of the will can be specific individuals; it does not necessarily mean only family.

Choice D is incorrect. The hospital lawyer is not needed to be present in signing the living will.

The nurse is in an elevator and observes two staff members discussing a client's condition. The nurse understands that this conversation may potentially violate which ethical principle?

• Beneficence

• Confidentiality

• Autonomy

• Veracity

Answer explanation

Explanation

Choice B is correct. This conversation being observed by the nurse may violate the client's confidentiality. Conversations about a client's personal medical information (PMI) should be kept private and involve only those involved in the client's care. This is considered the right to know, which mandates that information be safeguarded and limited in how it is shared.

Choices A, C, and D are incorrect. This discussion observed by the nurse does not potentially violate these ethical principles. Beneficence refers to taking positive actions to help others over themselves. Autonomy refers to protecting and promoting client independence. Veracity is an ethical principle referring to telling the truth. Honesty supports a trusting nurse-client relationship.

The nurse is providing care for a patient recently transferred from the post-anesthesia care unit [PACU]. The chart indicates that the patient was medicated for pain 1 hour ago, yet the patient reports that he is experiencing extreme pain. He is not due for further medication until another 2 hours. How might the nurse intervene as a patient advocate?

• Contact the physician regarding the need for more effective pain management.

• Assist the patient to use non-pharmacological pain management strategies.

• Explain to the patient that giving the pain medication too soon can be dangerous.

• Provide a quiet environment to help the patient rest and cope with his pain level.

Answer explanation

Explanation

Choice A is correct. An essential aspect of advocacy is speaking on behalf of the patient, to help meet the patient’s needs, such as when calling the physician to discuss the need for more effective pain management – since it is the patient’s fundamental right to be free from pain.

Choices B and D are incorrect. These are nursing interventions that can be employed to enhance the prescribed pain medication but do not meet defining characteristics related to advocacy.

Choice C is incorrect. While this is factual information, it does not address the need to provide adequate pain management.

The nurse is caring for a client who is asking about advanced directives. Many documents fall under the category of an advanced directive. The nurse knows that one of the most common legal papers is called 'Durable Power of Attorney for Health Care' and works to:

• Review a person’s personal preferences for medical care in the future.

• Authorize another person to make medical decisions for a person if they become unable to on their own.

• Assign a legal authority in making medical decisions while honoring the spoken word of the family.

• Define what care should be administered or withheld by health care professionals, no matter which medical facility the patient finds themselves in.

Answer explanation

Explanation

Choice B is correct. A 'Durable Power of Attorney for Health Care' authorizes a person to make medical decisions for the client if the client becomes unable to do so themselves due to a decrease in mental capacity or level of consciousness.

Choice A is incorrect. When a client and their healthcare team discuss their future medical preferences, they are creating a document known as a 'living will.'

Choice C is incorrect. If a legal authority is assigned to make medical decisions, as is the case with 'Durable Power of Attorney,' this person has full authority to make treatment decisions. If the family's opinions conflict with those of the assigned person, healthcare staff must prioritize the person with legal authority over family members.

Choice D is incorrect. This choice describes a guideline known as 'Physician Orders for Life-Sustaining Treatment' (POLST), which outlines the care that will be provided regardless of the healthcare facility where the client is located.

"The nurse is providing a handoff report to a nurse in the critical care unit. The nurse states that it would be helpful for the primary healthcare provider (PHCP) to refer the client to a support group upon discharge. This statement represents which part of the ISBAR handoff report?"

• Situation

• Background

• Assessment

• Recommendation

Answer explanation

Explanation

Choice D is correct. The nurse providing this statement to the critical care nurse illustrates recommendations. A recommendation is at the end of the ISBAR format, where the nurse can opine their thoughts on what would be necessary for the client.

Choices A, B, and C are incorrect.

➢ The situation is where the nurse explains the reason for the notification (I am concerned that the client is developing... or This client is being transferred to critical care because...).

➢ Background explains pertinent details regarding the client's care (The client is allergic to... He/she was admitted on...)

➢ Assessment is the nurses' overall impression of the client (I believe the client is demonstrating pulmonary edema because...)

You are caring for a 33-year-old male client at the end of life. This married client has two children; the son is 14-years-old and the daughter is 8-years-old. Both of these children are being prepared for their father’s imminent death. Which consideration should be incorporated into your explanations of death with these children?

• Children before the age of 12 view death as terrifying so the nurse should not discuss death with these young children.

• Children before the age of 12 do not have any perspectives about death, its meaning, and its finality or lack thereof.

• The cognitive development of young children impacts their understanding of death.

• The cognitive development of young children before 12 has no impact on their understanding of death.

Answer explanation

Explanation

Choice C is correct. The cognitive development of young children impacts their understanding of death. Since the meaning of death and the finality of death vary according to the age of the child, the nurse should listen to and support these children according to their level of understanding.

Choice A is incorrect. Nurses should openly discuss death with children as the need arises. Young children do not view death as terrifying, they do not even see death as final.

Choice B is incorrect. Children before the age of 12 do have perspectives about death, its meaning, and its finality or lack thereof. Although, these perspectives are not the same as older children and adults.

Choice D is incorrect. The cognitive development of young children before 12 most definitely impacts their understanding of death and its finality.