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== SAMPLE ==
Chapter 02: Ethical and Legal Issues
1. The difference between ethics and morals is that ethics
a. is more concerned with the “why” of behavior.
b. provides a framework for evaluation of the behavior.
c. is broader in scope than morals.
d. concentrates on the right or wrong behavior based on religion and culture values.
Ethics are concerned with the basis of the action rather than whether the action is right or wrong, good or bad.
2. A client’s wife has been informed by the physician that her spouse has a permanent C2–C3 spinal injury, which has resulted in permanent quadriplegia. The wife states that she does not want the physician or nursing staff to tell the client about his injury. The client is awake, alert, and oriented when he asks his nurse to tell him what has happened. The nurse has conflicting emotions about how to handle the situation and is experiencing
b. moral distress.
c. moral doubt.
d. moral courage.
The nurse has been placed in a situation initially causing moral distress and is struggling with determining the ethically appropriate action to take. Moral courage is the freedom to advocate for oneself, patients, and peers. Autonomy is an ethical principle. Moral doubt is not part of the AACN framework The 4A’s to Rise Above Moral Distress.
3. Critical care nurses can best enhance the principle of autonomy by
a. presenting only the information to prevent relapse in a patient.
b. assisting with only tasks that cannot be done by the patient.
c. providing the patient with all of the information and facts.
d. guiding the patient toward the best choices for care.
Clients and families must have all the information about a certain situation to make an autonomous decision that is best for them.
4. Which of the following ethical principles is most important when soliciting informed consent from a client?
Veracity is important when soliciting informed consent because the client needs to be aware of all potential risks of and benefits to be derived from specific treatments or their alternatives.
5. Fidelity includes faithfulness and promise-keeping to clients, and it incorporates the added concepts of
a. confidentiality and privacy.
b. truth and reflection.
c. autonomy and paternalism.
d. beneficence and nonmaleficence.
Confidentiality is a right involving the sharing of client information with only those involved in the client’s care. Privacy includes confidentiality but goes further to include the right to privacy of person and personal space, such as ensuring that a client is adequately covered during a procedure.
6. Which statement best reflects the concept of allocation of resources within the critical care setting?
a. Limitations of resources force reexamination of goals of critical care for clients.
b. Care is provided equally to all those who need the resources.
c. Equal access is available for those with the same condition or diagnosis.
d. Technologic advances are available to most of those in a given community.
Limited resources force society and critical care health practitioners to reexamine goals of critical care for clients.
7. When deciding whether to withdraw or withhold treatment, it is important to
a. examine one’s own beliefs to guide the family to a correct decision.
b. approach the family with honesty and provide clear information.
c. simply follow the advance directive if available.
d. allow the physician to approach the family.
This is a difficult time, and the nurse needs to be attuned to the family’s needs by providing timely information, honesty, and clear treatment options and by listening to the family.
8. The Code of Ethics for Nursing provides a framework for the nurse in ethical decision making and
a. is usurped by state or federal laws.
b. allows the nurse to focus on the good of society rather than the uniqueness of the client.
c. was recently adopted by the American Nurses Association.
d. provides society with a set of expectations of the profession.
The Code of Ethics for Nursing provides a framework for the nurse to follow in ethical decision making and provides society with a set of expectations of the profession.
9. Ethical decisions are best made by
a. following the guidelines of a framework or model.
b. having the client discuss alternatives with the physician or nurse.
c. prioritizing the greatest good for the greatest number of persons.
d. careful consideration by the Ethics Committee after all diagnostic data are reviewed.
To facilitate the ethical decision-making process, a model or framework must be used so that all involved will consistently and clearly examine the multiple ethical issues that arise in critical care.
10. The first step of the ethical decision-making process is
a. consulting with an authority.
b. identifying the health problem.
c. delineating the ethical problem from other types of problems.
d. identifying the client as the primary decision maker.
Step one involves identifying the major aspects of the client’s medical and health problems. Consulting an authority is not always necessary in the process. Delineating the ethical problem from other types of problems may not be necessary. Identification of the client as primary decision maker is not part of the process.
11. Values clarification can assist the client to clarify his or her own values to facilitate effective decision making. Which of the following nursing activities is incorporated into this intervention?
a. Avoid the use of open-ended questions.
b. Use multiple sessions to cross-examine the client to ensure he or she is clear about personal values.
c. Use appropriate questions to assist the client in reflecting on the situation and what is personally important.
d. Encourage members of the health care team to relate how they would make the decision.
As a patient advocate, the nurse provides more information as needed, clarifies points, reinforces information, and provides support during the decision-making process.
12. Institutional ethics committees (IECs) review ethical cases that are problematic for the practitioner. Major functions of IECs include
a. consultation with purely binding recommendations.
b. support and education to health care providers.
c. conflict resolution for moral dilemmas.
d. recommendations that are binding in all cases.
The IEC can function in a variety of ways, serving as consultants, providing education, and helping resolve ethical conflicts or dilemmas for health care providers. Recommendations from the formal IEC may or may not be binding and are relative to the situation at hand.
13. In the ethical decision-making process, after the identification of alternative options has been established,
a. an outcome for each action must be predicted.
b. the team must determine which options to present to the patient or family.
c. the choice of one option compromises the option not chosen.
d. “no action” is not an option in this step of the decision-making process.
After the identification of alternative options, the outcome of each action must be predicted. Consideration also must be given to the “no action” option, which is another choice.
14. A client’s wife has been informed by the physician that her spouse has a permanent C2–C3 spinal injury, which has resulted in permanent quadriplegia. The wife states that she does not want the physician or nursing staff to tell the client about his injury. The client is awake, alert, and oriented when he asks his nurse to tell him what has happened. Based on which ethical principles does the nurse answer the patient’s questions?
Autonomy is a freedom of choice or a self-determination that is a basic human right. It can be experienced in all human life events.
15. Place the following steps in ethical decision making in the order in which they should be carried out:
1. Identify the health problem.
2. Implement decisions.
3. Identify the decision maker.
4. Define the ethical issue.
5. Evaluate actions and decisions.
6. Gather additional information.
7. Examine moral and ethical principles.
8. Explore alternative options.
a. 1, 4, 6, 7, 8, 3, 2, 5
b. 1, 4, 3, 2, 5, 6, 7, 8
c. 1, 4, 2, 3, 5, 6, 7, 8
d. 4, 1, 3, 2, 5, 6, 7, 8
The steps in ethical decision making mirror those in the nursing process.
1. Which of the following is/are criteria for defining an ethical dilemma? (Select all that apply.)
a. An awareness of different options
b. An issue in which only one viable option exists
c. The choice of one option compromises the option not chosen
d. An issue that has different options
ANS: A, C, D
The criteria for identifying an ethical dilemma are threefold: (1) an awareness of the different options, (2) an issue that has different options, and (3) the choice of one option over another compromises the option not chosen.