Ethics and Issues in Contemporary Nursing

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A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, "I want to have this baby and give it up for adoption." However, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves the ethical principle of:

  • A. deontology.
  • B. veracity.
  • C. autonomy.
  • D. beneficence.
Correct Answer: C

Rationale: The correct answer is C: autonomy. Autonomy refers to a patient's right to make their own decisions about their healthcare, including the right to accept or refuse treatment. In this scenario, the 13-year-old female has expressed her desire to have the baby and give it up for adoption. By respecting her autonomy, healthcare providers must support her decision, even if it goes against her father's wishes.

A: Deontology is a moral theory that emphasizes the importance of following moral rules and duties. While autonomy is a principle within deontology, the main focus in this scenario is on respecting the patient's autonomy rather than following a specific moral rule.
B: Veracity refers to the principle of truth-telling. While honesty is important in healthcare, the main issue in this scenario is respecting the patient's autonomy rather than truth-telling.
D: Beneficence refers to the duty to do good and promote the well-being of the patient. In this scenario, respecting the patient's autonomy is

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A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a payment system.

  • A. prospective
  • B. retrospective
  • C. diagnosis-related group
  • D. capitated
Correct Answer: D

Rationale: The correct answer is D: capitated. In a capitated payment system, the physician receives a fixed amount per patient regardless of the services provided. This incentivizes cost-effective care and promotes preventive measures. In this scenario, the physician is receiving revenue for each procedure billed, which is not characteristic of capitated payment.

A: Prospective payment is when a fixed amount is determined in advance for specific services rendered. This is not the case in the scenario provided.
B: Retrospective payment involves reimbursement after the services are provided, which is not reflected in the scenario given.
C: Diagnosis-related group (DRG) is a payment system used in hospitals based on the diagnosis and procedures performed, not applicable to individual physician billing as presented in the question.

A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation?

  • A. Run chart
  • B. Pareto chart
  • C. Flowcharts
  • D. Cause-and-effect diagrams
Correct Answer: B

Rationale: The correct answer is B: Pareto chart. A Pareto chart is a quality improvement tool used to prioritize and focus efforts on the most significant causes of a problem. In this case, the hospital used the chart to identify the main causes of medication errors, helping them to allocate resources efficiently. The Pareto principle states that roughly 80% of effects come from 20% of causes, making it a powerful tool for process improvement.

A: Run chart is used to track data over time but does not prioritize causes like a Pareto chart.
C: Flowcharts are used to map out processes and are helpful for understanding the sequence of activities, not for prioritizing causes.
D: Cause-and-effect diagrams (Fishbone or Ishikawa diagram) are used to identify and organize potential causes of a problem but do not prioritize them like a Pareto chart.

In summary, the Pareto chart is the most appropriate tool in this situation because it helps focus efforts on the most significant causes

When using the ABC system of managing time, those items coded A include:

  • A. calling the pharmacy to see whether a drug insert is available for a patient.
  • B. checking to see why a ventilator is alarming.
  • C. organizing the medication cart.
  • D. writing memos to remind everyone to contribute to the boss's birthday gift.
Correct Answer: A

Rationale: The correct answer is A because in the ABC system, tasks coded as A are considered the most important and urgent. Calling the pharmacy to check drug availability for a patient directly impacts patient care and safety, making it a priority. B, checking a ventilator alarm, is important but not as urgent as ensuring medication availability. C, organizing the medication cart, is important but not necessarily urgent like patient-related tasks. D, writing memos for a birthday gift, is neither urgent nor directly related to patient care. Therefore, A is the correct choice for being the most critical task in the ABC system.

A nurse who functions in the role of team leader can be held negligent for matters involving:

  • A. inadequate training.
  • B. lack of development of proper policies and procedures.
  • C. failure to discipline unsafe workers.
  • D. delegation of client care tasks.
Correct Answer: D

Rationale: The correct answer is D: delegation of client care tasks. A team leader nurse can be held negligent for improper delegation as they are responsible for assigning tasks to appropriate staff ensuring safe and effective care. This is crucial for patient safety. Choices A, B, and C are incorrect because inadequate training, lack of policies, and failure to discipline unsafe workers are not directly related to the nurse's role in delegation and immediate patient care responsibilities.

A nurse asks, "What is meant by 'internal' customers?" The correct response is: (select all that apply)

  • A. insurance companies
  • B. accreditors such as The Joint Commission
  • C. X-ray technicians
  • D. clinical pharmacist
Correct Answer: C

Rationale: The correct answer is C: X-ray technicians. Internal customers refer to individuals or departments within the same organization who rely on each other's services to fulfill their roles effectively. X-ray technicians work within the healthcare facility and depend on other staff like nurses for patient care coordination. Insurance companies (A) and accreditors (B) are external entities. Clinical pharmacists (D) are also internal, but X-ray technicians have a direct service-dependency relationship with nurses in healthcare settings, making them the most relevant internal customers in this context.

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