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An adult patient has requested a do not resuscitate (DNR) order in light of his recent diagnosis with late stage pancreatic cancer. The patients son and daughter-in-law are strongly opposed to the patients request. What is the primary responsibility of the nurse in this situation?
- A. Perform a slow code until a decision is made.
- B. Honor the request of the patient.
- C. Contact a social worker or mediator to intervene.
- D. Temporarily withhold nursing care until the physician talks to the family.
Correct Answer: B
Rationale: The nurse must honor the patients wishes and continue to provide required nursing care. Discussing the matter with the physician may lead to further communication with the family, during which the family may reconsider their decision. It is not normally appropriate for the nurse to seek the assistance of a social worker or mediator. A slow code is considered unethical.
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The nurse has just taken report on a newly admitted patient who is a 15 year-old girl who is a recent immigrant to the United States. When planning interventions for this patient, the nurse knows the interventions must be which of the following?
- A. Appropriate to the nurses preferences
- B. Appropriate to the patients age
- C. Ethical
- D. Appropriate to the patients culture
- E. Applicable to others with the same diagnosis
Correct Answer: B,C,D
Rationale: Planned interventions should be ethical and appropriate to the patients culture, age, and gender. Planned interventions do not have to be in alignment with the nurses preferences nor do they have to be shared by everyone with the same diagnosis.
You are writing a care plan for an 85-year-old patient who has community-acquired pneumonia and you note decreased breath sounds to bilateral lung bases on auscultation. What is the most appropriate nursing diagnosis for this patient?
- A. Ineffective airway clearance related to tracheobronchial secretions
- B. Pneumonia related to progression of disease process
- C. Poor ventilation related to acute lung infection
- D. Immobility related to fatigue
Correct Answer: A
Rationale: Nursing diagnoses are not medical diagnoses or treatments. The most appropriate nursing diagnosis for this patient is ineffective airway clearance related to copious tracheobronchial secretions. Pneumonia and poor ventilation are not nursing diagnoses. Immobility is likely, but is less directly related to the patients admitting medical diagnosis and the nurses assessment finding.
A nurse has been offered a position on an obstetric unit and has learned that the unit offers therapeutic abortions, a procedure which contradicts the nurses personal beliefs. What is the nurses ethical obligation to these patients?
- A. The nurse should adhere to professional standards of practice and offer service to these patients.
- B. The nurse should make the choice to decline this position and pursue a different nursing role.
- C. The nurse should decline to care for the patients considering abortion.
- D. The nurse should express alternatives to women considering terminating their pregnancy.
Correct Answer: B
Rationale: To avoid facing ethical dilemmas, nurses can follow certain strategies. For example, when applying for a job, a nurse should ask questions regarding the patient population. If a nurse is uncomfortable with a particular situation, then not accepting the position would be the best option. The nurse is only required by law (and practice standards) to provide care to the patients the clinic accepts; the nurse may not discriminate between patients and the nurse expressing his or her own opinion and providing another option is inappropriate.
The physician has recommended an amniocentesis for an 18-year-old primiparous woman. The patient is 34 weeks gestation and does not want this procedure. The physician is insistent the patient have the procedure. The physician arranges for the amniocentesis to be performed. The nurse should recognize that the physician is in violation of what ethical principle?
- A. Veracity
- B. Beneficence
- C. Nonmaleficence
- D. Autonomy
Correct Answer: D
Rationale: The principle of autonomy specifies that individuals have the ability to make a choice free from external constraints. The physicians actions in this case violate this principle. This action may or may not violate the principle of beneficence. Veracity centers on truth-telling and nonmaleficence is avoiding the infliction of harm.
A care conference has been organized for a patient with complex medical and psychosocial needs. When applying the principles of critical thinking to this patients care planning, the nurse should most exemplify what characteristic?
- A. Willingness to observe behaviors
- B. A desire to utilize the nursing scope of practice fully
- C. An ability to base decisions on what has happened in the past
- D. Openness to various viewpoints
Correct Answer: D
Rationale: Willingness and openness to various viewpoints are inherent in critical thinking; these allow the nurse to reflect on the current situation. An emphasis on the past, willingness to observe behaviors, and a desire to utilize the nursing scope of practice fully are not central characteristics of critical thinkers.