Ethics & Issues in Contemporary Nursing

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Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria?

  • A. The RN administers all medications to all patients.
  • B. The LPN performs sterile dressings and IV tubing changes on all central lines.
  • C. The experienced UAP places telemetry electrodes and attaches to cardiac monitor.
  • D. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."
Correct Answer: B

Rationale: The correct answer is B because it aligns with improving quality of care and cost containment. LPNs are trained to perform sterile procedures like dressing changes and IV tubing changes, which can enhance patient outcomes. This assignment allows the RN to focus on tasks that require their specialized skills, promoting quality care. Furthermore, utilizing LPNs for these tasks is more cost-effective than having an RN perform them.

Choices A, C, and D are incorrect:
A: Having the RN administer all medications to all patients is not utilizing the team effectively. LPNs and UAPs can handle medication administration under appropriate supervision.
C: While experienced UAPs can assist with attaching telemetry electrodes, this task does not fully utilize the skills of the LPNs and RN to improve care quality.
D: Administering an enema is within the scope of an LPN's practice, and assigning this task to the RN is not the most efficient use of resources.

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Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is:

  • A. Pareto chart.
  • B. control chart.
  • C. deployment chart.
  • D. top-down flowchart.
Correct Answer: B

Rationale: The correct answer is B: control chart. A control chart is used to display data over time and indicate variations within set limits, making it ideal for monitoring compliance with a standard like "All patients will be assessed by an RN within 2 hours of admission." The control chart allows for easy identification of trends, shifts, or patterns that may indicate a need for corrective action to maintain the 97% compliance goal.

A: Pareto chart is used to identify the most significant factors contributing to a problem, not to monitor compliance over time.
C: Deployment chart is not a standard tool in quality control or process monitoring.
D: A top-down flowchart is used to depict the sequence of steps in a process, not to monitor compliance with a standard over time.

The massage therapist uses kinesthesia, or thinking about how movement is expressed, to correct habits that cause poor posture and limited movement. This type of massage is called:

  • A. Alexander technique.
  • B. Feldenkrais method.
  • C. healing touch.
  • D. Reiki.
Correct Answer: B

Rationale: The correct answer is B: Feldenkrais method. This method focuses on improving movement patterns through kinesthetic awareness and re-education. It helps correct habits that lead to poor posture and limited movement by increasing awareness of how the body moves. The Alexander technique (A) mainly focuses on improving posture and reducing tension. Healing touch (C) involves energy-based healing practices, not specifically related to movement correction. Reiki (D) is a form of energy healing that aims to promote relaxation and stress reduction, not movement correction. Therefore, the best choice for the given scenario is the Feldenkrais method.

An RN is counseled by the nurse manager regarding inappropriate delegation when the:

  • A. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms.
  • B. nursing assistant informs the RN that she has not been trained to collect a sputum specimen and the RN states, "I will show you this time and you can show me the next time."
  • C. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube.
  • D. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home.
Correct Answer: C

Rationale: The correct answer is C because delegating the task of completing a plan of care to a float LPN/LVN for a stable patient is inappropriate. LPNs/LVNs have a different scope of practice compared to RNs and should not be assigned tasks related to developing care plans. This task requires critical thinking skills and assessment that are within the RN's scope of practice.

A: A is incorrect because delegating the task of greeting and showing ambulatory surgery patients to their rooms is appropriate for a nursing assistant.
B: B is incorrect because delegating the task of collecting a sputum specimen, once trained, is appropriate for a nursing assistant under the supervision of an RN.
D: D is incorrect because delegating the task of performing a dressing change to a competent LPN/LVN is appropriate, as long as it falls within their scope of practice.

A nurse is admitting a Mexican-American child, and the mother comments that the child was exposed to mal ojo. The nurse should expect to find which symptom associated with this exposure?

  • A. Fever
  • B. Nervous tension
  • C. Bruising
  • D. Somnolence
Correct Answer: B

Rationale: The correct answer is B: Nervous tension. Mal ojo, commonly known as the evil eye, is a belief in many Latin American cultures that certain people have the power to cause harm with their gaze. Symptoms associated with mal ojo typically include nervous tension, irritability, and restlessness. Fever (choice A) is not a common symptom of mal ojo. Bruising (choice C) is also not typically associated with mal ojo. Somnolence (choice D) refers to excessive sleepiness, which is not a common symptom of mal ojo. Therefore, the correct answer is B as it aligns with the cultural belief and expected symptoms of mal ojo.

Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies?

  • A. Patient-centered care
  • B. Informatics
  • C. Teamwork
  • D. Quality improvement
Correct Answer: B

Rationale: The correct answer is B: Informatics. Nurses on the orthopedic unit are demonstrating informatics competency by using PDAs for medication review and accessing video clips for procedures. This showcases their ability to utilize technology to enhance patient care. Patient-centered care (A) focuses on individualized care, teamwork (C) emphasizes collaboration, and quality improvement (D) pertains to enhancing processes. The use of technology in this scenario aligns most closely with the informatics competency, making it the best choice.

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