Nokea
In a team meeting, a nurse says, 'I'm concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision.' Which ethical principle most clearly applies to this situation?
- A. Beneficence
- B. Autonomy
- C. Fidelity
- D. Justice
Correct Answer: D
Rationale: The nurse's concern about differing treatments for similar behaviors reflects justice, ensuring fair and equitable care. Beneficence promotes good, autonomy supports self-determination, and fidelity upholds loyalty.
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After leaving work, a staff nurse realizes that documentation of the administration of a medication to a patient was omitted. This off-duty nurse telephones the unit and tells the nurse, 'Please document the administration of the medication I forgot to do. My password is alphal.' What action should the on-duty nurse take?
- A. Suggest the nurse return and document.
- B. Refer the matter to the charge nurse to resolve.
- C. Access the record and document the information.
- D. Report the request to the patient's health care provider.
Correct Answer: B
Rationale: Referring to the charge nurse ensures policy compliance and proper documentation without risking unauthorized access.
An adolescent hospitalized after a violent physical outburst tells the nurse, 'I'm going to kill my father, but I know you can't tell anyone.' What is the nurse's best response?
- A. You're right. Federal law requires me to keep that information private.'
- B. Those kinds of thoughts will make your hospitalization even longer.'
- C. You really should share these kinds of thoughts with your psychiatrist.'
- D. I am required to share information like this with your treatment team.'
Correct Answer: D
Rationale: Threats of harm must be shared with the treatment team to ensure safety, overriding confidentiality.
A newly admitted patient who is acutely psychotic is a private patient of the senior psychiatrist. To whom does the psychiatric nurse who is assigned to this patient owe the duty of care?
- A. Health care provider
- B. Profession
- C. Hospital
- D. Patient
Correct Answer: D
Rationale: The primary duty of care is owed to the patient, despite accountability to others.
Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
- A. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
- B. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
- C. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
- D. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
Correct Answer: A
Rationale: Nurses must uphold ANA standards, even if agency policies are substandard. Agency policies do not override professional standards, and leaving or judicial interpretation are not primary guides.
In which situations does a nurse have a duty to intervene and report?
- A. A peer is unable to write behavioral outcomes.
- B. A health care provider consults the Physicians' Desk Reference.
- C. A peer tries to provide patient care in an alcohol-impaired state.
- D. A team member has violated the boundaries of a vulnerable patient.
- E. A patient refuses a medication prescribed by a licensed health care provider.
Correct Answer: C,D
Rationale: Impaired care and boundary violations jeopardize safety, requiring intervention. Other situations are less critical or acceptable.