Ethics and Issues in Contemporary Nursing

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Nurses on a busy medical schedule want to reduce documentation time and improve order entry. Additionally, patient records from previous visits are often incomplete or do not include care from other providers. To improve patient care, a taskforce suggests using an Electronic Medical Record for 1 month to determine whether this provides the desired outcomes. This unit is participating in which type of study?

  • A. Ethnography
  • B. Pilot
  • C. Secondary data analysis
  • D. Phenomenology
Correct Answer: B

Rationale: The correct answer is B: Pilot. A pilot study involves testing a new intervention on a small scale to assess feasibility and potential outcomes before implementing it on a larger scale. In this case, the unit is planning to use an Electronic Medical Record for a limited time to evaluate its impact on documentation time and patient care. This approach allows for targeted feedback and adjustments based on the outcomes observed during the trial period.

A: Ethnography involves in-depth observation and analysis of a specific culture or group, which is not the focus of the scenario.
C: Secondary data analysis involves the use of existing data for research purposes, not the implementation of a new intervention.
D: Phenomenology focuses on understanding individuals' subjective experiences, which is not the primary goal of implementing an Electronic Medical Record in this case.

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A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility?

  • A. Emergency Medical Treatment and Active Labor Law
  • B. Health Insurance Portability and Accountability Act
  • C. Patient Self-Determination Act
  • D. The Patient Safety and Quality Improvement Act
Correct Answer: A

Rationale: The correct answer is A: Emergency Medical Treatment and Active Labor Law (EMTALA). This act prohibits hospitals from transferring patients in active labor or with an emergency condition based on insurance status or ability to pay. It ensures that all individuals, regardless of insurance or immigration status, receive necessary emergency medical treatment. The other choices are incorrect because:
B: Health Insurance Portability and Accountability Act (HIPAA) protects patient privacy and does not address transfer of patients in active labor.
C: Patient Self-Determination Act focuses on patient autonomy in making healthcare decisions, not on preventing transfer based on insurance status.
D: The Patient Safety and Quality Improvement Act promotes patient safety and quality improvement but does not specifically address transfer of patients in active labor.

The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of:

  • A. direction and communication.
  • B. task.
  • C. person.
  • D. circumstances.
Correct Answer: A

Rationale: The correct answer is A: direction and communication. The RN failed to provide clear direction to the LPN regarding the specific type of enema to be administered and the amount. Furthermore, there was a lack of communication regarding the patient's current condition and the rationale for the enema. The other choices are incorrect because:
B: task - The task of administering the enema was clearly communicated.
C: person - The patient was identified by room number, so the person was specified.
D: circumstances - While the circumstances of the patient's complaint were mentioned, the specific details related to the enema administration were lacking.

In a large health care facility, the executive administrative leaders set the budget goals to decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue from lost supplies by 1%, and provide a 5% hourly salary incentive for working on a float unit when the assigned unit has a low census. Nurse managers meet with nursing administrators to design their unit budgets to meet these established goals. The budget approach that is being used is the approach.

  • A. top-down
  • B. participatory
  • C. iterative
  • D. incremental
Correct Answer: B

Rationale: The correct answer is B: participatory. This is because the nurse managers are actively involved in designing their unit budgets to meet the established goals set by the executive administrative leaders. In a participatory budgeting approach, input and collaboration from lower-level managers or staff members are encouraged, allowing for a more inclusive and bottom-up decision-making process. This approach fosters ownership, accountability, and transparency in budget planning.

Summary of other choices:
A: top-down - This approach involves setting budget goals and directives from the top management without much input or involvement from lower-level managers. Not applicable in this scenario.
C: iterative - This approach involves making continuous adjustments and refinements to the budget based on feedback and performance data. Not explicitly mentioned in the scenario.
D: incremental - This approach involves making small adjustments to the previous budget period. While there may be some incremental changes, the scenario emphasizes a more collaborative process involving nurse managers, making this choice less suitable.

When should a follow-up letter be written to a recruiter?

  • A. Before the interview to thank him or her for granting you the interview
  • B. Approximately 2 weeks after you did not get the job to inquire
  • C. A few days after the interview
  • D. When you are sure you got the position
Correct Answer: C

Rationale: The correct answer is C because following up a few days after the interview shows professionalism and eagerness. It allows you to express gratitude, reiterate your interest, and inquire about the next steps. This timing is crucial as it keeps you fresh in the recruiter's mind without being too pushy.

Choice A is incorrect because it is more appropriate to send a thank-you letter after the interview, not before. Choice B is incorrect as waiting 2 weeks after not getting the job may be too late for effective follow-up. Choice D is incorrect because you should not assume you got the position without confirmation.

A new graduate arrives for the first interview feeling prepared and excited about beginning a nursing career but quickly becomes concerned when the recruiter asks which illegal question?

  • A. "Have you been convicted of a crime other than a minor traffic violation?"
  • B. "We are very interested in hiring you but you do understand the position is contingent on the results of the preemployment physical and background check?"
  • C. "What do you consider to be your major weaknesses for this particular position?"
  • D. "Because you are applying for a position in the operating room, you must be able to be on call. How many children do you have responsibility for at home?"
Correct Answer: D

Rationale: The correct answer is D because asking about the number of children the candidate has could potentially lead to discrimination based on family responsibilities, which is illegal. This question is not related to the candidate's ability to perform the job duties in the operating room.

A: Asking about criminal convictions is legal for certain positions for safety reasons.
B: Mentioning pre-employment checks is standard practice and not illegal.
C: Inquiring about weaknesses is a common interview question and not discriminatory.

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