Which step of the nursing process is being used when the nurse decides whether an ethical dilemma exists?
- A. Analysis
- B. Planning
- C. Evaluation
- D. Assessment
Correct Answer: A
Rationale: Analysis is the step of the nursing process being used when the nurse decides whether an ethical dilemma exists. During the analysis step, the nurse gathers and interprets data to make sense of a clinical situation. In the case of ethical dilemmas, the nurse would assess the situation, gather relevant information, and analyze it to determine if there is a conflict in values, beliefs, or principles, which would classify it as an ethical dilemma. Once the nurse identifies the existence of an ethical dilemma through analysis, they can then move on to the planning phase to decide on a course of action.
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A medical-surgical nurse is asked to float to a women’s health unit to care for patients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and the nurse is familiar with caring for postoperative patients. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment?
- A. The staff nurse has the reNspoRnsibIilityG of Bac.ceCptinMg any assignment that is made U S N T O while working for a health care unit, so the nursing supervisor is within his or her rights to enforce this assignment.
- B. Because the unit is short-staffed, the staff nurse should accept the assignment to provide care by benefit of her or his experience to patients who need care.
- C. The staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment.
- D. The nursing supervisor should emphasize that this assignment requires care of a surgical patient for which the staff nurse is adequately trained and should therefore enforce the assignment.
Correct Answer: C
Rationale: In this situation, the nurse's refusal to accept the assignment is based on personal beliefs that conflict with the nature of the medical practice (therapeutic abortions). According to the American Nurses Association (ANA) Code of Ethics, nurses have the right to refuse assignments that go against their personal, cultural, or religious beliefs. The nurse in this scenario has expressed a legitimate concern, and the nursing supervisor should respect the nurse's autonomy and should not enforce the assignment. It is essential to balance respecting the nurse's beliefs while also ensuring patient safety and adequate staffing levels.
What nursing intervention would the nurse include in the preoperative care plan for a patient scheduled for an outpatient lumpectomy of a fibroadenoma?
- A. Administer pain and antiemetic medications.
- B. Help the patient arrange for a cab home after the procedure.
- C. Advise the patient to avoid food or drink for 2 hours before surgery.
- D. Review discharge instructions.
Correct Answer: C
Rationale: It is essential to advise the patient to avoid food or drink for at least 2 hours before surgery to reduce the risk of aspiration during the procedure. An empty stomach helps prevent vomiting and aspiration of stomach contents that could potentially lead to respiratory complications during the surgical procedure. This is a crucial preoperative nursing intervention to ensure patient safety and preparation for the lumpectomy surgery. Administering pain and antiemetic medications, arranging for transportation home, and reviewing discharge instructions are important aspects of care but do not directly impact the patient's safety during the procedure like fasting before surgery does.
A nurse who works in the emergency department (ED) is assigned to a patient who is experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this patient based on moral principles. What is the nurse manager’s initial response to the nurse?
- A. “I recall you sharing that information in your interview. I will arrange for another nurse to take report on this patient.”
- B. “Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this patient.”
- C. “I understand your point of view. You were hired to work here in the ED so you had to know this situation was possible.”
- D. “Abandonment is a serious issue. I have to advise you to continue to provide care for this patient.”
Correct Answer: D
Rationale: The nurse manager's initial response should prioritize patient care and safety. In this situation, the patient requires urgent medical attention due to heavy vaginal bleeding and the need for a dilation and evacuation procedure. The nurse's refusal to provide care based on personal moral principles can be considered as patient abandonment, which is a serious ethical and legal issue in healthcare. The nurse manager must advise the nurse to continue providing care for the patient to ensure that the patient's needs are met and to prevent harm resulting from abandonment. The nurse manager should also address the nurse's concerns separately through appropriate channels, such as discussing ethical considerations, providing support, and exploring options for accommodation or transfer if necessary.
A nurse who works in the emergency department (ED) is assigned to a patient who is experiencing heavy vaginal bleeding at 12 weeks’ gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the patient is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this patient based on moral principles. What is the nurse manager’s initial response to the nurse?
- A. “I recall you sharing that information in your interview. I will arrange for another nurse to take report on this patient.”
- B. “Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this patient.”
- C. “I understand your point of view. You were hired to work here in the ED so you had to know this situation was possible.”
- D. “Abandonment is a serious issue. I have to advise you to continue to provide care for this patient.”
Correct Answer: D
Rationale: The nurse manager's initial response should prioritize patient care and safety. In this situation, the patient requires urgent medical attention due to heavy vaginal bleeding and the need for a dilation and evacuation procedure. The nurse's refusal to provide care based on personal moral principles can be considered as patient abandonment, which is a serious ethical and legal issue in healthcare. The nurse manager must advise the nurse to continue providing care for the patient to ensure that the patient's needs are met and to prevent harm resulting from abandonment. The nurse manager should also address the nurse's concerns separately through appropriate channels, such as discussing ethical considerations, providing support, and exploring options for accommodation or transfer if necessary.
The nurse is providing education to the patient that is receiving a bisphosphate medication for osteoporosis. Which instructions should the nurse include in the teaching plan to reduce side effects and enhance absorption while taking bisphosphates? Select all that apply.
- A. Take the medication with a small meal at the same time
- B. Take the medication with at least 8 oz. of water.
- C. Remain upright for at least 30 minutes after taking a dos
- D. Take the medication on an empty stomach
Correct Answer: A
Rationale: A. Take the medication with a small meal at the same time: Bisphosphonate medications should be taken with a small meal rather than on an empty stomach to enhance absorption and reduce the risk of gastrointestinal side effects.