Name: ______________________ Class: _________________ Date: _________ Critical Thinking & Ethical Decision Making Exam ____ CLASSROOM

Name: ______________________ Class: _________________ Date: _________ Critical Thinking & Ethical Decision Making Exam ____ CLASSROOM 1. 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 nurse's personal beliefs. What is the nurse's 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. ____ ____ ____ 2. A terminally ill patient you are caring for is complaining of pain. The physician has ordered a large dose of intravenous opioids by continuous infusion. You know that one of the adverse effects of this medicine is respiratory depression. When you assess your patient's respiratory status, you find that the rate has decreased from 16 breaths per minute to 10 breaths per minute. What action should you take? A) Decrease the rate of IV infusion. B) Stimulate the patient in order to increase respiratory rate. C) Report the decreased respiratory rate to the physician. D) Allow the patient to rest comfortably. 3. An adult patient has requested a “do not resuscitate” (DNR) order in light of his recent diagnosis with late stage pancreatic cancer. The patient's son and daughter-in-law are strongly opposed to the patient's 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. 4. An elderly patient is admitted to your unit with a diagnosis of community-acquired pneumonia. During admission the patient states, “I have a living will.” What implication of this should the nurse recognize? A) This document is always honored, regardless of circumstances. B) This document specifies the patient's wishes before hospitalization. C) This document that is binding for the duration of the patient's life. D) This document has been drawn up by the patient's family to determine DNR status. 1 CLASSROOM CLASSROOM CLASSROOM CLASSROOM ID: A CLASSROOM Name: ______________________ ____ CLASSROOM 5. A nurse has been providing ethical care for many years and is aware of the need to maintain the ethical principle of nonmaleficence. Which of the following actions would be considered a contradiction of this principle? A) Discussing a DNR order with a terminally ill patient B) Assisting a semi-independent patient with ADLs C) Refusing to administer pain medication as ordered D) Providing more care for one patient than for another ____ ____ ____ ____ 6. You have just taken report for your shift and you are doing your initial assessment of your patients. One of your patients asks you if an error has been made in her medication. You know that an incident report was filed yesterday after a nurse inadvertently missed a scheduled dose of the patient's antibiotic. Which of the following principles would apply if you give an accurate response? A) Veracity B) Confidentiality C) Respect D) Justice 7. A nurse has begun creating a patient's plan of care shortly after the patient's admission. It is important that the wording of the chosen nursing diagnoses falls within the taxonomy of nursing. Which organization is responsible for developing the taxonomy of a nursing diagnosis? A) American Nurses Association (ANA) B) NANDA C) National League for Nursing (NLN) D) Joint Commission 8. In response to a patient's complaint of pain, the nurse administered a PRN dose of hydromorphone (Dilaudid). In what phase of the nursing process will the nurse determine whether this medication has had the desired effect? A) Analysis B) Evaluation C) Assessment D) Data collection 9. A medical nurse has obtained a new patient's health history and completed the admission assessment. The nurse has followed this by documenting the results and creating a care plan for the patient. Which of the following is the most important rationale for documenting the patient's care? A) It provides continuity of care. B) It creates a teaching log for the family. C) It verifies appropriate staffing levels. D) It keeps the patient fully informed. 2 CLASSROOM CLASSROOM CLASSROOM CLASSROOM ID: A CLASSROOM Name: ______________________ CLASSROOM ____ 10. The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequently combative and confused, despite the administration of benzodiazepines. The patient has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate action for the nurse to take? A) Leave the patient and get help. B) Obtain a physician's order to restrain the patient. C) Read the facility's policy on restraints. D) Order soft restraints from the storeroom. ____ 11. A patient admitted with right leg thrombophlebitis is to be discharged from an acute-care facility. Following treatment with a heparin infusion, the nurse notes that the patient's leg is pain-free, without redness or edema. Which step of the nursing process does this reflect? A) Diagnosis B) Analysis C) Implementation D) Evaluation ____ 12. During report, a nurse finds that she has been assigned to care for a patient admitted with an opportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she is refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which legal premise? A) Good Samaritan Act B) Nursing Interventions Classification (NIC) C) Patient Self-Determination Act D) ANA Code of Ethics ____ 13. An emergency department nurse is caring for a 7-year-old child suspected of having meningitis. The patient is to have a lumbar puncture performed, and the nurse is doing preprocedure teaching with the child and the mother. The nurse's action is an example of which therapeutic communication technique? A) Informing B) Suggesting C) Expectation-setting D) Enlightening ____ 14. The nurse, in collaboration with the patient's family, is determining priorities related to the care of the patient. The nurse explains that it is important to consider the urgency of specific problems when setting priorities. What provides the best framework for prioritizing patient problems? A) Availability of hospital resources B) Family member statements C) Maslow's hierarchy of needs D) The nurse's skill set CLASSROOM 3 CLASSROOM CLASSROOM CLASSROOM ID: A CLASSROOM Name: ______________________ CLASSROOM ____ 15. A medical nurse is caring for a patient who is palliative following metastasis. The nurse is aware of the need to uphold the ethical principle of beneficence. How can the nurse best exemplify this principle in the care of this patient? A) The nurse tactfully regulates the number and timing of visitors as per the patient's wishes. B) The nurse stays with the patient during his or her death. C) The nurse ensures that all members of the care team are aware of the patient's DNR order. D) The nurse liaises with members of the care team to ensure continuity of care. ____ 16. The care team has deemed the occasional use of restraints necessary in the care of a patient with Alzheimer's disease. What ethical violation is most often posed when using restraints in a long-term care setting? A) It limits the patient's personal safety. B) It exacerbates the patient's disease process. C) It threatens the patient's autonomy. D) It is not normally legal. ____ 17. While receiving report on a group of patients, the nurse learns that a patient with terminal cancer has granted power of attorney for health care to her brother. How does this affect the course of the patient's care? A) Another individual has been identified to make decisions on behalf of the patient. B) There are binding parameters for care even if the patient changes her mind. C) The named individual is in charge of the patient's finances. D) There is a document delegating custody of children to other than her spouse. ____ 18. In the process of planning a patient's care, the nurse has identified a nursing diagnosis of Ineffective Health Maintenance related to alcohol use. What must precede the determination of this nursing diagnosis? A) Establishment of a plan to address the underlying problem B) Assigning a positive value to each consequence of the diagnosis C) Collecting and analyzing data that corroborates the diagnosis D) Evaluating the patient's chances of recovery ____ 19. You are following the care plan that was created for a patient newly admitted to your unit. Which of the following aspects of the care plan would be considered a nursing implementation? A) The patient will express an understanding of her diagnosis. B) The patient appears diaphoretic. C) The patient is at risk for aspiration. D) Ambulate the patient twice per day with partial assistance. 4 CLASSROOM CLASSROOM CLASSROOM CLASSROOM ID: A CLASSROOM Name: ______________________ CLASSROOM ____ 20. 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?