Nursing Fundamentals Ch 6 & 8 Flashcards


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Values, Ethics and Advocacy. The Healthcare delivery system
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1

Which action most clearly demonstrates a nurse's commitment to social justice?
a)lobbying for an expansion of Medicare eligibility and benefits
b)documenting nursing care in a timely, honest, and thorough manner
c)answering a client's questions about her care clearly and accurately
d)ensuring that a hospital client's diet is culturally acceptable

lobbying for an expansion of Medicare eligibility and benefits

Social justice is a professional value that encompasses efforts to promote universal access to health care, such as the expansion of publicly funded programs like Medicare. Culturally competent care is a reflection of human dignity. Answering clients' questions and documenting them accurately are expressions of the value of integrity.

2

When instructing a group of older adults preparing for retirement, you would provide information regarding Medicare benefits. Medicare part A is:
a)a health insurance program administered locally to cover visits to physicians, medications, and home health.
b)an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services.
c)a federally funded public assistance program.
d)a plan for seniors that limits providers to those within the group plan.

an insurance program that pays a set amount based on the diagnosis and approved care for in-hospital services.

The nurse must understand that Medicare is a federal insurance program for the elderly. Medicare part A is based on a prospective payment plan which pays a predetermined fixed amount for in-hospital costs. Medicare part A does not pay physician groups, and is not for the poor, indigent to save on costs.

3

Which of the following is a characteristic of the care-based approach to bioethics?
a)the promotion of the dignity and respect of clients as people
b)the need to emphasize the relevance of clinical experience
c)the need for an orientation toward service
d)The rightness or wrongness of an action is independent of its consequences.

the promotion of the dignity and respect of clients as people

The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of clients and people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of the criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences.

4

A school nurse interviewing parents of a child who is doing poorly in school determines that the parents practice a laissez-faire method of discipline. What are examples of this form of value transmission? Select all that apply.
a)Before meals, a boy says a prayer that he learned from his parents.
b)A boy is taken for ice cream to celebrate his good report card.
c)A teenage boy explores religions of friends in hopes of developing his own faith.
d)A teenage girl tries alcohol at a party with her friends.
e)A teenage girl is punished for staying out too late with her friends.
f)A boy is taught how to behave in public by his schoolteacher.

• A teenage boy explores religions of friends in hopes of developing his own faith.
• A teenage girl tries alcohol at a party with her friends.
The laissez-faire approach to discipline would leave children to explore values on their own and to develop a personal value system from this exploration. This approach often involves little or no parental guidance, and may lead to confusion and conflict for the child. Examples of this form of discipline would be a teenage girl trying alcohol at a party with her friends and a teenage boy exploring religions of friends in hopes of developing his own faith. A child reciting a prayer learned by the parents would not be an example of this method. A child being taken for ice cream to celebrate would not be an example of this method. A child taught how to behave by the school teacher is not an example. A teenager being punished by the parents for breaking curfew is not an example.

5

A client was admitted to the hospital 2 weeks ago following an ischemic stroke. Following the early introduction of stroke rehabilitation, he has seen significant improvements in both his medical status and activities of daily living (ADLs). This morning, however, his nurse notes that the client has been coughing since he ate his minced and pureed breakfast. Auscultation of his chest reveals the presence of coarse crackles. Which practitioner should the nurse consult with in order to obtain a swallowing assessment?
a)Physician
b)Respiratory therapist
c)Speech therapist
d)Physical therapist

Speech therapist

The diagnosis and treatment of dysphagia (swallowing problems) is within the purview of speech therapists. The physician should be made aware, and respiratory therapy may be involved with assessing and promoting the client's oxygenation, but swallowing assessment is a task most often performed by a speech therapist.

6

A nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of the shift. Which of the following is the nurse attempting to enact?
a)Beneficence
b)Nonmaleficence
c)Fidelity
d)Justice

Justice

The ethical principle of justice includes an effort to fairly distribute benefits and to minimize discrimination, even when circumstances make this difficult to achieve. This is demonstrated by the nurse's efforts to fairly distribute her time and care.

7

A nursing instructor is discussing the 1999 Institute of Medicine report, "To Err Is Human," with a group of students. Which of the following statements made by the nurse accurately reflects the report's findings?
a)Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors.
b)A common source of medical errors and preventable death is the overly centralized nature of health care in the United States.
c)Encouraging health care organizations and practitioners to develop and participate in mandatory reporting systems is desirable.
d)The establishment of a local or regional, rather than a national, focus to create leadership in health care will improve outcomes.

Anywhere from 44,000 to 98,000 people are estimated to die in U.S. hospitals each year as a result of preventable medical errors.

It is the fragmented, rather than centralized, nature of health care that has contributed to medical errors. The report recommends a national, rather than local or regional, focus on leadership to improve outcomes. Voluntary reporting is encouraged

8

A clinic-based nurse in a sparsely populated remote area far from a regional hospital is working with other local healthcare team members on a plan to improve client health and outcomes. The team has decided that which of the following healthcare delivery systems would best meet the population's needs?
a)A preferred provider organization
b)APRN-run health clinic
c)A multi-specialty group practice
d)The medical neighborhood

APRN-run health clinic

The APRN-run health clinic would best meet the needs of clients who live both far from each other and from regional facilities. A PPO (preferred provider organization) is an insurance/provider model that does not address the question's intent. Similarly, a multi-specialty group would likely be unsustainable in a remote, sparsely populated area. The medical neighborhood is similar to an HMO model

9

Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when she reflects on the decision-making process and the role it will play in making future decisions?
a)Evaluating
b)Diagnosing
c)Planning
d)Implementing

Evaluating

Evaluating an ethical decision involves reflecting on the process and evaluating those elements that will be helpful in the future. The nurse may also question how this experience can improve reasoning and decision making in the future. Diagnosing the ethical problem involves stating the problem clearly. Planning includes identifying the options and exploring the probable short-term and long-term consequences. Implementing includes the implementation of the decision and comparing the outcomes of the action with what was considered and hoped for in advance.

10

The nurse is aware that a community health center provides which of the following?
a)Ensuring that clients under 62 years of age have access to health care regardless of ability to pay
b)Mostly primary care and education regionally for vulnerable geographic populations
c)Community health centers providing mostly obstetric and gynecological services (OB/GYN), regardless of the ability to pay
d)Community Health Centers serving the primary health care needs of more than a million patients in over 900 locations across the United States

Mostly primary care and education regionally for vulnerable geographic populations

These centers are mostly primary care and education centers for vulnerable populations. They are open to patients of any age and are not primarily OB/GYN centers. The centers provide care to 22 million clients in 9000 centers.

11

A nurse is preparing a client for discharge from the cardiac unit and observes cigarettes in the client's belongings. The nurse asks the client to consider her health and the health of her husband. This is an example of:
a)social justice.
b)values clarification.
c)ethical dilemma.
d)moral distress.

values clarification.

Values clarification is a process that allows an individual to examine and understand what choices to make. Moral distress, ethical dilemma, and social justice are not reflected in this scenario

12

The local community hospital is hosting a seminar on trends in healthcare and healthcare cost reduction. The nurse-presenter is discussing cost reduction techniques that also emphasize improved client outcomes. Which of the following cost-cutting changes is most likely to facilitate improved client outcomes?
a)Improving transitions across settings
b)A prospective payment system such as DRGs
c)Comparative effectiveness analysis
d)Increased emphasis on capitation and managed care

Improving transitions across settings

Improving transitions across settings is most likely to improve client outcomes since it involves better client hand-offs during changes from one level of care to another. DRGs help reduce costs but do not directly improve patient outcomes. Comparative effectiveness analysis encourages the provider to carefully select technologies with cost in mind. Capitation and managed care may actually decrease positive client outcomes if there is too much emphasis on cost cutting

13

A female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, “this happens to many women.” Which type of ethical approach is the nurse exhibiting?
a)Feminist
b)Values clarification
c)Paternalism
d)Moralizing

Feminist

A feminist approach is one where the focus is on specific female problems and concerns, and the statement "this happens to many women" is an example of this. The other choices are not correct as they are not reflective of this ethical approach.

14

A nurse who is caring for a new mother realizes that the woman is not prepared to go home with her newborn after a hospital stay of only 24 hours, but hospital policy dictates that the mother be discharged. This nurse may be faced with which moral problem?
a)Ethical uncertainty
b)Ethical dissatisfaction
c)Ethical dilemma
d)Ethical distress

Ethical distress

Ethical distress occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Ethical dilemmas arise when attempted adherence to basic ethical principles results in two conflicting courses of action.

15

The goal of healthcare reform is to address which of the following? Select all that apply.
a)Improved access
b)Safety improvement
c)Increased quality
d)Decreased centralization
e)Cost containment

• Improved access
• Increased quality
• Cost containment
Cost containment, improved access, and increased quality are goals of healthcare reform. A decrease in centralization is not a goal. Increased centralization is proposed to eliminate wasteful spending on duplicative services. Safety is not a goal of healthcare reform, it is a goal of QSEN (Quality and Saftey Education for Nurses.

16

The foundation for decisions about resource allocation throughout a society or group is based on the ethical principle of:
a)veracity.
b)autonomy.
c)confidentiality.
d)justice.

justice.

Justice is the foundation for decisions about resource allocation throughout a society or group.

17

A nurse is discharging a patient who was admitted for observation following a motor vehicle accident. The patient is a single parent who is living in a new community. What service would be an appropriate referral for this patient?
a)Hospice care
b)Medical home
c)Respite care
d)Parish nursing

Parish nursing

Parish nursing is an expanding area of specialty nursing practice that emphasizes holistic health care, health promotion, and disease-prevention activities. It combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Hospice care is appropriate for an individual with an advanced chronic illness that has a life expectancy of six months. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older patients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. A medical home is an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated patient-centered care.

18

A hospital social worker speaks to a group of students orienting to a local hospital for their first medical surgical nursing rotation. Which of the following roles is within the social worker's scope of practice? Select all that apply.
a)Social workers provide assistance with securing medical devices and supplies
b)Social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being
c)Social workers provide direct, in-hospital, psychological counseling
d)Social workers assist with discharge planning
e)Social workers make referrals to appropriate community resources

• Social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being
• Social workers make referrals to appropriate community resources
• Social workers provide assistance with securing medical devices and supplies
• Social workers assist with discharge planning
Hospital based social workers do not generally provide direct counseling for psychiatric patients, or other patients with psychiatric disorders. All other choices are correct

19

Which nursing practice is part of the tertiary health care system?
a)Oncology nursing
b)Community clinic nursing
c)Hospice care nursing
d)Emergency room nursing

Hospice care nursing

The U.S. Department of Health and Human Services Division of Nursing has analyzed current nursing practice and education in relation to population health care needs. Levels of health care are categorized as primary, secondary, and tertiary. Most current resources, services, nursing practice, and nursing education exist within the category of secondary health care: emergency care, acute and critical care, diagnosis, and treatment. The population's needs, however, fall mostly within the categories of primary health care (health promotion, education, protection, and screening) and tertiary health care (rehabilitation, long-term care, support services, and hospice care)

20

A parent of a high school student age 17 years is allowing the child to make the decision on the college he will attend. When the child requests direction from the parent in making this decision, the parent responds by informing him that he will need to make this decision on his own. This is an example of which type of value transmission?
a)Laissez-faire
b)Moralizing
c)Responsible choice
d)Modeling

Laissez-faire

This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values on his own and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict. Through modeling, children learn which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.