LEGAL AND ETHICAL, CULTURAL

In a situation in which there is insufficient staff to implement competent care, a nurse

should:

Inform the clients of the situation

Organize a strike
Refuse the assignment
Accept the assignment but make a protest in writing to the administration.

Cultural awareness is an in-depth self-examination of ones:

Social, cultural, and biophysical factors

Motivation and commitment to caring.
Engagement in cross-cultural interactions
Background, recognizing biases and prejudices.

Ethnocentrism is the root of:

Cultural beliefs
Meanings by which people make sense of their experiences.
Individualism and self-reliance in achieving and maintaining health.
Biases and prejudices

The dominant values in American society on individual autonomy and self-

determination:

May hinder ability to get into a hospice program

Rarely have an effect on other cultures
Do have an effect on healthcare
May be in direct conflict with diverse groups.

All of the following are crucial needs of the dying client except:

Preservation of dignity and self-worth

Freedom from decision making
Control of pain
 Love and belonging

The nurse is obligated to follow a physicians order unless:

The order is a verbal order

The order has not been transcribed
The physicians order is illegible
The order is an error, violates hospital policy, or would be detrimental to the
client.

Even though the nurse may obtain the clients signature on a form, obtaining informed
consent is the responsibility of the:

Client
Physician
Student nurse
Supervising nurse.

The dominant value orientation in North American society is:

Healing emphasizing naturalistic modalities

Group reliance and interdependence
Individualism and self-reliance in achieving and maintaining health.
Use of rituals symbolizing the supernatural.

The clients right to refuse treatment is an example of:

Nurse practice acts

Statutory law
Civil laws
Common law

Which statement about loss is accurate?

Loss is only experienced when there is an actual absence of something

valued.
Loss may be maturational, situational, or both.
 The more the individual has invested in what is lost, the less the feeling of
loss.
The degree of stress experienced is unrelated to the type of loss.

The code of ethics for nurses is composed and published by:

The American Nurses Association

The National Institutes of Health, Nursing division.
The Medical American Association
The national league for Nursing

The philosophy sometimes called the code of ethics of care suggests that ethical
dilemmas can best be solved by attention to:

Clients
Relationships
Code of ethics for nurses.
Ethical principles

The nurse practice acts are an example of:

Criminal law
Common law
Civil law
Statutory law

The scope of Nursing Practice, the established educational requirements for nurses, and
the distinction between nursing and medical practice is defined by:

Statutory law
Civil law
Nurse practice acts
Common law

Cultural competence is the process of:

Learning about vast cultures

 Motivation and commitment to caring.
Acquiring specific knowledge, skills, and attitudes
Influencing treatment and care of clients

Culture strongly influences pain expression and need for pain medication. However,
cultural pain:

Is not expressed verbally or physically

May be suffered by a client whose valued way of life is disregarded by
practitioners.
Is more intense, thus necessitating more medication.
Is expressed only to others of like culture.

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse
to:

Seek out the nursing supervisor in conflicting situations

Assess the clients point of view and prepare to articulate this point of view.
Document all clinical changes in the medical record in a timely manner.
Work to understand the law as it applies to the clients clinical condition.

Successful ethical discussion depends on people who have a clear sense of personal
values. When many people share the same values it may be possible to identify a
philosophy of utilitarianism, with proposes that:

The best way to determine the solution to an ethical dilemma is to refer the
case to the attending physician.
The decision to perform a lover transplant depends on a measure of the
moral life that the client has led so far.
The value of something is determined by its usefulness to society.
The value of people is determined solely by leaders in the Unitarian church.

When action is taken on ones prejudices:

People think/know you are a dumbass for being prejudiced.

Sufficient comparative knowledge of diverse groups is obtained.
Discrimination occurs
Delivery of culturally congruent care is ensured.
Disparities in heath outcomes between the rich and the poor illustrates: a (an)

Illness attributed to natural, impersonal, and biological forces.

Combination of naturalistic, religious, ad supernatural modalities.
Creation of own interpretation and descriptions of biological and
psychological malfunctions.
Influence of socioeconomic factors in morbidity and mortality.

Trying questionable and experimental forms of therapy is a behavior that is

characterized of which stage of dying?

Anger
Bargaining
Depression
Acceptance

In the United States, access to health care usually depends on a clients ability to pay
for health care, either through insurance or by paying cash. The client the nurse is
caring for needs a liver transplant to survive. This client has been out of work for
several months and does not have insurance or enough cash. A discussion about the
ethics of this situation would involve predominately the principle of:

Accountability, because you as the nurse are accountable for the well being
of this client.
Respect of autonomy, because this clients autonomy will be violated if he
does not receive the liver transplant.
Ethics of care, because the caring thing that a nurse could provide this
patient is resources for a liver transplant.
Justice, because the first and greatest question in this situation is how to
determine the just distribution of resources.

Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined
that the dilemma is ethical, a critical first step in negotiating the difference of opinion
would be to:

Gather all relevant information regarding the clinical, social, and spiritual
aspects of the dilemma.
Ensure that the attending physician has written an order for an ethics
consultation to support the ethics process.
 Consult a professional ethicist to ensure that the steps of the process occur
in full.
List the ethical principles that inform the dilemma so that negotiations agree
on the language of the discussion.

In most ethical dilemmas, the solution to the dilemma requires negotiation among
members of the health care team. The nurses point of view is valuable because:

The nurses code of ethics recommends that a nurse be present at any

ethical discussion about client care.
Nurses develop a relationship to the client that is unique among all
professional health care providers.
The principle of autonomy guides all participates to respect their own self-
worth.
Nurses have a legal license that encourages their presence during ethical
discussions.

Besides the Joint Commission on Accreditation of Healthcare Organizations (JACHO),

which governing agency regulates hospitals to allow continued safe services to be
provided, funding to be received from the government and penalties if guidelines are
not followed?

Board of Nursing Examiners (BNE)

Americans With Disabilities Act (ADA)
American Nurses Association (ANA)
Nurse Practice Act (NPA)

Which statement is correct?

Nurses who get sick and leave during a shift are not abandoning clients if
they call their supervisor and leave a message about their emergency illness.
Consent for medical treatment can be given by a minor with a sexually
transmitted disease (STD).
Student nurses cannot be sued for malpractice while in a nursing clinical
class.
A second trimester abortion can be given without state involvement.

Which statement would best explain the role of the nurse when planning care for a
culturally diverse population? The nurse will plan care to:
 Include care that is culturally congruent with the staff from predetermined
criteria
Focus only on the needs of the client, ignoring the nurses beliefs and
practices
Provide care while aware of ones own bias, focusing on the clients
individual needs rather than the staffs practices
Blend the values of the nurse that are for the good of the client and
minimize the clients individual values and beliefs during care

The distribution of nurses to areas of most need in the time of a nursing shortage is
an example of:

Justice
Utilitarianism theory
Deontological theory
Beneficence

The nurse places an aquathermia pad on a client with a muscle sprain. The nurse
informs the client the pad should be removed in 30 minutes. Why will the nurse return
in 30 minutes to remove the pad?

Systemic response occurs.

Reflex vasoconstriction occurs.
Local response occurs.
Reflex vasodilation occurs.

The best explanation of what Title VI of the Civil Rights Act mandates is the freedom to:

Have basic care with a sliding scale payment plan from all health care
facilities
Pick any physician and insurance company despite ones income
Receive free medical benefits as needed within the county of residence
Have equal access to all health care regardless of race and religion

What should the nurse do when planning nursing care for a client with a different
cultural background? The nurse should:
 Allow the family to provide care during the hospital stay so no rituals or
customs are broken
Identify how these cultural variables affect the health problem
Speak slowly and show pictures to make sure the client always understands
Explain how the client must adapt to hospital routines to be effectively cared
for while in the hospital

A bioethical issue should be described as:

The physicians making all decisions of client management without getting

input from the client
A research project that included treating all the white men and not treating
all the black men to compare the outcomes of a specific drug therapy.
After the client gives permission, the physicians disclosing all information to
the family for their support in the management of the client.
The withholding of food and treatment at the request of the client in a
written advance directive given before a client acquired permanent brain damage
from an accident.

Transcultural nursing implies:

Working in another culture to practice nursing within their limitations

Using a comparative study of cultures to understand similarities and
differences across human groups to provide specific individualized care that is
culturally appropriate
Ignoring all cultural differences to provide the best generalized care to all
clients.
Combining all cultural beliefs into a practice that is a nonthreatening
approach to minimize cultural barriers for all clients equality of care

Ethical principles for professional nursing practice in a clinical setting are guided by the
principles of conduct that are written as the:

Standards of care from experts in the practice field

Good Samaritan laws for civil guidelines
American Nurses Associations (ANAs) Code of Ethics
Nurse Practice Act (NPA) written by state legislation

Nurses are bound by a variety of laws. Which description of a type of law is correct?
 Criminal law creates boards that pass rules and regulations to control
society.
Common law protects the rights of the individual within society for fair and
equal treatment.
Regulatory law includes prevention of harm for the public and punishment
for those laws that are broken.
Statutory law is created by elected legislature, such as the state legislature
that defines the Nurse Practice Act (NPA).

A client has recently been told he has terminal cancer. As the nurse enters the room, he
yells, My eggs are cold, and Im tired of having my sleep interrupted by noisy nurses!
The nurse may interpret the clients behavior as:

An expression of the anger stage of dying

The result of previous losses
The result of maturational loss
An expression of disenfranchised grief

Which criterion is needed for someone to give consent to a procedure?

An appointed guardianship
Minimum of 21 years or older
An advocate for a child
Unemancipated minor

Most litigation in the hospital comes from the:

Supervisor watching a new employee check his or her skills level

Nurse abandoning the clients when going to lunch
Nurse following an order that is incomplete or incorrect
Nurse documenting blame on the physician when a mistake is made

Which activity would not be expected by the nurse to meet the cultural needs of the
client?

Develop structure and process for meeting cultural needs on a regular basis
and means to avoid overlooking these needs with clients
 Promote and support attitudes, behaviors, knowledge, and skills to
respectfully meet clients cultural needs despite the nurses own beliefs and
practices
Ensure that the interpreter understands not only the language of the client
but feelings and attitudes behind cultural practices to make sure an ethical
balance can be achieved
Expect the family to keep an interpreter present at all times to assist in
meeting the communication needs all day and night while hospitalized

Which factor is least significant during assessment when gathering information about
cultural practices?

Biocultural needs
Touch, eye contact
Pain perception, management expectations
Language, timing

When a client is confused, left alone with the side rails down, and the bed in a high
position, the client falls and breaks a hip. What law has been broken?

Civil tort
Battery
Assault
Negligence

When signing a form as a witness, your signature shows that the client:

Was free to sign without pressure

Has signed that form and the witness saw it being done
Is fully informed and is aware of all consequences.
Was awake and fully alert and not medicated with narcotics.

When helping a person through grief work, the nurse knows:

Most clients want to be left alone.

The sequencing of stages of grief may occur in order, they may be skipped,
or they may reoccur.
 Coping mechanisms that were effective in the past are often disregarded in
response to the pain of a loss
A persons perception of a loss has little to do with the grieving process.

When the nurse described the client as that nasty old man in 354, the nurse is
exhibiting which ethical dilemma?

Code of ethics violation

HIPPA violation
Gender bias and ageism
Beneficence

To be effective in meeting various ethnic needs, the nurse should:

Avoid asking questions about the clients cultural background.

Act as if he or she is comfortable with the clients behavior.
Treat all clients alike.
Be aware of clients cultural differences.

The scope of Nursing practice is legally defined by:

Hospital policy and procedure manuals

State nurses practice acts
Physicians in the employing institutions
Professional nursing organizations

Which of the following is not included in evaluating the degree of heritage consistency
in a client?

Ethnicity
Gender
Culture
Religion

The nurse is working with parents of a seriously ill newborn. Surgery has been
proposed for the infant, but the chances of success are unclear. In helping the parents
resolve this ethical conflict, the nurse knows that the first step is:
 Identifying people who can solve the difficulty.
Clarifying values related to the cause of the dilemma.
Exploring reasonable courses of action
Collecting all available information about the situation

When providing care to clients with varied cultural backgrounds, it is imperative for the
nurse to recognize that:

Similar reactions to stress will occur when individuals have the same cultural
background.
Generalizations about the behavior of a particular group may be inaccurate.
Cultural considerations must be put aside if basic needs are in jeopardy.
Current health standards should determine the acceptability of cultural
practices.

The nurse puts a restraint jacket on a client without the clients permission and without
the physicians order. The nurse may be guilty of:

Neglect
Battery
Invasion of privacy
Assault

When caring for a terminally ill client, it is important for the nurse maintain the clients
dignity. This can be facilitated by:

Decreasing emphasis on attending to the clients appearance because it only

increases their fatigue
Spending time to let clients share their life experiences
Making decisions for clients so they do not have to make them
Placing the client in a private room to provide privacy at all times

To respect a clients personal space and territoriality, the nurse:

Avoids the use of touch

Stands 8 feet away from the bed, if possible.
Explains nursing care and procedures
 Keeps the curtains pulled around the clients bed

The most important factor in providing nursing care to clients in a specific ethnic group
is:

Environmental control
Time orientation
Biological variation
Communication

A client who had a Do Not Resuscitate order passed away. After verifying there is no
pulse or respirations, the nurse should next:

Remove all tubes and equipment (unless organ donation is to take place),
clean the body, and position appropriately.
Have family members say goodbye to the deceased.
Call the transplant team to retrieve vital organs.
Call the funeral director to come and get the body.

A document that lists the medical treatment a person chooses to refuse if unable to
make decisions is the:

Informed consent
Durable power of attorney
Living will
Advance directives

A clients family member says to the nurse, The doctor said he will provide palliative
care. What does that mean? The nurses best response is:

The goal of palliative care is to affect a cure of a serious illness or disease.

Palliative care is given to those who have less than 6 months to live.
Palliative care aims to relieve or reduce the symptoms of a disease.
Palliative care means the client and family take a more passive role and the
doctor focuses on the physiological needs of the client. The location of death will
most likely occur in the hospital setting.
Miss Magu, an 88-year old woman, believes that life should not be prolonged when
hope is gone. She has decided that she does not want extraordinary measures taken
when her life is at its end. Because she feels this way, she has talked with her daughter
about her desires, completing a living will and left directions with her physician. This is
an example of:

Choosing a value
Prizing a value
Affirming a value
Reflecting a value

A health care issue often becomes an ethical dilemma because:

Decisions must be made quickly, often under stressful conditions.

Decisions must be made based on value systems.
The choices involved do not appear to be clearly right or wrong.
A clients legal rights coexist with a health professionals obligation.

Bereavement may be defined as:

The emotional response to loss.

The inner feeling and outward reactions of the survivor.
Postponing the awareness of the reality of the loss.
The outward, social expression of loss.

A client is hospitalized in the end stage of terminal cancer. His family members are
sitting at his bedside. What can the nurse do to best aid the family at this time?

Avoid telling family members about the clients actual condition so they will
not lose hope.
Find simple and appropriate care activities for the family to perform.
Discourage spiritual practices because this will have little connection to the
client at this time.
Limit the time visitors may stay so they do not become overwhelmed by the
situation.

Which statement about an institutional ethics committee is correct?

 The ethics committee relieves health care professionals from dealing with
ethical issues.
The ethics committee replaces decision making by the client and health care
providers.
The ethics committee is an additional resource for clients and health care
professionals.
The ethics committee would be the first option in addressing an ethical
dilemma.

A student nurse who is employed as a nursing assistant may perform any functions
that:

Are expected of a nurse at that level

Are identified in the positions job description
Have been learned about in school
Require technical rather than professional skill.

A confused client who fell out of bed because side rails were not used is an example of
which type of liability?

Felony
Battery
Assault
Negligence

What are the stages of dying according to Elizabeth Kubler-Ross?

Anticipatory grief, perceived loss, actual loss, and renewal.

Accepting the reality of loss, working through the pain of grief, adjusting to
the environment without the deceased, and emotionally relocating the deceased
and moving on with life.
Denial, anger, bargaining, depression, and acceptance.
Numbing; yearning and searching; disorganization and despair; and
reorganization.
ANTEPARTUM

A prenatal nurse is providing instructions to a group of pregnant client regarding

measures to prevent toxoplasmosis. Which statement if made by one of the clients
indicates a need for further instructions?

I need to cook meat thoroughly.

I need to avoid touching mucous membranes of the mouth or eyes while
handling raw meat.
I need to avoid contact with materials that are possibly contaminated with
cat feces.
I need to drink unpasteurized milk only.

A nurse is assisting in performing an assessment on a client who suspects that she is

pregnant and is checking the client for probable signs of pregnancy. Select all probable
signs of pregnancy.

Fetal heart rate detected by nonelectric device

Uterine enlargement
Ballottement
Outline of the fetus via radiography or ultrasound
Braxton Hicks contractions
Chadwicks sign

A nurse midwife is performing an assessment of a pregnant client and is assessing the

client for the presence of ballottement. Which of the following would the nurse
implement to test for the presence of ballottement?

Auscultating for fetal heart sounds

Initiating a gentle upward tap on the cervix
Palpating the abdomen for fetal movement
Assessing the cervix for thinning

A nursing instructor asks a nursing student who is preparing to assist with the
assessment of a pregnant client to describe the process of quickening. Which of the
following statements if made by the student indicates an understanding of this term?

It is the fetal movement that is felt by the mother.

 It is the thinning of the lower uterine segment.
It is the irregular, painless contractions that occur throughout pregnancy.
It is the soft blowing sound that can be heard when the uterus is
auscultated.

A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps
and is awakened by the cramps at night. To provide relief from the leg cramps, the
nurse tells the client to:

Dorsiflex the foot while extending the knee when the cramps occur
Dorsiflex the foot while flexing the knee when the cramps occur
Plantar flex the foot while flexing the knee when the cramps occur
Plantar flex the foot while extending the knee when the cramps occur.

A nurse is collecting data during an admission assessment of a client who is pregnant

with twins. The client has a healthy 5-year old child that was delivered at 37 weeks and
tells the nurse that she doesnt have any history of abortion or fetal demise. The nurse
would document the GTPAL for this client as:

G = 1, T = 1. P = 1, A = 0, L = 1
G = 2, T = 0, P = 0, A = 0, L = 1
G = 3, T = 2, P = 0, A = 0, L =1
G = 2, T = 0, P = 1, A = 0, L =1

In the 12th week of gestation, a client completely expels the products of conception.
Because the client is Rh negative, the nurse must:

Make certain she receives RhoGAM on her first clinic visit

Admister RhoGAM within 72 hours
Not give RhoGAM, since it is not used with the birth of a stillborn
Make certain the client does not receive RhoGAM, since the gestation only
lasted 12 weeks.

A client in the first trimester of pregnancy arrives at a health care clinic and reports that
she has been experiencing vaginal bleeding. A threatened abortion is suspected, and
the nurse instructs the client regarding management of care. Which statement, if made
by the client, indicates a need for further education?
 I will count the number of perineal pads used on a daily basis and note the
amount and color of blood on the pad.
I will avoid sexual intercourse until the bleeding has stopped, and for 2
weeks following the last evidence of bleeding.
I will maintain strict bedrest throughout the remainder of pregnancy.
I will watch for the evidence of the passage of tissue.

A nurse implements a teaching plan for a pregnant client who is newly diagnosed with
gestational diabetes. Which statement if made by the client indicates a need for further
education?

I need to avoid exercise because of the negative effects of insulin

production.
I will perform glucose monitoring at home.
I need to be aware of any infections and report signs of infection
immediately to my health care provider.
I need to stay on the diabetic diet.

A pregnant client is receiving magnesium sulfate for the management of preeclampsia.

A nurse determines the client is experiencing toxicity from the medication if which of
the following is noted on assessment?

Presence of deep tendon reflexes

Proteinuria of +3
Serum magnesium level of 6 mEq/L
Respirations of 10 per minute

A nurse is providing instructions to a client in the first trimester of pregnancy regarding

measures to assist in reducing breast tenderness. The nurse tells the client to:

Wash the nipples and areola area daily with soap, and massage the breasts
with lotion.
Avoid wearing a bra
Wear tight-fitting blouses or dresses to provide support
Wash the breasts with warm water and keep them dry

A nurse is performing an assessment of a primapira who is being evaluated in a clinic

during her second trimester of pregnancy. Which of the following indicates an abnormal
physical finding necessitating further testing?
 Quickening
Consistent increase in fundal height
Braxton hicks contractions
Fetal heart rate of 180 BPM

A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and
who is being monitored for pregnancy induced hypertension (PIH). Which assessment
finding indicates a worsening of the Preeclampsia and the need to notify the physician?

The client complains of a headache and blurred vision

Dependent edema has resolved
Blood pressure reading is at the prenatal baseline
Urinary output has increased

A nurse is reviewing the record of a client who has just been told that a pregnancy test
is positive. The physician has documented the presence of a Goodells sign. The nurse
determines this sign indicates:

The presence of fetal movement

The presence of hCG in the urine
A softening of the cervix
A soft blowing sound that corresponds to the maternal pulse during
auscultation of the uterus.

A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care
for the client determines that the magnesium therapy is effective if:

Ankle clonus in noted

Seizures do not occur
The blood pressure decreases
Scotomas are present

A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV
magnesium sulfate. Select all nursing interventions that apply in the care for the client.

Keep calcium gluconate on hand in case of a magnesium sulfate overdose

Notify the physician if urinary output is less than 30 ml per hour.
Notify the physician if respirations are less than 18 per minute.
 Monitor renal function and cardiac function closely
Monitor maternal vital signs every 2 hours
Monitor deep tendon reflexes hourly
Monitor I and Os hourly

A nursing instructor is conducting lecture and is reviewing the functions of the female
reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH)
and the luteinizing hormone (LH). Mark accurately responds by stating that:

FSH and LH are released from the anterior pituitary gland.

FSH and LH stimulate the formation of milk during pregnancy.
FSH and LH are secreted by the adrenal glands
FSH and LH are secreted by the corpus luteum of the ovary

Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a
newborn infant and the nurse provides information to the woman about the purpose of
the medication. The nurse determines that the woman understands the purpose of the
medication if the woman states that it will protect her next baby from which of the
following?

Having Rh positive blood

Developing a rubella infection
Being affected by Rh incompatibility
Developing physiological jaundice

A pregnant client in the last trimester has been admitted to the hospital with a
diagnosis of severe preeclampsia. A nurse monitors for complications associated with
the diagnosis and assesses the client for:

Any bleeding, such as in the gums, petechiae, and purpura.

Complaints of feeling hot when the room is cool
Periods of fetal movement followed by quiet periods
Enlargement of the breasts

During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse
determines that the fetal heart rate is normal if which of the following is noted?

100 BPM
 180 BPM
150 BPM
80 BPM

A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of
care for the client and documents in the plan that if the client progresses from
Preeclampsia to eclampsia, the nurses first action is to:

Assess the blood pressure and fetal heart rate

Administer magnesium sulfate intravenously
Administer oxygen by face mask
Clean and maintain an open airway

A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a
nurse that the first day of her last menstrual period was September 19th, 2005. Using
Nageles rule, the nurse determines the estimated date of confinement as:

June 12, 2007

July 12, 2007
June 26, 2006
July 26, 2006

A primagravida is receiving magnesium sulfate for the treatment of pregnancy induced

hypertension (PIH). The nurse who is caring for the client is performing assessments
every 30 minutes. Which assessment finding would be of most concern to the nurse?

Fetal heart rate of 120 BPM

Deep tendon reflexes of 2+
Urinary output of 20 ml since the previous assessment
Respiratory rate of 10 BPM

A nurse is describing the process of fetal circulation to a client during a prenatal visit.
The nurse accurately tells the client that fetal circulation consists of:

Two umbilical arteries and one umbilical vein

Two umbilical veins and one umbilical artery
Arteries carrying oxygenated blood to the fetus
Veins carrying deoxygenated blood to the fetus
A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at
risk for Preeclampsia. The nurse checks the client for which specific signs of
Preeclampsia (select all that apply)?

Increased respirations
Negative urinary protein
Facial edema
Elevated blood pressure