FREE Chapter 3: Clinical Judgment and Ethical Decision Making

Chapter 3: Clinical Judgment and Ethical Decision Making

Arnold: Interpersonal Relationships, 7th Edition

MULTIPLE CHOICE

1. Which of the following types of thinking reflects the nursing process?

a.

Habits

b.

Inquiry

c.

Mnemonic

d.

Practice

ANS: B

More structured methods of thinking, such as inquiry, have been developed in disciplines related to nursing. Repetitive practice does not reflect the nursing process. Memorizing does not reflect the nursing process.

DIF:Cognitive Level: KnowledgeREF:p. 40

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

2. Which of the following personality characteristics is a barrier to critical thinking?

a.

Accepting change

b.

Being open minded

c.

Stereotyping

d.

Going with the flow

ANS: C

Stereotyping is a cognitive barrier to critical thinking because it interferes with the ability to treat a client as an individual. Critical thinkers recognize that priorities change continually. Being open minded is the ability to consider alternatives. Being flexible is a bridge to critical thinking, not a barrier.

DIF:Cognitive Level: ComprehensionREF:p. 46

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

3. The ethical decision-making model where good is defined as maximum welfare or happiness is known as the

a.

utilitarian model.

b.

human rights based model.

c.

duty-based model.

d.

Kant’s model.

ANS: A

The utilitarian model is also known as the goal-based model, where the duties of the nurse are determined by what will achieve maximum welfare. In the human rights model, the client has basic rights, including the right to refuse care. In the duty-based model, rightness is determined by moral worth. The duty-based model is based on Kant’s philosophy.

DIF:Cognitive Level: KnowledgeREF:p. 41

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

4. Which of the following case examples represents the ethical concept of distributive justice?

a.

A famous baseball player receives a heart transplant.

b.

An older adult who has government insurance is denied standard cancer treatment.

c.

During a visit to his physician’s office, a client demands antibiotics for his cold and is given a prescription.

d.

A client suffering from cirrhosis of the liver is placed on a transplant list.

ANS: B

The decision to deny expensive treatments or to deny acute care to clients older than a certain age because of scarce treatment resources is an example of the concept of distributive justice. A famous baseball player who receives a heart transplant could be an example of the concept of social worth. A client demanding antibiotics for his cold during a physician’s office visit is an example of the concept of unnecessary treatment. A client who suffers from cirrhosis and who is placed on a transplant list is an example of justice, being fair or impartial.

DIF:Cognitive Level: AnalysisREF:pp. 43-44

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

5. Personal values are defined as

a.

values shaped by family, religious beliefs, and years of experience.

b.

altruism.

c.

two values that are in conflict.

d.

values determined by commitment.

ANS: A

We all have a personal value system developed over a lifetime that has been extensively shaped by our family, our religious beliefs, and our years of life experiences. Altruism is a core value of professional nursing. Cognitive dissonance refers to two conflicting values. Value intensity refers to the amount of an individual’s commitment to values.

DIF:Cognitive Level: KnowledgeREF:p. 46

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

6. A nurse values autonomy and self-determination as well as the preservation of life. This is an example of

a.

conceptions of the ideal.

b.

cognitive dissonance.

c.

operative values.

d.

commitment.

ANS: B

Cognitive dissonance refers to the mental discomfort felt when there is a discrepancy between what an individual already believes and some new information that does not go along with that view. It refers to the holding of two or more conflicting values at the same time. Conceptions of the ideal are conceived values. Operative values do not refer to conflicting values. Commitment refers to value intensity.

DIF:Cognitive Level: ApplicationREF:p. 46

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

7. Which of the following statements is true about the critical thinking process?

a.

It is a linear process.

b.

The skills are inborn.

c.

It is goal directed.

d.

It assists nurses to criticize the health care system.

ANS: C

The process of critical thinking is systematic, organized, and goal directed. As critical thinkers, nurses are able to explore all aspects of a complex clinical situation. Critical thinking is a circular process. Critical thinking is a learned skill that teaches you how to “think about your thinking.” Critical thinking is clinical judgment, not criticism.

DIF:Cognitive Level: ComprehensionREF:p. 49

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

8. Which of the following best describes the critical thinking skills of a novice nurse and an expert nurse?

a.

The expert nurse is able to diagnose faster than the novice nurse.

b.

The expert nurse does not need to question and reassess like the novice nurse.

c.

The novice nurse uses past knowledge, whereas the expert nurse stays in the here and now.

d.

The expert nurse organizes data more efficiently than the novice nurse.

ANS: D

The novice nurse collects lots of facts but does not logically organize them. Novice nurses tend to jump too quickly to a diagnosis without recognizing the need to obtain more facts. The expert nurse constantly questions and reassesses. The expert nurse compares new information with prior knowledge, while the novice nurse makes fewer connections to past knowledge.

DIF:Cognitive Level: ComprehensionREF:p. 45

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

9. A client with schizophrenia has been stabilized on long-acting haloperidol, an antipsychotic medication that is administered by injection every 3 weeks. The physician switches the medication to Seroquel, a new antipsychotic oral medication that is administered twice a day. The client complains that he cannot afford the new medication and will not be able to remember to take it. The physician replies, “I can’t help that; I have to treat you the way I think is best.” The client’s nurse may experience

a.

paternalism.

b.

cognitive dissonance.

c.

nonmaleficence.

d.

moral distress.

ANS: D

Moral distress results when the nurse knows what is right but is bound to do otherwise because of legal or institutional constraints. Paternalism is making decisions for clients based on what is thought best for them. Cognitive dissonance occurs when there are two conflicting values. Nonmaleficence is avoiding actions that bring harm to another person.

DIF:Cognitive Level: ApplicationREF:p. 47

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

10. Characteristics of a critical thinker include all but which of the following?

a.

Haphazardly seeking solutions

b.

Anticipating consequences

c.

Considering alternative solutions

d.

Revising actions based on new input

ANS: A

This is an example of a negative style question. “Haphazardly seeking solutions” is correct because a characteristic of a critical thinker is to systematically seek solutions, not to haphazardly seek solutions. All of the other options are characteristics of a critical thinker.

DIF:Cognitive Level: KnowledgeREF:p. 45

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

11. The best method for nurse educators to teach professional values is

a.

reading the ANA code.

b.

laissez-faire.

c.

role modeling.

d.

values clarification.

ANS: C

Nursing education helps a nurse to acquire a professional value system. In nursing school, the student nurse begins to take on some of the values of the nursing profession. Often, professional values are transmitted by tradition in nursing classes and clinical experiences. They are modeled by expert nurses and assimilated as part of the role socialization process during the years spent as a student and new graduate. Professional values are stated in the ANA code, but the best way to transmit them is by role modeling. Professional values are transmitted by tradition and assimilated in the role socialization process. Values clarification helps a nurse to identify and prioritize values.

DIF:Cognitive Level: KnowledgeREF:p. 49

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

12. Which of the following describes the first step in acquisition of a value?

a.

There must be pride in and happiness with the choice.

b.

The value must be acted upon in a pattern of behavior consistent with the choice.

c.

The value should be the result of conscious choice.

d.

The value must be chosen after careful consideration of each alternative.

ANS: C

Professional values acquisition should be the result of conscious choice. This is the first step in values acquisition. The value must be acted upon in a pattern of behavior consistent with the choice, which occurs during the seventh criteria for acquisition of a value. Pride and happiness with the choice occurs during the fourth criteria for acquisition of a value. Careful consideration of each alternative occurs during the third criteria for acquisition of a value.

DIF:Cognitive Level: KnowledgeREF:p. 49

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

13. The client’s values

a.

must coincide with those of the nurse.

b.

are only considered during assessment.

c.

influence the nurse’s interventions.

d.

are not influenced by culture.

ANS: C

In the planning phase, it is important to identify and understand the client’s value system as the foundation for developing the most appropriate interventions. It is not necessary for the client and nurse’s values to coincide; in fact, it is an unrealistic expectation. The client’s value system is important to consider throughout the nursing process. Values are influenced by culture and religious beliefs.

DIF:Cognitive Level: ComprehensionREF:p. 51

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

14. Values clarification can be incorporated within the intervention phase of the nursing process by

a.

identifying ineffective family coping.

b.

identifying care guidelines.

c.

identifying client’s values.

d.

identifying specific nursing diagnoses.

ANS: B

Plans of care that support rather than discount the client’s health care beliefs are more likely to be received favorably. Your interventions include values clarification as a guideline for care. Ineffective family coping is a nursing diagnosis, not an intervention. Values are identified and then used as care guidelines. Nursing diagnosis does not occur during the intervention phase of the nursing process.

DIF:Cognitive Level: ComprehensionREF:p. 51

TOP:Step of the Nursing Process: Implementation

MSC:Client Needs: Management of Care

15. During the third step in the critical thinking process

a.

new data are obtained.

b.

values are clarified.

c.

existing information is compared with past knowledge.

d.

the problem is identified.

ANS: C

During step 3, existing information is compared with past knowledge. New data are obtained in step 4. Values are clarified in step 2. The problem is identified in step 5.

DIF:Cognitive Level: ComprehensionREF:p. 51

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

16. The student nurse can best learn the steps in critical thinking through

a.

reading journals.

b.

classroom instruction.

c.

repeated practice.

d.

developing a mnemonic.

ANS: C

The most effective method of learning the steps in critical thinking is by repeatedly applying them to clinical situations. Reading journals, classroom instruction, and developing a mnemonic are not the most effective ways of learning the steps in critical thinking.

DIF:Cognitive Level: ApplicationREF:p. 54

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

17. The bioethical principle of autonomy refers to

a.

the client’s right to self-determination.

b.

avoiding actions that bring harm to another person.

c.

a decision resulting in the greatest good or least harm.

d.

being fair or impartial.

ANS: A

Autonomy is the client’s right to self-determination. Avoiding actions that bring harm to another person refers to the principle of nonmaleficence. A decision resulting in the greatest good or least harm refers to the principle of beneficence. Being fair or impartial refers to the principle of justice.

DIF:Cognitive Level: KnowledgeREF:p. 42

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care

MULTIPLE RESPONSE

1. Which of the following is true about critical thinkers? (Select all that apply.)

Critical thinkers

a.

are open minded.

b.

are able to consider alternatives.

c.

use a purposeful reasoning process.

d.

use a linear thinking process.

e.

are able to recognize information gaps.

ANS: A, B, C, E

Critical thinkers use specific thinking skills that are not rigid, and these allow the consideration of alternatives and recognition of gaps and available information. Critical thinkers do not use a linear process but constantly add new input.

DIF:Cognitive Level: KnowledgeREF:p. 45

TOP:Step of the Nursing Process: All phases

MSC:Client Needs: Management of Care