NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
The NR340 Exam 1 covers concepts in critical care nursing and includes questions that relate to disease
pathophysiology, the nursing process, pharmacology and laboratory interpretation. This exam will cover
Chapters 3, 4, 6, 8, and 12 in your textbook as well as content from ACLS. . Exam 1 may include
medication calculation, ABG interpretation, ECG interpretation, and/or laboratory interpretation
questions. Questions related to simulation and clinical experiences, ABGS and other laboratory findings
, and components of Advanced Cardiac Life Support (ACLS) may be included in each of the exams this
semester.
Exam 1 (200 points) – 50 questions (4 points each)
(Chapters 3, 4, 6, 8, 12 & ACLS)
Chapter 3: Ethical and Legal Issues in Critical Care Nursing
Nurse’s Ethical Responsibility in Patient Care-ANA Code of Ethics for Nursing with
Interpretative Statements
The document describes the moral principles that guide professional nursing
practice, and serves the following purposes: (1) it delineates the ethical
obligations and duties of every individual who enters the profession; (2) it is the
profession's nonnegotiable ethical standard; and (3) it is the expression of
nursing's own understanding of its commitment to society.6 The Code of Ethics
consists of nine provision statements. The first three describe fundamental
values and commitments of the nurse, the next three describe the boundaries of
duty and loyalty, and the last three describe duties beyond individual patient
encounters. Nurses in all practice arenas, including critical care, must be
knowledgeable about the provisions of the code and must incorporate its basic
tenets into their clinical practice
• Factors and situations that lead to ethical dilemmas in critical care
o Difference between contextual, physiological and personal factors
• An ethical dilemma is a difficult problem or situation in which conflicts arise
during the process of making morally justifiable decisions. In identifying a
situation as an ethical dilemma, certain criteria must be met. More than one
solution must exist, and there is no clear “right” or “wrong.” Each solution
must carry equal weight and must be ethically defensible. Arriving at a morally
justifiable decision when an ethical dilemma exists can be difficult for patients,
families, and health professionals. Critical care nurses must be careful not to
impose their own value system on that of the patient.
Ethical Dilemma Warning signs
• Emotionally charged
• Significant change in patient’s condition
• Confusion about facts
1
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
,NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
• Hesitancy about what is right
• Deviation from customary practice
• Need for secrecy regarding proposed actions
Nurse Involvement in Ethical Decision Making
• Advocacy
o Open communication of patient’s wishes and ethical concerns
o True collaboration with healthcare team members
• Dilemmas can result in moral distress
• Formal mechanisms (The Joint Commission)
o Bioethics committees
o Ethics consultation
• Opportunities for critical care nurses
o Ethics forums and rounds
o Peer review
o Institutional review boards (research)
BOX 3-3 SITUATIONS WHERE ETHICS CONSULTATION
MAY BE CONSIDERED
• Disagreement or conflict exists on whether to pursue aggressive
life-sustaining treatment in a seriously ill patient, such as
cardiopulmonary resuscitation, or emphasize comfort/palliative
care.
• Family demands to provide life-sustaining treatment, such as
mechanical ventilation or tube feeding, that the physician and
nurses consider futile.
• Competing family members are present and want to make
critical decisions on behalf of the patient.
• A seriously ill patient is incapacitated and does not have a
surrogate decision maker or an advance directive.
• Ethical Decision Making-points to consider; Importance of early end of life decision making
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
,NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
2
1. Assess
➢ Contextual factors
➢ Physiological factors
➢ Personal factors
2. Consider options
➢ Patient wishes
➢ Burden versus benefit
➢ Ethical principles
➢ Potential outcomes
3. Develop plan with patient, surrogate, family, and team
4. Act on plan
5. Evaluate plan
➢ Short-term outcomes
➢ Long-term outcomes
➢ Apply to other cases
Patient self-determination act
This act requires that all healthcare facilities that receive Medicare and Medicaid funding inform their
patients about their right to initiate an advance directive and the right to consent to or refuse medical
treatment.
Discussions regarding advance directives and end-of-life wishes should be made as early as
possible, preferably before death is imminent. The ideal time to discuss advance directives is when a
person is relatively healthy, not in the critical care or hospital setting
Advance directives
An advance directive is a communication that specifies a person's preference about medical treatment
should that person become incapacitated. Several types of advance directives exist, including DNR
orders, allow-a-natural-death orders, living wills, health care proxies, and other types of legal documents
• Review Landmark Legal cases in the right-to-die debate
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
, NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
3
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
College)
The NR340 Exam 1 covers concepts in critical care nursing and includes questions that relate to disease
pathophysiology, the nursing process, pharmacology and laboratory interpretation. This exam will cover
Chapters 3, 4, 6, 8, and 12 in your textbook as well as content from ACLS. . Exam 1 may include
medication calculation, ABG interpretation, ECG interpretation, and/or laboratory interpretation
questions. Questions related to simulation and clinical experiences, ABGS and other laboratory findings
, and components of Advanced Cardiac Life Support (ACLS) may be included in each of the exams this
semester.
Exam 1 (200 points) – 50 questions (4 points each)
(Chapters 3, 4, 6, 8, 12 & ACLS)
Chapter 3: Ethical and Legal Issues in Critical Care Nursing
Nurse’s Ethical Responsibility in Patient Care-ANA Code of Ethics for Nursing with
Interpretative Statements
The document describes the moral principles that guide professional nursing
practice, and serves the following purposes: (1) it delineates the ethical
obligations and duties of every individual who enters the profession; (2) it is the
profession's nonnegotiable ethical standard; and (3) it is the expression of
nursing's own understanding of its commitment to society.6 The Code of Ethics
consists of nine provision statements. The first three describe fundamental
values and commitments of the nurse, the next three describe the boundaries of
duty and loyalty, and the last three describe duties beyond individual patient
encounters. Nurses in all practice arenas, including critical care, must be
knowledgeable about the provisions of the code and must incorporate its basic
tenets into their clinical practice
• Factors and situations that lead to ethical dilemmas in critical care
o Difference between contextual, physiological and personal factors
• An ethical dilemma is a difficult problem or situation in which conflicts arise
during the process of making morally justifiable decisions. In identifying a
situation as an ethical dilemma, certain criteria must be met. More than one
solution must exist, and there is no clear “right” or “wrong.” Each solution
must carry equal weight and must be ethically defensible. Arriving at a morally
justifiable decision when an ethical dilemma exists can be difficult for patients,
families, and health professionals. Critical care nurses must be careful not to
impose their own value system on that of the patient.
Ethical Dilemma Warning signs
• Emotionally charged
• Significant change in patient’s condition
• Confusion about facts
1
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
,NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
• Hesitancy about what is right
• Deviation from customary practice
• Need for secrecy regarding proposed actions
Nurse Involvement in Ethical Decision Making
• Advocacy
o Open communication of patient’s wishes and ethical concerns
o True collaboration with healthcare team members
• Dilemmas can result in moral distress
• Formal mechanisms (The Joint Commission)
o Bioethics committees
o Ethics consultation
• Opportunities for critical care nurses
o Ethics forums and rounds
o Peer review
o Institutional review boards (research)
BOX 3-3 SITUATIONS WHERE ETHICS CONSULTATION
MAY BE CONSIDERED
• Disagreement or conflict exists on whether to pursue aggressive
life-sustaining treatment in a seriously ill patient, such as
cardiopulmonary resuscitation, or emphasize comfort/palliative
care.
• Family demands to provide life-sustaining treatment, such as
mechanical ventilation or tube feeding, that the physician and
nurses consider futile.
• Competing family members are present and want to make
critical decisions on behalf of the patient.
• A seriously ill patient is incapacitated and does not have a
surrogate decision maker or an advance directive.
• Ethical Decision Making-points to consider; Importance of early end of life decision making
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
,NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
2
1. Assess
➢ Contextual factors
➢ Physiological factors
➢ Personal factors
2. Consider options
➢ Patient wishes
➢ Burden versus benefit
➢ Ethical principles
➢ Potential outcomes
3. Develop plan with patient, surrogate, family, and team
4. Act on plan
5. Evaluate plan
➢ Short-term outcomes
➢ Long-term outcomes
➢ Apply to other cases
Patient self-determination act
This act requires that all healthcare facilities that receive Medicare and Medicaid funding inform their
patients about their right to initiate an advance directive and the right to consent to or refuse medical
treatment.
Discussions regarding advance directives and end-of-life wishes should be made as early as
possible, preferably before death is imminent. The ideal time to discuss advance directives is when a
person is relatively healthy, not in the critical care or hospital setting
Advance directives
An advance directive is a communication that specifies a person's preference about medical treatment
should that person become incapacitated. Several types of advance directives exist, including DNR
orders, allow-a-natural-death orders, living wills, health care proxies, and other types of legal documents
• Review Landmark Legal cases in the right-to-die debate
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
, NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
3
NURS 340 Nursing exam1 Study Guide(Chamberlain
College)
