NURSING EXAM TEST
[Author name]
[COMPANY NAME] [Company address]
, NURSING EXAM T
Critical care
Chapter 3
Laws: EMTALA: Emergency room law - everyone who comes in ER room must be treated whether they have insurance or
not.
Torts: Doing something legally wrong
✓ Intentional: Assault (Verbal threats), battery (Physical harm, putting your hands on them without permission),
false imprisonment (medical restraint is a necessity) (Haldol to sedate them is chemical restraint)
✓ Unintentional: Negligence (no harm to patient we just didn’t do what we were supposed to), Malpractice
(when harm is done to the patient). ON TEST
Dilemmas: No right or wrong
Principlism is a widely applied ethical approach based on four fundamental moral principles to contemporary ethical
dilemmas: respect for autonomy, beneficence, nonmaleficence, and justice.
• Autonomy states that all persons should be free to govern their lives to the greatest degree possible. This
implies a strong sense of self-determination and an acceptance of responsibility for one's own choices and
actions. To respect autonomy of others means to respect their freedom of choice and to allow them to make
their own decisions.
• Beneficence is the duty to provide benefits to others when in a position to do so and to help balance harms and
benefits. In other words, the benefits of an action should outweigh the burdens. Actions intended to benefit
the patients or others.
• Nonmaleficence is the explicit duty not to inflict harm on others intentionally.
• The principle of justice requires that health care resources be distributed fairly and equitably among groups of
people.
Other principals
• The principle of veracity states that persons are obligated to tell the truth in their communication with others.
• The principle of fidelity requires that one has a moral duty to be faithful to the commitments made to others.
These two principles, along with confidentiality, are the key to the nurse-patient relationship.
Bioethics committees – Address ethical concerns. Typical membership of a bioethics committee includes physicians,
nurses, chaplains, social workers, and, if available, bioethicists.
Informed consent: Three elements must be present.
Informed consent is not a form. It is a process that entails the exchange of information between the health care provider
and the patient or patient's proxy.
1. Competence (or capacity) refers to a person's ability to understand information regarding a proposed medical or
nursing treatment. Patients providing informed consent should be free from severe pain and
, NURSING EXAM T
depression. Critically ill patients usually do not have the mental capacity to provide informed consent because of
the severe nature of their illness or their treatment (e.g., sedation). If the patient is not mentally capable of
providing consent, informed consent is obtained from the designated healthcare surrogate or legal next of kin.
Advance directive: Witnessed written document or oral statement in which instructions are given by a person to express
desires related to healthcare decisions.
Living will: A witnessed written document or oral statement voluntarily executed by a person that expresses the
person's instructions concerning life-prolonging procedures.
Proxy: A competent adult who has not been expressly designated to make health care decisions for an incapacitated
person, but is authorized by state statute to make healthcare decisions for the person.
, NURSING EXAM T
Surrogate: A competent adult designated by a person to make health care decisions should that person become
incapacitated.
Life-prolonging procedure: Any medical procedure or treatment, including sustenance and hydration, that sustains,
restores, or supplants a spontaneous vital function. Does not include the administration of medication or treatments
deemed necessary to provide comfort care or to alleviate pain.
In hospice AND (allow natural death) - don’t treat just about comfort y
DNR in hospice (you do treat like antibiotics but if they code you do nothing)
Extraordinary care includes complex, invasive, and experimental treatments such as resuscitation efforts by CPR or
emergency cardiac care, maintenance of life support through invasive means, or renal dialysis. Experimental
treatments such as gene therapy also are extraordinary therapies.
Ordinary care usually involves common, noninvasive, to tested treatments such as providing nutrition, hydration, or
antibiotic therapy. In the critical care setting the noninvasive criterion does not apply; ordinary care is defined as usual
and customary for the patient's condition. Maintenance of hydration and nutrition through a tube feeding is an
example of a treatment that falls somewhere between ordinary and extraordinary care and is a highly debatable
issue. Therefore it is important for individuals to document their wishes rather than relying on the members of the
healthcare team to assist in the decision-making process related to nutrition and hydration. ON TEST
Withholding or stopping extraordinary resuscitation efforts is ethically and legally appropriate if patients or surrogates
have previously made their preferences known through advance directives. It is also acceptable if the physician
determines that resuscitation is futile or has discussed the situation with the patient, family, and/or surrogate as
appropriate, and there is mutual agreement not to resuscitate in the event of cardiopulmonary arrest. In brain death,
complete and irreversible cessation of brain function occurs, whereas in irreversible coma or persistent vegetative
state, some brain function remains intact. ON TEST Criteria for brain death include absence of cerebral blood flow,
absence of brainstem reflexes, and flat electroencephalograph. The presence of Cheyne-Stokes respirations would
indicate some brain function. All orders except antibiotic adjustment may be considered withdrawal or withholding of life
support and should be written only after informed consent from the healthcare surrogate or family has been obtained.
Because the patient has expressed a request to not have food or fluids withdrawn, it would not be appropriate for the
physician to write an order to discontinue the tube feeding.
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.
Chapter 4
[Author name]
[COMPANY NAME] [Company address]
, NURSING EXAM T
Critical care
Chapter 3
Laws: EMTALA: Emergency room law - everyone who comes in ER room must be treated whether they have insurance or
not.
Torts: Doing something legally wrong
✓ Intentional: Assault (Verbal threats), battery (Physical harm, putting your hands on them without permission),
false imprisonment (medical restraint is a necessity) (Haldol to sedate them is chemical restraint)
✓ Unintentional: Negligence (no harm to patient we just didn’t do what we were supposed to), Malpractice
(when harm is done to the patient). ON TEST
Dilemmas: No right or wrong
Principlism is a widely applied ethical approach based on four fundamental moral principles to contemporary ethical
dilemmas: respect for autonomy, beneficence, nonmaleficence, and justice.
• Autonomy states that all persons should be free to govern their lives to the greatest degree possible. This
implies a strong sense of self-determination and an acceptance of responsibility for one's own choices and
actions. To respect autonomy of others means to respect their freedom of choice and to allow them to make
their own decisions.
• Beneficence is the duty to provide benefits to others when in a position to do so and to help balance harms and
benefits. In other words, the benefits of an action should outweigh the burdens. Actions intended to benefit
the patients or others.
• Nonmaleficence is the explicit duty not to inflict harm on others intentionally.
• The principle of justice requires that health care resources be distributed fairly and equitably among groups of
people.
Other principals
• The principle of veracity states that persons are obligated to tell the truth in their communication with others.
• The principle of fidelity requires that one has a moral duty to be faithful to the commitments made to others.
These two principles, along with confidentiality, are the key to the nurse-patient relationship.
Bioethics committees – Address ethical concerns. Typical membership of a bioethics committee includes physicians,
nurses, chaplains, social workers, and, if available, bioethicists.
Informed consent: Three elements must be present.
Informed consent is not a form. It is a process that entails the exchange of information between the health care provider
and the patient or patient's proxy.
1. Competence (or capacity) refers to a person's ability to understand information regarding a proposed medical or
nursing treatment. Patients providing informed consent should be free from severe pain and
, NURSING EXAM T
depression. Critically ill patients usually do not have the mental capacity to provide informed consent because of
the severe nature of their illness or their treatment (e.g., sedation). If the patient is not mentally capable of
providing consent, informed consent is obtained from the designated healthcare surrogate or legal next of kin.
Advance directive: Witnessed written document or oral statement in which instructions are given by a person to express
desires related to healthcare decisions.
Living will: A witnessed written document or oral statement voluntarily executed by a person that expresses the
person's instructions concerning life-prolonging procedures.
Proxy: A competent adult who has not been expressly designated to make health care decisions for an incapacitated
person, but is authorized by state statute to make healthcare decisions for the person.
, NURSING EXAM T
Surrogate: A competent adult designated by a person to make health care decisions should that person become
incapacitated.
Life-prolonging procedure: Any medical procedure or treatment, including sustenance and hydration, that sustains,
restores, or supplants a spontaneous vital function. Does not include the administration of medication or treatments
deemed necessary to provide comfort care or to alleviate pain.
In hospice AND (allow natural death) - don’t treat just about comfort y
DNR in hospice (you do treat like antibiotics but if they code you do nothing)
Extraordinary care includes complex, invasive, and experimental treatments such as resuscitation efforts by CPR or
emergency cardiac care, maintenance of life support through invasive means, or renal dialysis. Experimental
treatments such as gene therapy also are extraordinary therapies.
Ordinary care usually involves common, noninvasive, to tested treatments such as providing nutrition, hydration, or
antibiotic therapy. In the critical care setting the noninvasive criterion does not apply; ordinary care is defined as usual
and customary for the patient's condition. Maintenance of hydration and nutrition through a tube feeding is an
example of a treatment that falls somewhere between ordinary and extraordinary care and is a highly debatable
issue. Therefore it is important for individuals to document their wishes rather than relying on the members of the
healthcare team to assist in the decision-making process related to nutrition and hydration. ON TEST
Withholding or stopping extraordinary resuscitation efforts is ethically and legally appropriate if patients or surrogates
have previously made their preferences known through advance directives. It is also acceptable if the physician
determines that resuscitation is futile or has discussed the situation with the patient, family, and/or surrogate as
appropriate, and there is mutual agreement not to resuscitate in the event of cardiopulmonary arrest. In brain death,
complete and irreversible cessation of brain function occurs, whereas in irreversible coma or persistent vegetative
state, some brain function remains intact. ON TEST Criteria for brain death include absence of cerebral blood flow,
absence of brainstem reflexes, and flat electroencephalograph. The presence of Cheyne-Stokes respirations would
indicate some brain function. All orders except antibiotic adjustment may be considered withdrawal or withholding of life
support and should be written only after informed consent from the healthcare surrogate or family has been obtained.
Because the patient has expressed a request to not have food or fluids withdrawn, it would not be appropriate for the
physician to write an order to discontinue the tube feeding.
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.
Chapter 4
