A home care nurse visits a client who is confined to bed and is cared for by an adult child with substance use disorder. The home is cluttered and unclean, and the nurse notes that the client is wet with urine and shows signs of dehydration. After caring for the client, the nurse contacts the health care provider and reports the incident to Adult Protective Services. What ethical principle is the nurse practicing?

autonomy

nonmaleficence

justice

fidelity

Answer and Explanation

The Correct Answer is B

A. Autonomy refers to respecting the patient’s right to make their own decisions. While important, it is not the ethical principle that guides the nurse's decision to report the situation to Adult Protective Services.
B. Nonmaleficence refers to the duty to do no harm. Reporting the neglect of the client to Adult Protective Services is consistent with preventing further harm and ensuring the client’s safety.
C. Justice refers to fairness and equal treatment. While the nurse is working to protect the client, the situation involves more than just fairness, making nonmaleficence the more applicable principle.
D. Fidelity refers to loyalty and keeping promises, but it does not specifically guide the nurse’s action in this situation.

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Correct Answer is C

Explanation

A. Physiologic indicators can be helpful in pain assessment, but they are not directly linked to pain intensity scales, which are focused on subjective reports.
B. Pain intensity scales still involve a subjective component, as they rely on the patient’s report of their pain, even if the scale itself is structured.
C. A specific pain intensity scale provides consistency in how pain is assessed, allowing for more reliable tracking and management of pain across different shifts and caregivers.
D. While pain scales include subjective reports, they do not focus solely on objective data. The goal is to measure the patient's perception of pain.

A. Fidelity B. Nonmaleficence C. Beneficence D. Veracity

Correct Answer is D

Explanation

A. Fidelity refers to being loyal, faithful, and keeping promises, but it is not the primary principle when obtaining informed consent.
B. Nonmaleficence means "do no harm," which is important in healthcare but does not directly relate to the process of informed consent.
C. Beneficence involves promoting good and acting in the best interest of the patient but is secondary to ensuring informed consent is given.
D. Veracity is the ethical principle of truth-telling. It is most important when obtaining informed consent because the patient must fully understand the information about the procedure, including the risks and benefits, before giving consent.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Why use a specific pain intensity scale in the critical care unit?

Correct Answer is C

Explanation

Which ethical principle is most important when soliciting informed consent from a patient?

Correct Answer is D

Explanation

The nurse in the ED is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client's EKG should the nurse interpret as a sign of hypokalemia?

An adult client with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?

Which patient finding supports the nurse's decision to place a patient in the urgent triage category?

A nurse demonstrates the professional value known as altruism when caring for clients in a long-term care facility. What nursing action demonstrates this behavior?

A female patient was sexually assaulted when leaving work. When assisting with the physical examination, what nursing interventions should be provided? (Select all that apply.)

A patient is admitted with the diagnosis of a gunshot wound to the head due to a suicide attempt. While in the patient care unit, the plan of care should include which intervention?