NCLEX : Ethics and Judgment

Study concepts, example questions & explanations for NCLEX

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Example Questions

Example Question #1 : Ethical Responsibilities

Which of the following describes the professional role of the nurse in a healthcare setting?

Possible Answers:

Assessment

All of these

Caregiver

Patient advocate

Correct answer:

All of these

Explanation:

All of these are important professional roles of the nurse in a healthcare setting.

Example Question #1 : Ethics And Judgment

You are a new nurse taking care of a patient with congestive heart failure. You see an order to administer 500 mL of 0.9% normal saline over 6 hours. Later on in your shift, you realize that you mistakenly administered 2000 mL of 0.9% normal saline over 2 hours, and now the patient is slightly short of breath. Which of the following is the most appropriate next step?

Possible Answers:

Immediately inform the covering physician

Immediately administer furosemide to diurese the patient

Do not tell anyone of the error since the patient is stable

Ask your co-nurses whether or not to inform the covering physician

Immediately contact your hospital's safety oversight committee 

Correct answer:

Immediately inform the covering physician

Explanation:

The correct answer is "immediately inform the covering physician." This is the correct choice because in this case, a medical error was committed, and the most appropriate immediate course of action is to let the patient's covering physician know, so that they can determine what effect this may have on the patient, assess the patient, and determine what, if any, immediate intervention needs to be performed to ensure that the adverse effect on the patient is minimized. 

While it is possible in this case, given that the patient has congestive heart failure, and that they may have been fluid overloaded by the administration of excess fluids, that they will need to be diuresed with furosemide, this medication cannot be administered without the order of the covering physician, and it would be inappropriate to administer furosemide without their orders. 

While your hospital's safety oversight committee may ultimately need to be informed of this incident, the most immediate priority is patient safety, and as such, the patient's physician should be notified of the medical error before anyone else so that they can best manage any immediate consequences of the error. 

It would be highly inappropriate to not inform anyone of the error, as an unintended dose of IV fluids was administered and this can be dangerous in a patient with congestive heart failure. Any delay, whether due to not telling anyone, or to conferring with co-nurses, in informing the supervising physician would be inappropriate and potentially dangerous to the patient.

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