np exam 1

Ethics: Autonomy

A patient’s right to make their own healthcare decisions, including the right to accept or refuse treatment. NCLEX clue: A competent patient refuses treatment and the nurse respects the decision.

Ethics: Beneficence

Doing good or taking actions intended to benefit the patient. NCLEX clue: The nurse provides an intervention that improves the patient’s health, comfort, or well-being.

Ethics: Nonmaleficence

“Do no harm.” The nurse takes action to prevent or avoid causing harm. NCLEX clue: Checking allergies before medication or stopping an unsafe medication order.

Ethics: Justice

Fairness and equitable treatment. NCLEX clue: Providing the same quality of care regardless of income, social status, background, or personal beliefs.

Ethics: Fidelity

Being faithful to commitments and keeping promises made to the patient. NCLEX clue: The nurse promises to return and follows through.

Ethics: Veracity

Truthfulness and honesty. NCLEX clue: The nurse gives accurate information rather than lying or intentionally misleading the patient.

Autonomy vs beneficence

Autonomy = the patient’s right to choose. Beneficence = the nurse acts for the patient’s benefit. If a competent patient refuses something beneficial, autonomy means respecting the refusal.

Beneficence vs nonmaleficence

Beneficence = do good. Nonmaleficence = prevent harm. Example: Giving pain medication to relieve pain = beneficence. Checking allergies to prevent an adverse reaction = nonmaleficence.

A nurse provides equitable care to two patients even though one is wealthy and one has limited financial resources. Which principle?

Justice

Fidelity scenario

A nurse tells a patient, “I will return in 30 minutes to reassess your pain,” and returns as promised. Which principle? Answer: Fidelity.

Veracity scenario

A patient asks about a procedure and the nurse provides truthful information rather than giving a false answer. Which principle? Answer: Veracity.

Autonomy scenario

A competent adult refuses a blood transfusion after receiving information about the risks and benefits. What should the nurse recognize? Answer: The patient’s autonomy/right to choose.

Beneficence scenario

A nurse gives a prescribed intervention that improves the patient’s comfort. Which principle? Answer: Beneficence.

Nonmaleficence scenario

A nurse discovers that a medication dose appears unsafe and holds the medication while clarifying the prescription. Which principle? Answer: Nonmaleficence.

Tort

A wrongful act or omission that causes harm or injury and may result in civil liability.

Negligence

Failure to use reasonable care that results in patient harm. Think: The nurse should have done something but failed to do it.

Negligence example

A nurse fails to implement appropriate fall precautions for a high-risk patient, and the patient falls and is injured. This is an example of negligence.

Malpractice

Professional negligence. A healthcare professional fails to meet the expected professional standard of care and the patient is harmed.

Negligence vs malpractice

Negligence is failure to use reasonable care. Malpractice is negligence by a professional while performing professional duties.

Assault

A threat or action that creates reasonable fear of unwanted physical contact. Physical contact does NOT have to occur.

Assault example

A nurse says, “If you don’t take this medication, I will force it into your mouth.” The nurse does not touch the patient. This is assault.

Battery

Unauthorized physical contact with a patient. Actual contact occurs without consent or legal justification.

Battery example

A competent patient refuses an injection, but the nurse gives the injection anyway. This is battery.

Assault vs battery

Assault = threat/fear of unwanted contact. Battery = actual unauthorized contact. Remember: Assault = threat; Battery = touch.

False imprisonment

Unlawfully restricting a person’s freedom of movement or preventing them from leaving when there is no legal justification.

False imprisonment example

A competent patient wants to leave the hospital, but the nurse physically prevents the patient from leaving without legal justification. This may be false imprisonment.

Defamation

Communication of false information that damages another person’s reputation. The two forms are slander and libel.

Slander

Spoken defamation. A false verbal statement that damages someone’s reputation.

Slander example

A nurse falsely tells another staff member that a patient is a drug addict. If the statement is false and damages the patient’s reputation, this may be slander.

Libel

Written defamation. A false written statement that damages someone’s reputation.

Libel example

A nurse writes a false statement about a patient that damages the patient’s reputation. This may be libel.

Slander vs libel

Slander = spoken. Libel = written.

Invasion of privacy

Improperly exposing, accessing, or discussing a patient’s private information or personal affairs.

Invasion of privacy example

A nurse discusses a patient’s diagnosis loudly in a hallway where visitors can hear. This may be invasion of privacy.

Invasion of privacy: records

A nurse accesses a patient’s medical record without a legitimate reason. This is an inappropriate privacy violation.

Tort quick identification

Threat = assault. Unauthorized touch = battery. Unlawful restraint = false imprisonment. Failure to provide reasonable care = negligence. Professional negligence = malpractice. Spoken false statement = slander. Written false statement = libel.

Therapeutic communication

The purposeful use of communication techniques to help patients express feelings, explore concerns, understand information, and participate in care.

Goal of therapeutic communication

The goal is not to immediately solve the patient’s problem. The nurse should encourage expression, listen actively, clarify concerns, and help the patient explore options and feelings.

Reflection

Repeating or reflecting the patient’s feelings or ideas back to them to encourage further discussion.

Reflection example

Patient: “I’m really scared about my surgery.” Nurse: “You’re feeling frightened about your surgery.” Answer: Reflection.

Empathy

Recognizing and acknowledging another person’s feelings without judging, minimizing, or taking over the situation.

Empathy example

Patient: “I’m terrified about what is going to happen.” Nurse: “It sounds like you’re really frightened about what will happen.” Answer: Empathy.

Clarifying

Seeking additional information when the patient’s statement is vague, confusing, or unclear.

Clarifying example

Patient: “I don’t feel right.” Nurse: “Can you tell me more about what you mean by ‘don’t feel right’?” Answer: Clarifying.

Focusing

Directing the conversation toward an important issue or specific concern.

Focusing example

A patient discusses many concerns. The nurse says, “You mentioned that you’re especially worried about your children. Tell me more about that.” Answer: Focusing.

Paraphrasing

Restating the patient’s message in the nurse’s own words to verify understanding.

Paraphrasing example

Patient: “I don’t think I can manage all these medications.” Nurse: “You’re concerned that managing your medications will be difficult.” Answer: Paraphrasing.

Summarizing

Bringing together the major points of a conversation into a concise overview. Often used at the end of a conversation or before moving to a new topic.

Summarizing example

Nurse says, “Today we discussed your pain, medications, and concerns about going home.” Answer: Summarizing.

Reflection vs paraphrasing

Reflection focuses on reflecting feelings or ideas back. Paraphrasing restates the patient’s message using different words.

Clarifying vs focusing

Clarifying makes an unclear statement clearer. Focusing directs attention toward a particular important topic.

Focusing vs summarizing

Focusing directs the conversation toward one important issue. Summarizing reviews several major points that have already been discussed.

Therapeutic response to fear

Patient says, “I’m scared about my diagnosis.” A therapeutic response is: “Tell me more about what concerns you.”

Therapeutic response to vague statement

Patient says, “Something is wrong.” A therapeutic response is: “Can you tell me more about what you mean?”

Therapeutic response to sadness

Patient is crying and says, “I don’t know what to do.” A therapeutic response could be: “This seems very difficult for you. Tell me more about what you’re feeling.”

Giving advice

Giving personal advice such as “You should quit your job” is generally nontherapeutic because it tells the patient what decision to make instead of helping them explore their own choices.

False reassurance

Statements such as “Everything will be fine” or “Don’t worry” are nontherapeutic when the nurse cannot guarantee the outcome.

Judging

Statements that criticize or approve/disapprove of the patient’s choices are nontherapeutic. Example: “That was a terrible decision.”

Minimizing

Downplaying the patient’s feelings or concerns is nontherapeutic. Example: “It’s not that bad.”

Changing the subject

Redirecting away from the patient’s concern instead of exploring it is generally nontherapeutic.

Why questions

Repeatedly asking “Why did you do that?” can sound judgmental or accusatory and may be nontherapeutic.

Nontherapeutic advice

Patient: “Should I leave my job?” Nurse: “Yes, you should quit.” Answer: Nontherapeutic because the nurse is giving personal advice.

Nontherapeutic reassurance

Patient: “I’m terrified about surgery.” Nurse: “Don’t worry; everything will be fine.” Answer: Nontherapeutic because this is false reassurance.

Nontherapeutic minimizing

Patient: “I’m really upset about my diagnosis.” Nurse: “Other people have it much worse.” Answer: Nontherapeutic because the nurse is minimizing the patient’s feelings.

Best therapeutic response rule

When choosing between answers, prefer the response that encourages the patient to talk, explore feelings, or clarify concerns without judging, advising, minimizing, or giving false reassurance.

Maslow’s hierarchy order

Physiological → Safety → Love and Belonging → Esteem → Self-Actualization.

Physiological needs

Basic survival needs: oxygen, breathing, food, fluids, elimination, sleep, temperature regulation, and physical comfort/pain.

Safety needs

Protection from injury, falls, violence, unsafe environments, and other threats to physical security.

Love and belonging needs

Family, relationships, friendship, social connection, acceptance, and feeling connected to others.

Esteem needs

Self-worth, confidence, recognition, achievement, independence, and feeling valued.

Self-actualization

Reaching one’s potential, personal growth, achieving goals, creativity, and fulfillment.

Maslow priority rule

Lower-level/basic survival needs generally take priority over higher-level psychosocial needs.

Maslow priority scenario

Patient A wants to discuss loneliness. Patient B is having difficulty breathing. Who should the nurse see first? Answer: Patient B because breathing is a physiological survival need.

Maslow safety scenario

Patient A has low self-esteem. Patient B is at high risk for falling. Who generally has priority? Answer: Patient B because safety needs take priority over esteem needs.

Maslow psychosocial order

Love and belonging comes before esteem, and esteem comes before self-actualization.

Subjective data

Information that comes from the patient’s personal experience, feelings, perceptions, or symptoms. Think: what the patient SAYS.

Objective data

Information that can be observed, measured, inspected, palpated, heard, or otherwise verified. Think: what the nurse OBSERVES or MEASURES.

Subjective pain

Patient says, “My pain is 8/10.” Answer: Subjective data because pain is the patient’s personal experience.

Subjective nausea

Patient says, “I feel nauseated.” Answer: Subjective data.

Subjective dizziness

Patient says, “I feel dizzy when I stand.” Answer: Subjective data.

Subjective anxiety

Patient says, “I feel very anxious.” Answer: Subjective data.

Objective vital signs

Nurse records BP 150/90, HR 110, and temperature 101.4°F. Answer: Objective data because the findings are measurable.

Objective observation

Nurse observes the patient grimacing, sweating, or vomiting. Answer: Objective data.

Objective oxygen saturation

Pulse oximeter reads 88%. Answer: Objective data because it is a measurable finding.

Subjective vs objective memory trick

Subjective = what the patient SAYS. Objective = what the nurse OBSERVES or MEASURES.

Pain rating trap

A numerical pain rating such as 8/10 is still subjective because it is the patient’s report of their personal experience.

ADPIE

Assessment → Diagnosis → Planning → Implementation → Evaluation.

Assessment

First step of the nursing process. The nurse collects subjective and objective data.

Assessment scenario

Nurse asks about the patient’s symptoms, obtains health history, checks vital signs, and performs a physical assessment. Answer: Assessment.

Diagnosis

Second step of ADPIE. The nurse analyzes assessment data and identifies a nursing diagnosis/patient response.

Diagnosis scenario

Nurse analyzes weakness and unsteady gait and identifies Risk for Falls. Answer: Diagnosis.

Planning

Third step of ADPIE. The nurse establishes priorities, goals/expected outcomes, and interventions.

Planning scenario

Nurse establishes the goal, “Patient will remain free from falls during hospitalization.” Answer: Planning.

Implementation

Fourth step of ADPIE. The nurse carries out the planned interventions.

Implementation scenario

Nurse places the call light within reach, activates fall precautions, and assists the patient with ambulation. Answer: Implementation.

Evaluation

Fifth step of ADPIE. The nurse determines whether interventions worked and whether goals were achieved.

Evaluation scenario

Nurse reassesses the patient after an intervention and determines whether the goal was met. Answer: Evaluation.

ADPIE: collecting

Collecting patient information = Assessment.

ADPIE: identifying problem

Identifying a nursing problem after analyzing data = Diagnosis.