Ethics
The nurse realizes that an individual clients value system is most affected by: 1. Life experiences 2. Economic status 3. Spiritual beliefs 4. Formal education
(1) Development of values begins in childhood, shaped by experiences within the family unit, especially dramatic events during the formative years. The other options may influence the value system, but not to the same extent.
A nurses use of ethical responsibility can best be seen in which of the following nursing actions? 1. Delivery of competent care 2. Formation of interpersonal relationships 3.Correct application of the nursing process 4. Evaluation of new computerized technologies
(1) The term responsibility refers to the characteristics of reliability and dependability. In professional nursing, responsibility includes a duty to perform actions well and thoughtfully. When the nurse provides competent care, the nurse is demonstrating ethical responsibility. Formation of interpersonal relationships is not an ethical responsibility. Application of the nursing process is not an ethical responsibility. Evaluation of new computerized technologies is not an ethical responsibility.
On admission to the hospital, a terminal cancer patient says he has a living will. This document functions to state the clients desire to: 1. Receive all technical assistance to prolong his life 2. Have his wife make the decisions regarding his care 3. Be allowed to die without life-prolonging techniques 4. Have a lethal injection administered to relieve his suffering
(3) A living will is an advance directive, prepared when the individual is competent & able to make decisions, regarding that persons specific instructions about end-of-life care. Living wills allow people to specify whether they would want to be intubated, treated w/ pressor drugs, shocked w/ electricity, & fed or hydrated intravenously. A living will specifies what interventions the client does not want, so that his life will not be prolonged. If his wife has power of attorney she would be able to make decisions regarding the clients care. Assisted suicide, such as a lethal injection, is not a function of a living will. *A living will defines a clients wishes for withholding treatment that would prolong his or her life.*
The nurse is aware that an ethics committee in a health care facility serves to: 1. Interview all persons involved in a case 2. Illustrate circumstances that demonstrate malpractice 3. Serve as a resource for specific situations that may occur 4. Examine similar previous instances for comparison of outcome decisions
(3) Ethics committees serve as a resource to support the processing of ethical dilemmas. Ethics committees serve several purposes: education, policy recommendation, and case consultation or review. Although an ethics committee may gather further info, ethics committees do not interview all persons involved in a case. Rather, they offer consultation or case review. Illustrating circumstances that demonstrate malpractice is not a purpose of an ethics committee. Examining similar previous instances for comparison of outcome decisions may be part of data gathering to help process an ethical dilemma or for policy recommendation, but it is not the purpose of an ethics committee.
The nursing professional code of ethics is best defined as: 1. The criteria for judging nursing professionalism 2. A benchmark for professional nursing deeds and actions 3. The nursing professions expectations of its members behavior 4. A document that holds nurses responsible for professional behavior
(3) It is a collective statement about the groups expectations and standards of behavior. The remaining options are not accurate or complete descriptions of the nursing professional code of ethics.
The correct sequence for attaining the resolution of an ethical problem is: 1. Examine values, evaluate, and identify the problem 2. Evaluate the outcomes, gather data, and consider actions 3. Gather facts, verbalize the problem, and consider actions 4. Recognize the dilemma, evaluate, and gather information
(3) The correct sequence for resolving ethical problems is recognizing the dilemma, (1) gathering facts, (2) examining ones own values, (3) verbalizing the problem, (4) considering actions, (5) negotiating the outcome, and (6) evaluating the action.
Which of the following statements related to confidentiality made by a nurse requires immediate follow-up by the nurse manager? 1. I believe the client is eligible for both Medicare and Medicaid. 2. The client with pneumonia has tested positive for TB (tuberculosis). 3. Did you know that the client in Room 45 has a daughter who has type 1 diabetes mellitus? 4. I arranged for the clients information to be faxed to the assistive living facility she will be transferred to
(3) This information is private and the nurse is violating the clients right to confidentiality because the information has no bearing on the care needs of the client. The remaining options are not reflective of an ethical breech because the exchange of that information has a direct bearing on the clients care.
Which of the following statements made by a terminally ill client reflects the best understanding of the purpose of a living will? 1. It will make sure my wishes are respected. 2. My family wont be burdened with making those hard decisions. 3. I dont want strangers making those kinds of decisions for me. 4. I can make my wishes known while I still have the ability to express them.
(4) A living will is an advance directive, prepared when the individual is competent and able to make and communicate personal decisions, regarding specific instructions about end-of-life care. The remaining options represent motivation for implementing a living will.
Regarding the nurses use of the specific ethical principle of autonomy in a client situation, an example would be: 1. Learning to do a procedure safely and effectively 2. Returning to speak to a client at an agreed upon time 3. Preparing the clients room for comfort and privacy 4. Supporting a clients right to refuse a specific type of therapy
(4) Following the ethical principle of autonomy, the nurse allows a client to make his or her own decisions regarding care and then supports that decision. Learning how to perform a procedure safely and effectively is a nurses use of ethical responsibility. Returning to speak to a client at an agreed upon time demonstrates the ethical principle of fidelity. Preparing the clients room for comfort and privacy is a nurses use of ethical responsibility.
Which of the following statements best reflects the nurses ethical concern for nonmaleficence regarding the clients treatment plan? 1. The radiation therapy has not substantially decreased the clients tumor related pain. 2. The client expressed the idea that this treatment was definitively going to cure her cancer: 3. The clients family requested that she not be informed of the seriousness of her cardiac condition. 4. The procedure is quite invasive, and there is little chance that it will improve the clients quality of life.
(4) Nonmaleficence is the avoidance of harm or hurt. Whether the discomforts of treatment are benefiting the client or are worse than the disease itself have to be considered. The health care professional tries to balance the risks and benefits of a plan of care while striving to do the least harm possible. The remaining options are related to veracity (truthfulness), fidelity (keeping a promise), and possibly fairness.
Ethical dilemmas are common occurrences when caring for patients. The nurse understands that dilemmas are a result of a. Presence of conflicting values. b. Hierarchical systems. c. Judgmental perceptions of patients. d. Poor communication with the patient.
(a( Poor communication and the hierarchical systems that exist in health care, such as reporting structures within the hospital or the historically unequal relationship between physicians and nurses, may complicate dilemmas. The primary, underlying reason that ethical dilemmas occur is that there are no clear cut, universally accepted solutions to a problem when participating individuals do not share the same values. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgmental attitudes.
Determinations regarding quality of life are a. Based on a persons ability to act according to ethical principles. b. Based on a patients self-determination. c. Value judgments that can vary from person to person. d. Consistent and stable over the course of ones lifetime.
(c) Determinations regarding quality of life are value judgments. This means that they are judgments based on what individuals believe is desirable. Beliefs about what people find desirable vary from person to person.
The patients son requests to view the documentation in his mothers medical record. What is the nurses best response to this request? a. Ill be happy to get that for you. b. You will have to talk to the physician about that. c. You will need your mothers permission. d. You are not allowed to see it.
(c) The nurse understands that sharing health information is governed by HIPAA legislation, which defines rights & privileges of patients for protection of privacy. Private health information cannot be shared without the patients specific permission. The other three responses either are outright false and/or use poor communication techniques.
The nurse finds it difficult to care for a patient whose advance directive states that no extraordinary resuscitation measures should be taken. Which step may help the nurse to find resolution in this assignment? a. Call for an ethical committee consult. b. Decline the assignment on religious grounds. c. Scrutinize her own personal values. d. Convince the family to challenge the directive.
(c) Values develop over time and are influenced by family, schools, religious traditions, and life experiences. The nurse must recognize that no two humans have the same set of experiences, and so differences in values are more likely the norm than the exception. Closer inspection of ones values may be a step in gaining understanding of another persons perspective. Calling for a consult, declining the assignment, and convincing the family to challenge the patients directive are not ideal resolutions because they do not address the reason for the nurses discomfort, which is the conflict between the nurses values and those of the patient.
Although the American Nurses Associations (ANAs) code of ethics is reviewed and revised regularly to reflect changes in nursing practice, the basic principles that remain constant are: (Select all that apply) 1. Advocacy 2. Reliability 3. Responsibility 4. Accountability 5. Confidentiality 6. Professionalism
ANS: 1, 3, 4, 5 The American Nurses Association (ANA) established the first code of nursing ethics decades ago. The ANA reviews and revises the Code regularly to reflect changes in practice. Basic principles remain constant; however, responsibility, accountability, advocacy, and confidentiality. Although admirable, the remaining options are not considered core principles of the code.
Which of the following elements are essential among a group working towards the successful resolution of a conflict of opinion? (Select all that apply.) 1. Similar value systems 2. Presumption of good will 3. Similar cultural background 4. Client-centered decision making 5. Strict adherence to confidentiality 6. Participation of all involved parties
ANS: 2, 4, 5, 6 The resolution of conflicting opinions works best when the following elements are part of the process: the presumption of good will on the part of all participants, strict adherence to confidentiality, client-centered decision making, and the welcome participation of families and primary caregivers. The remaining options represent group characteristics that usually minimize conflict in decision making.
The nurse is caring for a patient supported with a ventilator who has been unresponsive since arrival via ambulance 8 days ago. The patient has not been identified, and no family members have been found. The nurse is concerned about the plan of care regarding maintenance or withdrawal of life support measures. The nurse determines that this is an ethical dilemma not resolved by scientific data. Place the steps the nurse will use to resolve this ethical dilemma in the correct order. a. The nurse identifies possible solutions or actions to resolve the dilemma. b. The nurse reviews the medical record, including entries by all health care disciplines, to gather information relevant to this patients situation. c. Health care providers use negotiation to redefine the patients plan of care. d. The nurse evaluates the plan and revises it with input from other health care providers as necessary. e. The nurse arranges a meeting with health care team members to clarify opinions, values, and facts. f. The nurse states the problem.
ANS: B, E, F, A, C, D Using the steps of processing an ethical dilemma, once the nurse identifies that an ethical dilemma exists, the nurse then gathers information relevant to the case; clarifies values and distinguishes between fact, opinion, and values; and verbalizes the problem. Then the nurse identifies possible solutions or actions, works with the health care team to negotiate a plan, and evaluates the plan over time.
At an accident scene a nurse stopped and began to provide emergency care for the victims. Her actions are best labeled ethically as: 1. Triage 2. Beneficence 3. Nonmaleficence 4. Respect for persons
Beneficence refers to taking positive actions to help others, as in providing emergency care at an accident scene. Triage is the screening and classification of casualties to make optimal use of treatment resources and to maximize the survival and welfare of clients. Nonmaleficence is the avoidance of harm or hurt. Respect for persons has to do with treating people equally despite their social standing, for example.
The nurse is explaining the rationale for seeking the familys permission to apply a physical restraint to a combative client. This is an example of the nurse exhibiting the professional principle of: 1. Advocacy 2. Responsibility 3. Accountability 4. Confidentiality
Accountability refers to the ability to answer for ones own actions. Nurses should ensure that their professional actions are explainable to their clients and to their employer. The remaining options are reflective of other professional principles.
The nurse holds a clients hand during a painful procedure. This action shows a positive act towards the client that is referred to as: 1. Veracity 2. Fidelity 3. Beneficence 4. Nonmaleficence
Beneficence refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest. The remaining options reflect truthfulness, keeping true to a promise, and doing no harm.
A nursing student that immediately informs her clinical instructor after she realizes that she has administered the wrong dose of medication to a patient is best described professionally as: 1. Confident 2. Trustworthy 3. Compliant 4. Accountable
Accountability refers to the ability to answer for ones own actions. The goal is the prevention of injury to the client. The student nurse who informs her instructor of an error is being accountable for her actions and has a goal to prevent injury to the client. The student nurse would not be described professionally as confident (i.e., sure of oneself). The student is not best described as trustworthy. To be trustworthy, one is worthy of trust or confidence and reliable. In this case, the student was not reliable to administer medication correctly. This student nurse is not best described professionally as compliant. The student is not acting in accordance with wishes, commands, or requirements.
The nurse values autonomy above all other principles. Which patient assignment will the nurse find most difficult to accept? a. Teenager in labor who requests epidural anesthesia b. Middle-aged father of three with an advance directive declining life support c. Elderly patient who requires dialysis d. Family elder who is making the decisions for a 30-year-old female member
Autonomy refers to freedom from external control. A person who values autonomy highly may find it difficult to accept situations where the patient is not the primary decision maker regarding his or her care. A teenager requesting an epidural, a father with an advanced directive, and an elderly patient requiring dialysis all describe a patient or family that can make their own decisions and choices regarding care.
The nurse questions a physicians order to administer a placebo to the patient. The nurses action is based on which ethical principle? a. Autonomy b. Beneficence c. Justice d. Fidelity
Autonomy refers to the freedom to make decisions free of external control. In this case, the nurse questions the physicians order for a placebo because it supports the patients autonomy. Although beneficence, taking a positive action for others, has implications here, it is not the primary operating principle. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises.
Abandoning a client would be an example of a nurses failure to professionally display: 1. Justice 2. Fidelity 3. Beneficence 4. Nonmaleficence
Fidelity refers to the agreement to keep promises. A commitment to fidelity supports the reluctance to abandon clients. The remaining options refer to fairness, kindness, and doing no harm.
When a client who is in need of a lung transplant is placed on the organ donor registry according to his current health needs, this is an example of ethical: 1. Justice 2. Fidelity 3. Beneficence 4. Nonmaleficence
Health care providers agree to strive for fairness in health care. Criteria set by a national multidisciplinary committee make every effort to ensure justice by ranking client organ recipients according to need. The remaining options refer to keeping a promise, kindness, and doing no harm.
Which of the following statements reflects application of the specific ethical principle of confidentiality? 1. Im concerned that funding may affect the outpatient program. 2. Im going to make sure that the client understands the instructions. 3. I cannot share that information with you about the clients condition. 4. I need to get more information about the clients personal health history.
I cannot share that information with you about the clients condition reflects the application of the ethical principle of confidentiality. Information is not to be shared with others without specific client consent. Im concerned that funding may affect the outpatient program reflects a concern regarding allocation of resources. It is not a confidentiality issue. The nurse who makes sure a client has gained understanding is being ethically responsible. I need to get more information about the clients personal health history reflects data gathering. Information gathered is to be used for the purpose of providing competent health care. It should not be shared with others without specific consent of the client.
Four patients in labor all request epidural analgesia to manage their pain at the same time. Which ethical principle is compromised when only one nurse anesthetist is on call? a. Justice b. Nonmaleficence c. Beneficence d. Fidelity
Justice refers to fairness & is used in discussion regarding access to health care resources. Here the just distribution of resources, in this case pain management, cannot be justly apportioned. Nonmaleficence means do no harm, beneficence means to do good, and fidelity means to be true to, or honest. Each of these principles is partially expressed in the question; however, justice is most comprised because not all laboring patients have equal access to pain management owing to lack of personnel resources.
In the emergency department a client feels that she has been waiting longer than the other individuals due to the fact that she has no insurance. The ethical principle that is involved in this exact situation is: 1. Justice 2. Autonomy 3. Beneficence 4. Nonmaleficence
Justice refers to treating people fairly. Allocation of resources and access to health care involves the ethical principle of justice. The client without medical insurance should not have to wait longer to receive health care than those with insurance. Autonomy refers to a persons independence. Autonomy represents an agreement to respect anothers right to determine a course of action. Beneficence refers to taking positive actions to help others. Nonmaleficence refers to the avoidance of harm or hurt.
When people work together to solve ethical dilemmas, individuals must examine their own values. This step is crucial to ensure that a. The group identifies the one correct solution. b. Fact is separated from opinion. c. Judgmental attitudes are not provoked. d. Different perspectives are respected.
Values are personal beliefs that influence opinions. To be able to negotiate differences in opinions, the nurse must first be clear about personal values, which will influence behaviors, decisions, and actions. Ethical dilemmas are a problem in that no one right solution exists.
When a nurse considers the possible positive effect a treatment will have against the pain it may cause the client, the nurse is displaying: 1. Justice 2. Fidelity 3. Beneficence 4. Nonmaleficence
Nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good but also the equal commitment to do no harm. The remaining options refer to fairness, truthfulness, and kindness.
The client has been diagnosed with malignant bone cancer and the treatment involves chemotherapy on an outpatient basis. While treating the cancer the client unfortunately becomes very ill, experiences significant side effects from the therapy, and has a severe reduction in the quality of life. The specific ethical principle that is in question in this situation is: 1. Veracity 2. Fidelity 3. Justice 4. Nonmaleficence
Nonmaleficence is the avoidance of harm or hurt. Whether the discomforts of treatment are benefiting the client or are worse than the disease itself have to be considered. The health care professional tries to balance the risks and benefits of a plan of care while striving to do the least harm possible. Veracity refers to truthfulness. This situation is not questioning truthfulness. Fidelity refers to the agreement to keep promises. This situation does not question fidelity. Justice refers to fairness. This situation is not a matter of justice.
A young woman who is pregnant with a fetus exposed to multiple teratogens consents to have her fetus undergo serial PUBS (percutaneous umbilical blood sampling) to examine how exposure affects the fetus over time. Although these tests will not improve the fetus outcomes and will expose it to some risks, the information gathered may help infants in the future. Which ethical principle is at greatest risk? a. Autonomy b. Fidelity c. Nonmaleficence d. Beneficence
Nonmaleficence is the ethical principle that focuses on avoidance of harm or hurt. The nurse must balance risks and benefits of care. Repeated PUBS may place the mother and fetus at risk for infection and increased pain, and may place the mother at risk for increased emotional health stress. Fidelity refers to the agreement to keep promises. Autonomy refers to freedom from external control, and beneficence refers to taking positive actions to help others.
The patient tells the nurse that she is afraid to speak up regarding her desire to end care for fear of upsetting her husband and children. Which principle in the nursing code of ethics ensures that the nurse will promote the patients cause? a. Responsibility b. Advocacy c. Confidentiality d. Accountability
Nurses advocate for patients when they support the patients cause. A nurses ability to adequate advocate for a patient is based on the unique relationship that develops and the opportunity to better understand the patients point of view. Responsibility refers to respecting ones professional obligations and following through on promises. Confidentiality deals with privacy issues, and accountability refers to owning ones actions.
The nurse has become aware of missing narcotics in the patient care area. Which ethical principle obligates the nurse to report the missing medications? a. Advocacy b. Responsibility c. Confidentiality d. Accountability
Responsibility refers to ones willingness to respect and adhere to ones professional obligations. One of the obligations nursing has is to protect patients and communities, including other nurses. If narcotics are missing, this may indicate that patients have not received medications ordered for their care, or it may suggest that a health care professional may be working under the influence. Accountability refers to the ability to answer for ones actions. Advocacy refers to the support of a particular cause. The concept of confidentiality is very important in health care and involves protecting patients personal health information.
A nurse is ambivalent as to the need to vigorously suction the secretions of a terminal client in a comatose state. Which of the following is an appropriate statement by the nurse in regard to processing an ethical dilemma? 1. I just feel like I should not suction this client. 2. I need to know the legalities of the living will of this client. 3. I cannot figure out whats right in this situation. I need to collect more data. 4. My spiritual beliefs mandate that I continue to provide all the interventions in my scope of practice.
The 1st step in processing an ethical dilemma is determining whether the problem is an ethical one. The nurse who cannot figure out what is right, is stating a characteristic of an ethical dilemma, which is that the problem is perplexing. The 2nd step is to gather as much information as possible that is relevant to the case. I just feel like I should not suction this client is the nurse is stating the problem according to her feelings. I need to know the legalities of the living will of this client is the nurse who wants to know the legalities of the living will of a client is collecting some, but not all, data pertaining to the problem. My spiritual beliefs mandate that I continue to provide all the interventions in my scope of practice is the nurse stating her own beliefs.
A client who is recently diagnosed with cancer is encouraged to consider sharing the information with her family so they can support her through the decisions she will need to make regarding her care. The nurse is using the principle of: 1. Confidentiality 2. Fidelity 3. Veracity 4. Justice
Veracity in general means accuracy or conformity to truth. The nurse is encouraging the client to be truthful with the clients family. Confidentiality means to not impart private matters. Fidelity refers to the agreement to keep promises. Justice refers to fairness.
Which patient is most likely to have difficulty with the ethical concept of autonomy? a. 18-year-old patient in labor b. 35-year-old patient with appendicitis c. 53-year-old patient with pancreatitis d. 78-year-old patient with rheumatoid arthritis
The principle of autonomy refers to freedom from external control & includes commitment to include patients in decisions about their care. People from different generations have differing expectations regarding inclusion in their care. Often, patients who are part of the Silent Generation (born 1925-1945) value formality and authority, which may make them less comfortable with making their own health care decisions.
The nurse is showing respect for a clients right to autonomy regarding an invasive procedure by: 1. Obtaining consent for the procedure 2. Performing the procedure appropriately 3. Providing client education regarding the procedure 4. Being frank when discussing the pros and cons of the procedure
The signed consent ensures that the nurse obtained the clients permission before proceeding with the procedure. The remaining options are examples of nonmaleficence, client right to be informed, and veracity.