NU140- Chapter 6 Values, Ethics, and Advocacy

A nurse pulls the curtains closed before changing the dressing of the surgical wound on the abdomen of a postsurgical client. What value is served?

Dignity

The focus of the unit where a nurse works is changing. The nurse has deeply held moral and religious objections to procedures that will be commonly performed on clients on this new unit. Which action(s) should the nurse take? Select all that apply.

Discuss the situation with the unit nurse manager. Do not compromise the nurse's own personal moral standards.

The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards?

International Council of Nurses

A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?

Paternalism

What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?

Peers

A parent teaches a child not to drink and drive; however, the parent does drink and drive. This action results in:

a failure to model one's own values.

Nursing ethics

a subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments

To practice ethically, the nurse should avoid:

allowing the nurse's own judgment to guide practice.

Principle-based approach

an approach to bioethics that offers specific action guides

Care-based approach

approach to bioethics that directs attention to the specific situations of individual patients viewed within the context of their life narrative

Nonmaleficence

principle of avoiding evil

Beneficence

principle of doing good

Conscientious objection

refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurse's personal and professional ethical beliefs and standards

Which ethical principle is related to the idea of self-determination?

Autonomy

It is time for a nurse to renew licensure. The nurse says, "I need some really easy and quick continuing education hours. I don't understand why we have to do these every year." What is the nurse's coworker's best response?

"Life-long learning is part of the code for nurses."

An older female client has just informed her family that she does not want to have surgery if the biopsy on a lung mass shows malignancy. Which statement(s), made by family members, violate the concept of feminist ethics? Select all that apply.

"Of course you would have the surgery." "Daddy will want you to have the surgery." "You need to do what the doctor thinks is best for you." "If it was me who was sick, you would want me to have the surgery."

A nurse's friend states, "I admire you so much. I would love to be a nurse, but I don't think I have the courage." Which response will the nurse make?

"You can work on being more courageous as you learn to be a nurse."

Which best defines value clarification?

A process by which people come to understand their own values and value systems

A nurse has completed 4 hours of an 8-hour shift on a medical-surgical unit when the nursing supervisor calls. The nursing supervisor directs the nurse to give a report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that the nurse has been busy with client assignments and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem?

Allocation of scarce nursing resources

Which example best describes feminist ethics?

An approach critiquing existing patterns of oppression and domination in society

A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee?

Assist in decision making based on the client's best interests.

A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision?

Autonomy

A nurse is providing care to a client with end-stage cancer. After weighing the alternatives, the client decides not to participate in a clinical trial offered and is requesting no further treatment. The nurse advocates for the client's decision based on the understanding that the client has the right to self-determination, interpreting the client's decision as reflecting which ethical principle?

Autonomy

Which nursing situation is an example of an ethical dilemma?

Deciding whether to perform cardiac compressions against a client's wishes

Which statement best conveys the concept of ethical agency?

Ethical practice requires a skill set that must be conscientiously learned and nurtured.

Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when reflecting on the decision-making process and the role it will play in making future decisions?

Evaluating

A female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, "This happens to many women." Which type of ethical approach is the nurse exhibiting?

Feminist

A client rings the call bell to request pain medication. On performing the pain assessment, the nurse informs the client that the nurse will return with the pain medication. After a few moments, the nurse returns with the pain medication. The nurse's returning with the pain medication is an example of which principle of bioethics?

Fidelity

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?

Integrity

A nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of the shift. Which ethical principle is the nurse attempting to practice?

Justice

Value system

organization of values ranked along a continuum of importance

The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy?

Limiting visitors due to the client reporting pain

Which action most clearly demonstrates a nurse's commitment to social justice?

Lobbying for an expansion of healthcare resources and benefits to those in poverty

A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Ultimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?

Shared

A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing the nurse's own judgments based on the nurse's expertise. Which type of healthcare decision making does this represent?

Shared decision making

When analyzing an ethical dilemma according to the ethical framework, what is most important for the nurse to take into consideration?

Standards of conduct

The principle of autonomy by a client is applied in which situation?

The client has decided to stop chemotherapy treatments.

Which is the best definition of ethics?

The formal, systematic study of moral beliefs

Which statements indicate a correct understanding of the tenets of the Code of Ethics for Nurses? Select all that apply.

The nurse maintains standards of personal conduct. The nurse is active in developing a core of research-based principles. The nurse holds personal information as confidential.

Which action would cause a charge nurse to have concerns about a nurse's moral agency?

The nurse was seen at a grocery store after calling in sick.

What are standards for decision-making that endure for a significant time in one's life?

Values

Which is a characteristic of the care-based approach to bioethics?

The promotion of the dignity and respect of clients as people

A nurse incorporates the "five values that epitomize the caring professional nurse" (identified by the American Association of Colleges of Nursing) into a home health care nursing practice. Which attribute is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice? a. Altruism b. Autonomy c. Human dignity d. Integrity

d. Integrity

Moral resilience

developed capacity to respond well to morally distressing experiences and to emerge strong

A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches the principle of:

ethical conduct.

Virtues

human excellences; cultivated dispositions of character and conduct that motivate and enable us to be good human beings

Fidelity

keeping promises and commitments made to others

Ethical distress is:

knowing the correct action but being unable to perform it due to constraints.

Morals

like ethics, concerned with what constitutes right action; more informal and personal than the term ethics

A nurse shows client advocacy by:

offering a hospice consultation to a client who is terminally ill.

Autonomy

self-determination; being independent and self-governing

Values

set of beliefs that are meaningful in life and that influence relationships with others

Ethical dilemma

situation that arises when attempted adherence to basic ethical principles results in two conflicting courses of action

What would be an example of the nurse practicing fidelity? The nurse:

stays with a client during death as promised.

Feminist ethics

type of ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor

A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:

personal values.

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value?

Integrity

Which ethical principle refers to the obligation to do good?

Beneficence

A school nurse interviewing parents of a child who is doing poorly in school determines that the parents practice a laissez-faire method of discipline. What are examples of this form of value transmission? Select all that apply.

A teenage boy explores religions of friends in hopes of developing his own faith. A teenage girl tries alcohol at a party with her friends.

A nurse is providing care for a client with cancer. The client's spouse requests that the client not be told that the client is terminal. The nurse complies with this request. The nurse's action is a breach of which ethical principle?

Fidelity

Nurses who value client advocacy follow what guideline?

They give priority to the good of the individual client rather than to the good of society in general.

Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply.

Trustworthiness Humility Compassion

A nurse arrives on the medical unit wearing large, dangling earrings. This is an example of which type of conduct?

Unprofessional

What is the term for the beliefs held by the individual about what matters?

Values

An older nurse asks a younger coworker why the new generation of nurses just aren't ethical anymore. Which reply reflects the BEST understanding of moral development? a. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." b. "I don't agree that nurses were more ethical in the past. It's a new age and the ethics are new!" c. "Ethics is genetically determined...it's like having blue or brown eyes. Maybe we're evolving out of the ethical sense your generation had." d. "I agree! It's impossible to be ethical when working in a practice setting like this!"

a. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code."

Moral agency

ability to behave in an ethical way; to do the ethically right thing because it is the right thing to do

Utilitarian

action-guiding theory of ethics that states that the rightness or wrongness of an action depends on the consequences of the action

Deontologic

ethical system in which actions are right or wrong independent of the consequences they produce

Bioethics

ethics that encompass all those perspectives that seek to understand human nature and behavior, the domain of social science, and the natural world

A client tells the nurse that the client does not want to have a painful procedure. By respecting and supporting the client's right to make decisions, the nurse is demonstrating:

advocacy.

A nurse caring for patients in an institutional setting expresses a commitment to social justice. What action best exemplifies this attribute? a. Providing honest information to patients and the public b. Promoting universal access to health care c. Planning care in partnership with patients d. Documenting care accurately and honestly

b. Promoting universal access to health care

Ethics

system dealing with standards of character and behavior related to what is right and wrong

A hospice nurse is caring for a patient with end-stage cancer. What action demonstrates this nurse's commitment to the principle of autonomy? a. The nurse helps the patient prepare a durable power of attorney document. b. The nurse gives the patient undivided attention when listening to concerns. c. The nurse keeps a promise to provide a counselor for the patient. d. The nurse competently administers pain medication to the patient.

a. The nurse helps the patient prepare a durable power of attorney document.

An illegal immigrant with no health insurance sustained life-threatening injuries in an automobile accident. Which action in this case demonstrates the ethical principle of justice?

Airlifting the client to a local trauma center for emergency surgery

A nurse who is working in a hospital setting uses value clarification to help understand the values that motivate patient behavior. Which examples denote "prizing" in the process of values clarification? Select all that apply. a. A patient decides to quit smoking following a diagnosis of lung cancer. b. A patient shows off a new outfit that she is wearing after losing 20 pounds. c. A patient chooses to work fewer hours following a stress-related myocardial infarction. d. A patient incorporates a new low-cholesterol diet into his daily routine. e. A patient joins a gym and schedules classes throughout the year. f. A patient proudly displays his certificate for completing a marathon.

b. A patient shows off a new outfit that she is wearing after losing 20 pounds. f. A patient proudly displays his certificate for completing a marathon.

A nurse wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. The nurse believes his dying is being prolonged painfully. The patient's doctor threatens the nurse with firing if the nurse raises questions about the patient's care or calls the consult. What ethical conflict is this nurse experiencing? a. Ethical uncertainty b. Ethical distress c. Ethical dilemma d. Ethical residue

b. Ethical distress

A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statements best describe this process? Select all that apply. a. People are born with values. b. Values act as standards to guide behavior. c. Values are ranked on a continuum of importance. d. Values influence beliefs about health and illness. e. systems are not related to personal codes of conduct. f. Nurses should not let their values influence patient care.

b. Values act as standards to guide behavior c. Values are ranked on a continuum of importance d. Values influence beliefs about health and illness

A client is brought to the emergency department by an adult child, who states, "I am unable to care for my parent anymore. Although I would like to, financially and physically I can't do it anymore." What ethical problem is the adult child experiencing?

Distress

Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing?

Care-based ethics

When examining values, a nurse notes that one country allows physician-assisted suicide and another outlaws it, making it punishable by imprisonment. Which factors best explain the differences in values between these two countries?

Cultural

A nurse is involved in ethical decision-making. Place the steps in the order that the nurse will follow to achieve an ethical decision. Use all options.

Describe the situation and factors associated with the ethical problem. Clarify that the issue is ethical in nature. Identify options and explore short- and long-term consequences. Make the decision. Determine the effectiveness of the decision and implications for the future.

Which example most accurately depicts the ethical principle of autonomy?

Describing a surgery to a client before the consent is signed

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle?

Fidelity

A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability?

Filling out an occurrence report and notifying the healthcare provider

A client continues to complain of pain despite receiving medication. The family states, "In our culture it is acceptable to complain out loud." What would be the best response by the nurse?

Tell me more about your cultural beliefs.

A parent of a 17-year-old high school student is allowing the child to decide which college the child will attend. When the child requests direction from the parent in making this decision, the parent responds by stating, "You will need to make this decision on your own." What type of value transmission is the parent displaying?

Laissez-faire

A nurse working in a critical care unit has experienced personal tragedy, extreme shortage of staff in the work environment, and health issues. The nurse has overcome much of these hardships and is now mentoring other nurses in similar situations. What behavior is this nurse demonstrating?

Moral resilience

A nurse knows that the expression "Do not cause harm" refers to which ethical principle?

Nonmaleficence

A nurse believes that abortion is an acceptable option if a pregnancy results from a situation of rape. What is the best description of this belief?

Personal moral

A nurse is reviewing The International Council of Nurses (ICN) Code of Ethics for Nurses. Based on this code, the nurse would identify which responsibilities as being fundamental? Select all that apply.

Promoting health Preventing illness Restoring health Alleviating suffering

A client has been diagnosed with a debilitating neuromuscular disease that has left the client tired, confused, and in pain. Which action(s) will the nurse choose to advocate for this client in planning future care? Select all that apply.

Provide education about treatments. Facilitate involvement of people essential to the decision. Explain laboratory and radiology findings.

A nurse gives the 400 IU of a vitamin supplement that was in the client's medications instead of the 200 IU that was prescribed. The dosage was given when the unit was busy admitting three clients and another client was in crisis. Which action(s) by the nurse demonstrate the professional value of integrity? Select all that apply.

The nurse documents the dose given. The nurse completes a variance or incident report.

A student nurse begins a clinical rotation in a long-term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements accurately describe this concept? Select all that apply. a. Advocacy is the protection and support of another's rights. b. Patient advocacy is primarily performed by nurses. c. Patients with special advocacy needs include the very young and the older adult, those who are seriously ill, and those with disabilities. d. Nurse advocates make good health care decisions for patients and residents. e. Nurse advocates do whatever patients and residents want. f. Effective advocacy may entail becoming politically active.

a. Advocacy is the protection and support of another's rights. c. Patients with special advocacy needs include the very young and the older adult, those who are seriously ill, and those with disabilities. f. Effective advocacy may entail becoming politically active.

A pediatric nurse is assessing a 5-year-old boy who has dietary modifications related to his diabetes. His parents tell the nurse that they want him to value good nutritional habits, so they decide to deprive him of a favorite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission? a. Modeling b. Moralizing c. Laissez-faire d. Rewarding and punishing

d. Rewarding and punishing

A home health nurse performs a careful safety assessment of the home of a frail older adult to prevent harm to the patient. The nurse's action reflects which principle of bioethics? a. Autonomy b. Beneficence c. Justice d. Fidelity e. Nonmaleficence

e. Nonmaleficence

A nurse working on a critical care unit was informed by a client with multiple sclerosis that the client did not wish to be resuscitated in the event of cardiac arrest. Now the client is no longer able to express wishes, and the family has informed the physician that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve:

ethical distress.

Code of ethics

principles that reflect the primary goals, values, and obligations of the profession

Values clarification

process by which people come to understand their own values and value system

Justice

process that distributes benefits, risks, and costs fairly

Advocacy

protection and support of another's rights