chapter 6 values, ethics, advocacy Paul Paper
A client with five children suspects that she is pregnant again. She is also going through a financial crisis and asks the nurse for a medicine to cause abortion. The nurse is under obligation to promote family planning but feels the need to save the unborn fetus. What value is the nurse considering more important? a) Accountability b) Esthetics c) Choice d) Respect for life
d. respect for life Explanation: In this situation, the nurse values respect for life more important than anything else. Choice, accountability, and esthetics are not considered important in this situation. The nurse who values choice as most important would let the client decide whether she wants an abortion or not. The nurse who values accountability documents nursing care accurately and honestly. The nurse who adapts the environment so that it is pleasing to the client values esthetics. 101
Which organization first adopted an international code of ethics in 1953? a) American Hospital Association b) American Nurses Association c) International Council of Nurses d) Canadian Nurses Association
International Council of Nurses Explanation: An international code of ethics for nurses was first adopted by the International Council of Nurses in 1953. It has been revised and reaffirmed at various times since. 94
A nurse is caring for a woman 28 years of age who has delivered a baby by Cesarean section. She describes her pain as a 9. The nurse medicates her for pain. This is an example of which of the following ethical frameworks? a) Beneficence b) Justice c) Nonmaleficence d) Fidelity
a. Beneficence Explanation: Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good. 90
Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: An ethical conflict exists around a female client's expressed desire to have a neighbor make her treatment decisions. This neighbor is an individual who the client's children characterize as a predator. Place in the correct order the steps that the nurse should follow in resolving this ethical conflict. 1 Identify the different options 2 Make and evaluate a decision 3 Clearly identify the ethical problem 4 Gather relevant data about the situation 5 Apply ethical principles to the situation
4. Gather relevant data about the situation 3. Clearly identify the ethical problem 1. Identify the different options 5. Apply ethical principles to the situation 2. Make and evaluate a decision Explanation: The nursing process of assessment, diagnosis, planning, implementation, and evaluation can be applied to appropriately respond to many ethical dilemmas. 99
A nurse has a duty of nonmaleficence. Which of the following would be considered a contradiction to that duty? a) Refuse to administer pain medication as ordered. b) Assist the patient with ADLs. c) Provide all information related to procedures. d) Provide comfort measures for a terminally ill patient.
a. Refuse to administer pain medication as ordered. Explanation: The duty not to inflict harm, as well as prevent and remove harm, is termed nonmaleficence. Providing comfort measures for a terminally ill patient, assisting a patient with ADLs and providing information related to procedures would not be considered a contradiction to the nurse's duty of nonmaleficence. 91
What would be an example of the nurse practicing fidelity? The nurse: a) Stays with the patient during his or her death as promised b) Withholds information as requested c) Regulates visitors d) Provides continuity of care
a. Stays with the patient during his or her death as promised Explanation: Fidelity requires the nurse to keep promises made and to be faithful to one's commitments. 91
Which ethics theory focuses on ends or consequences of actions? a) Utilitarian theory b) Adaptation theory c) Deontological theory d) Formalist theory
a. Utilitarian theory Explanation: Utilitarian theory is based on the concept of the greatest good for the greatest number. Formalist theory argues that moral standards exist independently of the ends or consequences. Deontological theory argues that moral standards exist independently of the ends or consequences. Adaptation theory is not an ethics theory. 90
The client was diagnosed with diabetes three years ago, but has failed to integrate regular blood glucose monitoring or dietary modifications into his lifestyle. He has been admitted to the hospital for treatment of acute renal failure secondary to diabetic nephropathy, an event that has prompted the client to reassess his values. Which of the following actions most clearly demonstrates that this client is engaging in the step of prizing within his valuing process? a) The client states that he will now begin to check his blood glucose before each meal and at bedtime. b) The client expresses pride that he now has the knowledge and skills to take control of his diabetes management. c) The client is now able to explain how his choices have contributed to his renal failure. d) The client expresses remorse at how his failure to take make lifestyle changes has adversely affected his health.
b. The client expresses pride that he now has the knowledge and skills to take control of his diabetes management. Explanation: Within the valuing process, expressions of pride and happiness are considered to be indications of prizing. Resolving to make changes is an aspect of choosing, while expressing insight about his role in his current diagnosis demonstrates that the client has the desire to re-examine his values. 88
A patient who stopped smoking 3 years ago has not resumed smoking and actively encourages other family members to stop smoking. This patient is demonstrating which step in the process of valuing? a) Treasuring b) Choosing c) Prizing d) Acting
d. Acting Explanation: This patient is demonstrating the consistency and regularity on the value that is consistent with the acting phase of the process of valuing. Choosing involves freely selecting from alternatives after careful consideration of the consequences of each alternative. Prizing and treasuring involve pride, happiness, and public affirmation. 89
An oncology patient in an outpatient chemotherapy clinic asks several questions regarding his care and treatment. The nurse explains the clinic's routine, typical side effects of the chemotherapy, and ways to decrease the number of side effects experienced. What characteristic is the nurse demonstrating? a) Fidelity b) Autonomy c) Justice d) Veracity
d. Veracity Explanation: Veracity means telling the truth, which is essential to the integrity of the patient-provider relationship. 90
Which of the following ethical principles is related to the idea of self-determination? a) Beneficence b) Confidentiality c) Nonmaleficence d) Autonomy
d. autonomy Explanation: Autonomy refers to self-rule, or self-determination; it respects the rights of patients or their surrogates to make health care decisions. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm 91
What is the function of the American Nurses Association's Code of Ethics for Nurses? a) Delineates nurses' conduct and responsibilities b) Plays an important role in legal proceedings c) Serves to establish personal ethics for nurses d) Serves as a guideline for all health care practice
a. Delineates nurses' conduct and responsibilities Explanation: The ANA recently revised the Code of Ethics for Nurses that delineates the conduct and responsibilities expected of all nurses in their nursing practices. 93
Which of the following actions most clearly demonstrates a nurse's commitment to social justice? a) Lobbying for an expansion of Medicare eligibility and benefits b) Documenting nursing care in a timely, honest, and thorough manner c) Ensuring that a hospital client's diet is culturally acceptable d) Answering a client's questions about her care clearly and accurately
a. Lobbying for an expansion of Medicare eligibility and benefits Explanation: Social justice is a professional value that encompasses efforts to promote universal access to health care, such as the expansion of publicly funded programs like Medicare. Culturally competent care is a reflection of human dignity. Answering clients' questions and documenting them accurately are expressions of the value of integrity. 87
A hospice nurse is caring for a patient with terminal cancer. The family would like the patient to continue aggressive therapy to treat the cancer, but the patient has voiced to the nurse that, after much thought, he does not want to pursue any further treatment. The nurse speaks to the family about the patient's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation? a) Moral values b) Nursing education principles c) Advanced practice licensure guidelines d) Legal responsibilities
a. Moral values Explanation: Moral values involve correct behavior, such as having some sense of right and wrong. Moral values help direct nurses to deal with human interactions that involve the integrity of life or health. 85
A client age 46 years has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This patient is utilizing which ethical principle in making his decision? a) Autonomy b) Justice c) Beneficence d) Confidentiality
a. autonomy Explanation: Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that like cases should be treated alike 91
An employee health nurse is assisting a stressed, working mother with value clarification. Which of the following best defines value clarification? a) A systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct. b) A process by which people come to understand their own values and value systems. c) An organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. d) A belief about the worth of something, about what matters, that acts as a standard to guide one's behavior.
b. A process by which people come to understand their own values and value systems. Explanation: Value clarification is a process by which people come to understand their own values and value systems. A value is a belief about the worth of something, about what matters, that acts as a standard to guide one's behavior. A value system is an organization of values in which each is ranked along a continuum of importance, often leading to a personal code of conduct. Ethics is a systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil, as they relate to conduct. 88
A hospital owned by a Catholic order of nuns will not allow tubal ligations to be performed. This is considered to be a) Legal obligation b) Institutional policy c) Personal values d) Personal morality
b. Institutional policy Explanation: Institutional policies are guidelines developed by healthcare institutions to direct professional practice. 102
The children of a female client 78 years of age with a recent diagnosis of early-stage Alzheimer's disease are attempting to convince their mother to move into an assisted living facility, a move to which the client is vehemently opposed. Both the client and her children have expressed to the nurse how they are entrenched in their position. Which of the following statements expresses a utilitarian approach to this dilemma? a) The client has a right to self-determination. b) The decision should be made in light of consequences. c) Benefits and burdens should be evenly distributed between the children and the client. d) The client's autonomy and independence are the priority considerations.
b. The decision should be made in light of consequences. Explanation: Utilitarianism is the theory of ethics that weighs rightness and wrongness according to consequences and outcomes for all those who are affected. Utilitarianism prioritizes these consequences and outcomes over principles such as autonomy and justice; principles that underlie the other statements addressing the patient's right to self-determination; and fair distribution of benefits and burdens. 90
Nursing students in an ethics class have been asked to define "ethics". What would be the best definition of ethics? a) The adherence to formal personal values. b) The formal, systematic study of moral beliefs. c) The informal, systematic study of moral beliefs. d) The adherence to informal personal values.
b. The formal, systematic study of moral beliefs. Explanation: Ethics is a formal inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to human conduct and human flourishing. "Morals" usually refers to personal or communal standards of right and wrong. 89
What are standards for decision making that endure for a significant time in one's life? a) Roles b) Values c) Ethics d) Beliefs
b. Values Explanation: Values are standards for decision making that endure for a significant time in one's life. 85
Choice Multiple question - Select all answer choices that apply. A patient in a clinical research study has given informed consent. This means that the patient has certain rights. These rights include which of the following? Select all that apply. a) Free medical care b) Protection from harm c) Refusal to participate d) Guarantee of treatment e) Confidentiality
b• Protection from harm c• Refusal to participate e• Confidentiality Explanation: Informed consent in the research process protects the patient's rights to consent knowledgeably, to participate in a study without coercion, to refuse to participate without jeopardizing the care received, to expect confidentiality, and to be protected from harm. It does not give the patient the right to free care. 98
Several times you've had the opportunity to share personal prescriptions with family members when they were in need of pain medication or antibiotics. Which area of rules should govern your moral decision? a) Common law b) Administrative law c) Ethics d) Civil law
c. Ethics Explanation: While all of the options may affect your decision, moral decisions are guided by ethics (moral principles and values that guide the behavior of honorable people). 89
How are values converted from knowledge into messages which can then be processed as information? a) Time b) Activity c) Religion d) Nature
c. Religion Explanation: Values are codified in social institutions such as family, school, and religion. Values can then be adopted, adapted, or dismissed based on the person's life experiences and social system. 86-87
A nurse is providing homecare to a client with a diabetic foot ulcer who needs daily insulin injections. The family caregivers do not possess the technical skill to inject insulin. Which of the following should the nurse keep in mind? a) Nurses should avoid asking the family caregivers to conduct the skilled task b) Family caregivers are always perceived to be supportive of good care c) The nurse needs to be creative in integrating the technical and relational aspects of care d) The current reimbursement system recognizes the family's nontechnical value priorities
c. The nurse needs to be creative in integrating the technical and relational aspects of care Explanation: The nurse needs to be creative in integrating the technical and relational aspects of care. The current reimbursement system does not recognize the family's nontechnical value priorities. Nurses are expected to educate the family caregivers to conduct the skilled task where possible. In this case, the nurse can teach the family caregivers to inject insulin. Family caregivers can be perceived to be nonsupportive of good care if the families do not follow through. 101
A woman age 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. This is an example of what ethical principle? a) Veracity b) Justice c) Autonomy d) Nonmaleficence
c. autonomy Correct response: Autonomy Explanation: Autonomy essentially means independence and the ability to be self-directed. 91
Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when he or she reflects on the decision-making process and the role it will play in making future decisions? a) Implementing b) Planning c) Evaluating d) Diagnosing
c. evaluating Explanation: Evaluating an ethical decision involves reflecting on the process and evaluating those elements that will be helpful in the future. The nurse may also question how this experience can improve reasoning and decision making in the future. Diagnosing the ethical problem involves stating the problem clearly. Planning includes identifying the options and exploring the probable short-term and long-term consequences. Implementing includes the implementation of the decision and comparing the outcomes of the action with what was considered and hoped for in advance. 97
To practice ethically, the nurse should a) Allow a committee to guide her practice b) Ask the family their views on caring c) Review past cases before guiding practice d) Avoid allowing her judgment to guide practice
d. Avoid allowing her judgment to guide practice Explanation: Personal convictions apply only to situations and decisions pertaining to the individual. In ethical practice, nurses avoid allowing personal judgments to bias their treatment of patients. 88
A nurse is caring for a client who is a celebrity in the area. A person claiming he is a family member inquires about the medical details of the client. The nurse reveals the information but later comes to find out that the person was not a family member. The nurse has violated which of the following? a) Veracity b) Fidelity c) Autonomy d) Confidentiality
d. Confidentiality Explanation: The nurse has violated the principle of confidentiality by revealing the client's personal medical information to a third person. Confidentiality is a professional duty and a legal obligation. What is documented in the client's record is accessible only to those providing care to that client. The nurse's action does not violate rules of veracity, fidelity, or autonomy. Fidelity means being faithful to one's commitments and promises. Veracity means telling the truth, which is essential to the integrity of the client-provider relationship. Autonomy involves a client making his or her own decisions. 101
A parent teaches his or her children not to drink and drive; however, the parent does drink and drive. This action causes a) Conflict with society b) Insecurity and lack of safety c) Disruption in consistency d) Failure to reflect own values
d. failure to reflect own values Explanation: Many role models fail to reflect on their own values and, as a result, model conflict and confusion. 87
A client who is scheduled to have surgery for a hernia the next day is anxious about the whole procedure. The nurse assures the client that surgery for hernias is very common and that the prognosis is very good. What skills of the nurse are reflected here? a) Interpersonal skills b) Systems skill c) Instrumental skills d) Imaginal skills
a. Interpersonal skills Explanation: The scenario reflects the nurse's interpersonal skills. It shows how a person relates with others. The nurse shows imaginal skills when he or she envisions a plan for adapting and personalizing client care. Instrumental skills are associated with basic physical and intellectual competencies. Systems skills are those that help the nurse see the whole picture and how various parts relate. 103
A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accord with which of the following, a principle of bioethics? a) Nonmaleficence b) Advocacy c) Morals d) Values
a. Nonmaleficence Explanation: Nonmaleficence is a principle of bioethics and is defined as the obligation to prevent harm. Advocacy, morals, and values are not principles of bioethics. 91
What is the term for the beliefs held by the individual about what matters? a) Bioethics b) Ethics c) Morals d) Values
d. values Explanation: Values are ideals and beliefs held by an individual or group; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people. A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death and questions and concerns regarding quality of life as it relates to advanced technology. 85
Choice Multiple question - Select all answer choices that apply. Values are known to affect a person's functional health. Which of the following values may be related to the perception of health? Select all that apply. a) Cooperation b) Language c) Discipline d) Intuition e) Responsibility
e• Responsibility c• Discipline a• Cooperation Explanation: Responsibility, discipline, and cooperation are values related to health perception and management. Language and intuition are not values related to health perception; they are values related to cognition and perception. Language reflects cultural patterns of thinking in such areas as time, space, and world view. 85
A nurse pulls the curtains before changing the dressing of the surgical wound on the abdomen of a post-surgical client. What value is served? a) Dignity b) Freedom c) Altruism d) Accountability
a. Dignity Explanation: The nurse values the dignity of the client and provides the client with privacy before changing the wound dressing. This incident does not serve the values of accountability, freedom, or altruism. A nurse values accountability when documenting nursing care accurately and honestly. The nurse values freedom when the client's right to refuse treatment is honored. The nurse shows value for altruism when showing concern for the client's welfare. 87
A nurse working on a critical care unit was informed by a client with multiple sclerosis that she did not wish to be resuscitated in the event of cardiac arrest. The client is no longer able to express her 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 what? a) Ethical distress b) Paternalism c) Deception d) Confidentiality
a. Ethical distress Explanation: The nurse is involved in a situation that involves ethical distress. Ethical distress occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. Paternalism is acting for clients without their consent to secure good or prevent harm. Deception and confidentiality can result in ethical problems for nurses when there is a conflict between the client's and nurse's values and interests. In this scenario, the nurse is aware of the client's wishes, but the conflict lies with the family and thus the nurse will experience ethical distress. 96
An emergency department nurse and health care team is caring for a semiconscious child age 2 years with numerous fractures and evidence of cigarette burns. They suspect child abuse. The nurse reports the family to the child abuse hotline. The nurse is following which ethical principle? a) Nonmaleficence b) Justice c) Fidelity d) Beneficence
a. Nonmaleficence Explanation: The principle of nonmaleficence means to avoid doing harm, to remove harm, and to prevent harm. 91
During adolescence, values are primarily formed from a) Peers b) Schools c) Work d) Parents
a. Peers Explanation: In adolescence, peer groups are the primary source of value formation. The attitudes, beliefs, and behaviors that grow out of peer group relationships are powerful. 87
A nurse is of the Catholic faith and votes pro-life. He is considered to have a) Personal values b) Personal morality c) Ethics d) Legal obligations
a. Personal values Explanation: Personal values are ideas or beliefs a person considers important and feels strongly about. 87
A nursing instructor is teaching a class about ethical principles to a group of nursing students. The instructor determines that the teaching was successful when the students give which of the following as an example of nonmaleficence? a) Protecting clients from a chemically impaired practitioner b) Administering pain medications to a client in pain c) Providing emotional support to clients who are anxious d) Performing dressing changes to promote wound healing
a. Protecting clients from a chemically impaired practitioner Explanation: Protecting clients from a chemically impaired practitioner is an appropriate example of nonmaleficence. Nonmaleficence means to avoid doing harm, to remove from harm, and to prevent harm. Performing dressing changes to promote wound healing, providing emotional support to clients who are anxious, and administering pain medications to a client in pain are examples of beneficence, which means doing or promoting good. 91
A client who is scheduled for abdominal surgery gives informed consent. While reviewing the client's medical record, the nurse identifies the consent form, interpreting it as most reflective of which of the following? a) Protection of the client's right to self-determination in decision making b) Assurance of client's ability to refuse treatment if necessary c) Client's in-depth knowledge about the treatment options available d) Confirmation of the client's mental capacity
a. Protection of the client's right to self-determination in decision making Explanation: Informed consent protects the client's right to self-determination in healthcare decision making. Informed consent helps the client to refuse a treatment that the client does not wish to undergo and helps the client to gain in-depth knowledge about the treatment options available. However, the most important function of informed consent is to encourage shared decision making. Informed consent does not determine the client's mental capacity. 98
Which of the following is a characteristic of the care-based approach to bioethics? a) The promotion of the dignity and respect of clients as people b) The need for an orientation toward service c) The rightness or wrongness of an action is independent of its consequences d) The need to emphasize the relevance of clinical experience
a. The promotion of the dignity and respect of clients as people Explanation: The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of patients and people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences. 91
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? a) Personal morality b) Ethics c) Legal obligations d) Professional values
a. personal morality Explanation: Personal morality is the set of beliefs about the standards of right and wrong that helps a person determine the correct or permissible action in a given situation. 87
A client who is mentally incapacitated is scheduled to undergo surgery. The nurse demonstrates understanding of the principle of autonomy and checks the client's medical record to ensure that consent has been obtained from which person? a) Surrogate decision maker b) Operating surgeon c) Client d) Attending nurse
a. surrogate decision maker Explanation: A surrogate decision maker should be identified to give consent for the client who is mentally incapacitated. Infants, young children, people who are severely mentally handicapped or incapacitated, and people in a persistent vegetative state or coma do not have the capacity to participate in decision making about their healthcare. For such people, a surrogate decision maker must be identified to act on their behalf. The surgeon and the nurse are not eligible to give consent for the client. 98
A nurse is caring for a client who is a practicing Jehovah's Witness. The physician orders two units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the patient's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions? a) Siding with the patient over the surgeon b) Acting in the patient's best interest c) Observing institutional policies d) Being legally responsible
b. Acting in the patient's best interest Explanation: Nurses' ethical obligations include acting in the best interest of their clients, not only as individual practitioners, but also as members of the nursing profession, the health care team, and the community at large. 103
A nurse has completed four hours of his eight-hour shift on a medical-surgical unit when he receives a phone call from the nursing supervisor. The nursing supervisor informs him that he needs 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 he has been busy with his client assignment 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? a) Conflicts concerning new technology b) Allocation of scarce nursing resources c) Deception d) Advocacy in a market-driven environment
b. Allocation of scarce nursing resources Explanation: This is a clear example of ethical issues surrounding the allocation of scarce nursing resources and involves distributing nursing care. 101
A nursing instructor is describing values and how they can reflect a person's age and stage of development. At which stage would the instructor explain that values typically evolve into guiding principles in life? a) At infancy b) At adulthood c) At childhood d) At old age
b. At adulthood Explanation: At adulthood, the values of a person develop into his or her guiding principles in life. This does not occur at infancy, childhood, or in old age. At infancy, a person learns to establish trust. At childhood, a person learns to distinguish between right and wrong. At old age, a person focuses on personal integrity and the wisdom that he or she has accumulated over a lifetime. 87
Which ethical principle refers to the obligation to do good? a) Fidelity b) Beneficence c) Veracity d) Nonmaleficence
b. Beneficence Explanation: Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; it is more binding than beneficence. 91
Which of the following theories of ethics most highly prioritizes the nurse's relationship with patients and the nurse's character in the practice of ethical nursing? a) Deontology b) Care-based ethics c) Utilitarianism d) Principle-based ethics
b. Care-based ethics Explanation: Central to the care-based approach to ethics is the nurse's relationships with patients and the nurse's "being," or character and identity. Deontology, utilitarianism, and principle-based ethics each prioritize goals and principles that exist beyond the particularities of the nursepatient relationship. 91
A nurse states to the client that she will keep her free of pain. However, her family wishes to try a treatment to prolong her life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle? a) Autonomy b) Fidelity c) Justice d) Veracity
b. Fidelity Explanation: Fidelity means being faithful to one's commitments and promises. 91
A nurse working in a long-term care facility has an elderly male client who is very confused. What ethical dilemma is posed when using restraints in a long-term care setting? a) It prevents self-directed care. b) It threatens autonomy. c) It increases confusion. d) It limits personal safety.
b. It threatens autonomy. Explanation: Because there are safety risks involved when using restraints on elderly confused clients, this is a common ethical problem in long-term care settings, as well as other health care settings. Restraints limit the individual's autonomy because they are perceived as imprisonment. Restraints should not limit personal safety. Often, restraints increase confusion, and they prevent self-directed care. 91
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 patient still receives a reasonable amount of time, attention, and care during the course of the shift. Which of the following is the nurse attempting to enact? a) Beneficence b) Justice c) Fidelity d) Nonmaleficence
b. Justice Explanation: The ethical principle of justice includes an effort to fairly distribute benefits and to minimize discrimination, even when circumstances make this difficult to achieve. This is demonstrated by the nurse's efforts to fairly distribute his or her time and care. 91
A client rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the cliient that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? a) Nonmaleficence b) Fidelity c) Justice d) Autonomy
b. fidelity Explanation: Fidelity is keeping one's promises and never abandoning a client entrusted to your care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make health care decisions. Nonmaleficence is avoiding causing harm. Justice involves giving each client his or her due and acting fairly. 90
Which of the following words is best described by the following: the protection and support of another's rights? a) Paternalism b) Autonomy c) Advocacy d) Ethics
c. Advocacy Explanation: Advocacy is the protection and support of another's rights. Nurses who value patient advocacy make sure their loyalty to an employing institution or colleague does not compromise their primary commitment to the patient; give priority to the good of the individual patient rather than to the good of society in general; and carefully evaluate the competing claims of the patient's autonomy and patient well-being. Paternalism is acting for patients without their consent to secure good or prevent harm. Autonomy is respecting the rights of patients or their surrogates to make healthcare decisions; it is also known as self-determination. Ethics is the formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing. 103
In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? a) Human dignity b) Altruism c) Social justice d) Integrity
d. Integrity Explanation: The nurse is demonstrating integrity, which is defined as acting in accordance with an appropriate code of ethics and accepted standards of practice. Seeking to remedy errors made by self or others is an example of integrity. Altruism is a concern for the welfare and being of others. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the inherent worth and uniqueness of individuals and populations. 87
Which of the following best describes feminist ethics? a) A combination of elements of utilitarian and deontologic theories that offers specific action guides for practice. b) Attention directed to the specific situation of individual patients viewed within the context of their life narratives. c) An approach critiquing existing patterns of oppression and domination in society. d) The formal study of ethical issues that arise in the practice of nursing.
c. An approach critiquing existing patterns of oppression and domination in society. Explanation: Feminist ethics offers an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guides for practice. The care-based approach directs attention to the specific situation of individual patients viewed within the context of their life narratives. And the formal study of ethical issues that arise in the practice of nursing describes nursing ethics. 89
A child on a pediatric unit hits one of the other children and subsequently has video game privileges revoked for the rest of the day. The next day the same child plays with the other children without any problems in order to avoid losing video game privileges again. According to Kohlberg, the child is demonstrating what stage of development? a) Self-actualization b) Trust versus mistrust c) First-level preconventional stage d) Moralizing
c. First-level preconventional stage Explanation: As children progress to toddlerhood, morals and values development begins as they identify behaviors that elicit reward or punishment. Kohlberg refers to this process as the first-level preconventional stage when children learn to distinguish right from wrong and understand the choice between obedience and punishment. 89
A male client age 56 years is experiencing withdrawal from alcohol and is placing himself at risk for falls by repeatedly attempting to scale his bedrails. Benzodiazepines have failed to alleviate his agitation and the nurse is considering obtaining an order for physical restraints to ensure his safety. The nurse should recognize that this measure may constitute what? a) Harm b) Deception c) Paternalism d) Advocacy
c. Paternalism Explanation: Paternalism involves the violation of a client's autonomy in order to maximize good or minimize harm, a situation that requires careful consideration in light of ethical principles. Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy is the protection and support of another's rights. 100
The physician has recommended an amniocentesis for an 18-year-old woman. The patient is 34 weeks' gestation and does not want this procedure. The physician is insistent the patient has the procedure. The physician arranges for the amniocentesis to be done. What is this would be an example of? a) Veracity b) Autonomy c) Paternalism d) Beneficence
c. Paternalism Explanation: Paternalism is the act of acting for patients without their consent to secure good or prevent harm. 100
Upon entering the hospital system, the nurse discusses the patient's rights and responsibilities that he is entitled to in the institution. The information the nurse discusses is commonly referred to as: a) Standards of Clinical Nursing Practice. b) The Code of Ethics for Nurses. c) Patient's Bill of Rights. d) The Bill of Rights for Registered Nurses.
c. Patient's Bill of Rights. Explanation: The American Hospital Association developed A Patient's Bill Of Rights (revised in 2003 as The Patient Care Partnership). The Bill of Rights includes the rights and responsibilities of the patient while receiving care in the hospital, and range from "the right to considerate and respectful care" to "the right to be informed of hospital policies and practices that relate to patient care, treatment and responsibilities." 94
Which of the following statements best conveys the concept of ethical agency? a) Ethical practice is best learned and fostered by surrounding oneself with people who exhibit ethical character. b) Individuals who enter the nursing profession often innately possess ethical characteristics. c) A nurse's understanding and execution of ethical practice is primarily a result of increased years of experience. d) Ethical practice requires a skill set that must be conscientiously learned and nurtured.
d. Ethical practice requires a skill set that must be conscientiously learned and nurtured. Explanation: Ethical agency must be cultivated in the same way that nurses cultivate the ability to do the scientifically right thing in response to a physiologic alteration. It is inaccurate to assume that it will passively develop from the presence of other ethical practitioners, or from years of experience. It is not an innate characteristic of personality. 92
A client with cancer of the stomach tells the nurse, "I cannot bear the pain anymore. Please give me something to end all my suffering and this agonizing pain." The nurse faces a value conflict. Which of the following would be most important for the nurse to keep in mind in this situation? a) The responsbility is to focus solely on the values of the client. b) Value conflict has no effect on the client's compliance. c) Values conflict is consistently destructive in nature. d) Human need may affect the values conflict.
d. Human need may affect the values conflict. Explanation: Human need may affect the values conflict. Though the client is refusing further treatment, the nurse should be aware that the client needs the treatment. The nurse should not consider only the values of the client. When faced with a values conflict, nurses should examine their own values regarding the conflict. Value conflict may affect the client's compliance. Values conflict is not always destructive in nature. At times, it may even be constructive. 101
A client with a diagnosis of colorectal cancer has been presented with her treatment options, but wishes to defer any decisions to her uncle, who acts in the role of a family patriarch within the client's culture. By which of the following is the client's right to self-determination best protected? a) Teaching the client about her right to autonomy b) Revisiting the decision when the uncle is not present at the bedside c) Holding a family meeting and encouraging the client to speak on her own behalf d) Respecting the client's desire to have the uncle make choices on her behalf
d. Respecting the client's desire to have the uncle make choices on her behalf Explanation: The right to self-determination (autonomy) means that it should never be forced on anyone. The client has the autonomous right to defer her decision-making to another individual if she freely chooses to do so. 87
When individuals or groups use utilitarianism to make ethical decisions, which of the following do they consider? a) Duty is equally important. b) Consequences are not the only issue. c) Actions are independently right or wrong. d) Rightness or wrongness depends on consequences.
d. Rightness or wrongness depends on consequences. Explanation: Utilitarianism states that the rightness or wrongness of an action depends on the consequences of the action. Another theory of ethics, deontology, argues that an action is right or wrong independent of its consequences. 90
A group of nurse researchers has proposed a study to examine the efficacy of a new wound care product. Which of the following aspects of the methodology demonstrates that the nurses are attempting to maintain the ethical principle of nonmaleficence? a) The nurses have organized the study in such a way that the foreseeable risks and benefits are distributed as fairly as possible. b) The nurses have completed a literature review that suggests the new treatment may result in decreased wound healing time. c) The nurses have given multiple opportunities for potential participants to ask questions, and have been following the informed consent process systematically. d) The nurses are taking every reasonable measure to ensure that no participants experience impaired wound healing as a result of the study intervention.
d. The nurses are taking every reasonable measure to ensure that no participants experience impaired wound healing as a result of the study intervention. Explanation: The principle of nonmaleficence dictates that nurses avoid causing harm. In this study, this may appear in the form of taking measures to ensure that the intervention will not cause more harm than good. The principle of justice addresses the distribution of risks and benefits, and the informed consent process demonstrates that autonomy is being protected. Preliminary indications of the therapeutic value of the intervention show a respect for the principle of beneficence. 91
