E1: Ethical/Legal Issues and Advocacy

There are many terms used to describe moral issues faced by nurses, including moral uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. Which statement describes how moral uncertainty occurs? A) Occurs when an individual is unsure which moral principles or values apply andmay even include uncertainty as to what the moral problem is B) Occurs when the individual knows the right thing to do but organizationalconstraints make it difficult to take the right course of action C) Occurs when an individual witnesses the immoral act of another but feelspowerless to stop it D) Occurs when being forced to choose between two or more undesirable alternatives

A

Which activity best demonstrates a nursing unit managers attention to the ethics standards of practice required of that position? A) Membership on the institutions ethic board B) Terminates a staff member for absenteeism C) Assures staff and patients that unit decisions are ethically sound D) Holds membership in the local and state American Nurses Association (ANA)

A

Collecting data about the ethical problem and identifying who should be involved in the decision-making process is accomplished in which phase of the MORAL decision- making model? A) Massage the dilemma B) Outline options C) Review criteria and resolve D) Affirm position and act

A Feedback: Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process. Outline options: Identify alternatives, and analyze the causes and consequences of each. Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid. Affirm position and act: Develop the implementation strategy.

Which factor should be considered when assessing the quality of ethical problem solving? Select all that apply. A) Outcomes B) Decision-making process C) Multiple alternatives D) Data gathering

A, B

Which characteristic of an organization has influence on the ethical decisions its managers make? Select all that apply. A) Purpose B) Societal role C) Societal constraints D) Values

A, B, C

Which statement concerning autonomy and the employee is true? Select all that apply. A) It is a form of personal liberty B) Its legal equivalent is self determination C) It is based on a persons right to make a choice D) It is supported by the process of progressive employee discipline

A, B, C, D

Which statement is correct regarding the distinction between legal and ethical obligations in decision making? A) Ethical controls are clearer and philosophically impartial B) Ethical controls are much clearer and individualized C) Legal controls are clearer and philosophically impartial D) Legal controls are much less clear and individualized

Ans: C Feedback: In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized.

16. What is one way to promote open communication between patients and practitioners? A) Involving health-care consumers as active members of the health-care team B) Promoting the creation of cultures of patient safety in health-care organizations C) Establishing a federal leadership locus for advocacy of patient safety and health- care quality D) Building an evidence-based information and technology system that impacts

Ans: A Feedback: One way to promote open communication between patients and practitioners is involving health-care consumers as active members of the health-care team. Pursing patient safety initiatives prevent medical injury by promoting the creation of cultures of patient safety in health-care organizations; establishing a federal leadership locus for advocacy of patient safety and health-care quality; and building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs.

What does the morale principle of autonomy govern? A) A persons right to make his or her own decision B) The obligation to do good and prevent harm C) Doing what is right and fair D) Truth telling

Ans: A Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for ones choice. None of the other options addresses this concept.

17. What document permits a registered nurse to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful? A) A state nursing license B) Institutional licensure C) ANA certificate D) ANA practice standards

Ans: A Feedback: In general, a license is a legal document that permits a person to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful. A state nursing license allows for the practice of nursing in a specific state. Some professionals have advocated shifting the burden of licensure, and thus accountability, from individual practitioners to an institution or agency. Proponents for this move believe that institutional licensure would provide more effective use of personnel and greater flexibility. The ANA is not capable of permitting a person to practice nursing.

4. The nurse witnesses a patient sign an operative permit form. Legally, what does the nurses signature imply? A) Observed the client sign the consent form B) Is certain the client understands the proposed procedure C) Believe the client is capable of understanding the proposed procedure D) Assumes the client has had an adequate evaluation to agree to the procedure

Ans: A Feedback: Informed consent is obtained by a physician; therefore, a nurse is not legally responsible for informed consent but is confirming that the client signed the consent form. The other options are the responsibilities of the professional performing the procedure.

9. A state Nurse Practice Act is an example of which source of law? A) Statutes B) Constitution C) Administrative D) Judicial

Ans: A Feedback: Statutes are the only laws made by official enactment by the legislative body.

2. How is the question of whether a nurse acted with reasonable care generally proven? A) The expert testimony of nursing witnesses B) The defendants explanation of what the nurse did C) The trial judge, after checking the outcome of prior similar court cases D) The testimony of expert medical witnesses

Ans: A Feedback: The testimony of other nurses in the same specialty as the defendant may be used to prove breach of duty. The other options are not considered qualified to testify to this matter.

19. What is an example of an unintentional tort? A) Professional negligence B) Assault C) Battery D) False imprisonment

Ans: A Feedback: While professional negligence is considered to be an unintentional tort, assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts.

Which leadership role is associated with advocacy? A) Create a climate where advocacy and its associated risk-taking are valued B) Give subordinates and patients adequate information to make informed decisions C) Ensure that rights and values of patients supersede those of the health-care providers D) Seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict

Ans: A Feedback: A leadership role associated with advocacy is to create a climate where advocacy and its associated risk-taking are valued. Management functions include the following: give subordinates and patients adequate information to make informed decisions; ensure that rights and values of patients supersede those of the health-care providers; and seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict.

Which management function is associated with advocacy? A) Awareness of current legislative efforts affecting nursing practice and organizational and unit management B) Role modeling proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives C) Participation in professional nursing organizations and other groups that seek to advance the profession of nursing D) Assertively advocating on behalf of patients and subordinates when an intermediary is necessary

Ans: A Feedback: A management function associated with advocacy is awareness of current legislative efforts affecting nursing practice and organizational and unit management. Leadership roles include the following: role models' proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives; participates in professional nursing organizations and other groups that seek to advance the profession of nursing; assertively advocate on behalf of patients and subordinates when an intermediary is necessary.

How is the action of advocacy described? A) Informing others of their rights and making certain they have sufficient information to make decisions B) Learning about the need for a decision and then making a good decision for other people C)Supporting an individual's right to make a decision even when they do not have accurate information D) Protecting the rights of patients in accordance with the law

Ans: A Feedback: The advocate informs others of their rights and makes certain they have sufficient information to make decisions. The remaining options are incorrect when describing the action associated with advocacy.

Whose rights do the legislative controls of nursing practice primarily protect? A) Patients B) Subordinates C) Managers D) Administrators

Ans: A Feedback: The legislative controls of nursing practice primarily protect the rights of patients. Protection of those identified by the other options while important is the primary focus of the nursing practice legislative bodies.

How can nurses act as advocates? Select all that apply. A) Helping others make informed decisions B) Directly intervening on behalf of others C) Providing consent to treat for the cognitively impaired patients D)Making health-care decisions for those who are not able to do so

Ans: A, B Feedback: Nurses may act as advocates by either helping others make informed decisions, by acting as intermediary in the environment, or by directly intervening on behalf of others. Advocates do not make decisions or provide consent but rather educate patients so they can be informed.

21. Which statement is true regarding criminal law cases? Select all that apply. A) Incarceration is a likely consequence of being found guilty of a criminal offense B) Intentionally giving an overdose of a potent narcotic is a criminal offense C) A guilty verdict requires evidence beyond a reasonable doubt D) Most malpractice cases are tried in criminal court

Ans: A, B, C Feedback: In criminal cases, the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in a criminal court. Most malpractice cases are tried in civil court.

24. Which action demonstrates appropriate management regarding legal issues? Select all that apply. A) Remains current on all institutional policies and procedures B) Delegates with consideration to appropriate scopes of practice C) Requires physical proof of appropriate professional licensure each year D) Provides yearly in-services on the operation of newly acquired equipment

Ans: A, B, C Feedback: Sound management functions regarding legal issues include understanding and adhering to institutional policies and procedures delegating to subordinates wisely, looking at the managers scope of practice and that of the individuals he or she supervises, and monitoring subordinates to ensure they have a valid, current, and appropriate license to practice nursing. In-services should be held frequently especially when related to issues that affect care delivery. The reliance on peers for advice in such matters is not prudent; the institutions legal advisor is much better prepared for this task.

Which nursing intervention demonstrates attention to the nursing values central to patient advocacy? Select all that apply. A) Assuring the patient that their wishes will be respected regarding the care they receive B) Identifying the patient's religious dietary practices when discussing a prescribed diet C) Answering the patient's questions regarding the alternatives to a proposed procedure D) Suggesting to a patient that a social services consult would help with discharge needs

Ans: A, B, C, D Feedback: The nursing values central to advocacy emphasize caring, autonomy, respect, and empowerment. While appropriate, comforting a patient is not an act of advocacy in this situation.

11. A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, and a causal relationship between breach of duty and injury. What else must be included? Which element is necessary to prove professional negligence? Select all that apply. A) Breach of duty B) Presence of injury C) Ability to foresee harm D) Causal relationship

Ans: A, B, C, D Feedback: A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, a causal relationship between breach of duty and injury, and the ability to foresee harm. Intent to cause injury is not a requirement.

15. Which situations is a nurse-manager illegally responsible for reporting? Select all that apply. A) Suspected incidents of elder abuse B) Examples of substandard medical care C) Client-reported incidents of child abuse D) Confirmed case of a communicable disease

Ans: A, B, C, D Feedback: In addition, the manager, like all professional nurses, is responsible for reporting improper or substandard medical care, child and elder abuse, and communicable diseases, as specified by the Centers for Disease Control and Prevention. Disagreements are not mandated reportable situations.

Which intervention demonstrates that the nurse-manager is to advocate for patients in common areas of concern? Select all that apply. A)Staffing a unit with sufficient care providers B) Orienting staff to safely use a new patient lift C) Providing an in-service on culturally meeting end-of-life needs D) Arranging for patient consultations with members of the financial office

Ans: A, B, C, D Feedback: Common areas for managers to advocate for patients include distribution of resources; use of technology; end-of-life decisions; and health-care reimbursement. While aesthetics is an important consideration, it is not a common area for managers to act as advocators

Which are common areas requiring nurse-patient advocacy? Select all that apply. A) Securing patient consents B)Preventing medication errors C)Facilitating access to health-care services D) Respect for patient dignity and cultural values

Ans: A, B, C, D Feedback: Common areas requiring nurse-patient advocacy include inadequate patient consents; medical errors; access to health care; and respect for patient dignity and cultural values. While hospitalization is expensive, education on this subject is not considered a nursing advocacy role.

Managerial advocacy has resulted in which profession of nursing characteristics? Select all that apply. A) Ethical code B) Legal recognition C)Nurse Practice Acts D)Professional licensing

Ans: A, B, C, D Feedback: Managers must be advocates for the nursing profession. It was nurses who pushed for accountability through state nurse practice acts and state licensing. Nurse-leaders collaborated on defining the profession, achieving legal recognition of the profession and establishing a culture for professional nursing which has continued to the present time. Advocating for professional nursing is a leadership role. Professional issues are always ethical issues. When nurses find a discrepancy between their perceived role and society's expectations, they have a responsibility to advocate for the profession. This includes speaking out on consumer issues, continuing and expanding attempts to influence legislation, and increasing membership on governmental health policy-making boards and councils. Only then will nurses be able to influence the tremendous problems facing society today.

Which characteristic associated with being a patient increases the need for advocacy? Select all that apply. A) Loss of physical freedom as a result of extended hospitalizations B) Decreased independence due to physical or psychosocial limitations C) Physical or psychosocial limitations negatively impacted autonomy D) Illness tends to make an individual more vulnerable to unethical activities

Ans: A, B, C, D Feedback: Patient advocacy is necessary because disease almost always results in decreased independence, loss of freedom, and interference with the ability to make choices autonomously. In addition, aging, as well as physical, mental, or social disability may make individuals more vulnerable and in need of advocacy. It is not true that cognitive function is impaired as a result of chronic and/or acute illness.

Which strategy demonstrates an understanding of the management's role as advocate for their subordinates? Select all that apply. A) Staff representatives on all unit committees B) Monthly "brown bag lunches" with the staff C) Requests revising criteria for granting a "leave of absence" D) Working with primary care providers to expand standing nursing orders

Ans: A, B, C, D Feedback: The following are suggestions for creating an environment that promotes subordinate advocacy: Invite collaborative decision making; get to know staff personally; "go to bat" for staff when needed; and promote nurse autonomy. Rather than anticipating educational needs, the manager advocates by asking for and then respecting their suggestions by planning accordingly.

. To make appropriate ethical decisions the nurse-manager must have knowledge of what items to assist in making decisions? Select all that apply: A) Organizational processes 1, 2 B) Proven decision-making models 1, 2, and 3 C) Professional approach that eliminates trial and error D) Ethical principles and frameworks

Ans: A, B, C, D Feedback: To make appropriate ethical decisions then, the manager must have knowledge of ethical principles and frameworks, use a professional approach that eliminates trial and error and focuses on proven decision-making models, and use available organizational processes to assist in making such decisions. Knowledge of the involved parties wishes is not a focus of the decision-making process.

18. Professional organizations generally espouse standards of care that have what relationship to those required by law? Select all that apply. A) Higher than those required by law B) The same as those required by law C) Are established after those required by law D) Are established prior to those required by law

Ans: A, D Feedback: Professional organizations generally espouse standards of care that are higher than those required by law. These voluntary controls often are forerunners of legal controls. The standards are written by health-care professionals while laws are written by legislatures.

6. What is the responsibility of a charge nurse who discovers that a medication error was made on the previous shift? A) Share that information with the charge nurse on the previous shift B) Document the incident as per hospital policy C) Write a memo to the nurse who made the error requesting incident report be written D) Write a note in the clients chart that an incident report will be completed

Ans: B Feedback: It is the responsibility as manager to immediately document the error according to hospital policy. Since policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the clients chart.

Which member of the health-care team is often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting wants and goals? A) Physicians B) Nurses C) Nurse practitioners D) Social workers

Ans: B Feedback: Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals. The nature of the patient contact of a nurse is more direct and involves more time than the other members of the health-care team.

22. Which behavior will best minimize a nurses risk for a malpractice claim? A) Always carry a personal liability insurance policy B) Always function with the states nursing practice act C) Ask for assistance when engaged in complicated procedures D) Devote time to establishing an effective nursenpatient relationship

Ans: B Feedback: Nurses can reduce the risk of malpractice claims by practicing within the scope of the Nurse Practice Act. Nurses should purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help to protect a nurse from financial ruin should there be a malpractice claim. While the other options present reasonable advice, they will not necessarily help in the avoidance of a malpractice claim.

25. Which statement best describes the impact that the concept of respondeat superior has on the issue of nursing liability? A) It allows for joint liability among physicians, nurses, and health-care organizations B) It supports the sharing of blame among all involved sources of health-care services C) It encourages legal intervention when health care is thought to be substandard D) It implies that the institution is responsible for the acts of its employees

Ans: B Feedback: Nurses must remember that the purpose of respondeat superior is not to shift the burden of blame from the employee to the organization but rather to share the blame, increasing the possibility of larger financial compensation to the injured party. While the other options may be true statements, the correct option describes the more nurse-related implication of the concept.

1. What defines the legal boundaries of nursing at the state level? A) The states Attorney General B) The Nurse Practice Act C) The ANA standards of practice D) The ANA Code for Nurses

Ans: B Feedback: The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes. These Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. Although Nurse Practice Acts may vary among states, all must be consistent with provisions or statutes established at the federal level. The other options lack the comprehensiveness and focus of a states Nurse Practice Act.

Which statement regarding the responsibility of a manager in advocacy is accurate? A) Advocacy is a management function and not a leadership role B) Managers advocate only as needed to meet organizational goals C) Managers should advocate for patients as well as subordinates D) Professional advocacy is not a primary concern for most managers

Ans: C Feedback: Advocacy is helping others to grow and self-actualize. The manager must be an advocate for patients, subordinates, and the nursing profession. The remaining statements are not accurate descriptions of the manager's role as advocate.

What is the role of the American Nurses Association Code of Ethics and Interpretive Statements? A) Outlines minimum levels of ethical behavior that nurses must maintain B) Functions as a guide to the highest standards of ethical practice for nurses C) Is a legally binding document that directs a nurses ethical and moral behavior D) Mandates the ethical behavior prerequisite for maintaining a nursing licensure

Ans: B Feedback: The ANA Code of Ethics outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse in order to achieve and maintain the highest standards. The document is not legally binding nor is it a mandate of behavior.

7. What is the best reason that nurse-managers have an ongoing responsibility to be aware of legislation affecting nursing practice? A) This will prevent them from getting sued B) Laws are fluid and subject to change C) It will protect the agency from a lawsuit D) It will ensure that correct procedure is carried out

Ans: B Feedback: When using doctrines as a guide for nursing practice, the nurse must remember that all laws are fluid and subject to change. Laws are not static. It is the responsibility of each manager to keep abreast of legislation and laws affecting both nursing practice and management practice. While the other options are correct, they do not describe the most encompassing reason that nurse-managers need to keep aware of current legislature affecting nursing practice.

Which ethical framework would most likely be used to arrive at the nurses decision to work overtime in spite of previous social plans? A) Utilitarianism B) Duty based C) Rights based D) Intuitionism

Ans: B Feedback: The duty framework says that some things should be done just because there is a duty to do them or refrain from doing them. Utilitarianism states that the good of the many outweighs the wants or needs of the individual. The remaining options are not relevant to the situation.

Which statement regarding the MORAL decision-making model is true? A) It is a problem-solving model B) It does not include an evaluation step C) The identification and analysis of multiple alternatives for action is required D) The decision is arrived upon with only the involvement of the decision maker

Ans: C Feedback: MORAL is a decision-making model that is useful in clarifying ethical problems, and it requires the identification and analysis of multiple alternatives for action. The other options are not true statements regarding this decision-making model.

10. A verdict of suspension or loss of licensure represents what type of law? A) Criminal B) Civil C) Administrative D) Judicial

Ans: C Feedback: A verdict of suspension or loss of licensure represents administrative law. This type of law is not based on any of the other options.

3. A doctor orders a medical procedure that the staff nurse has reason to believe will harm the patient. Which statement accurately states the legal consequences of carrying out, or refusing to carry out, the procedure? A) The staff nurse cannot be held legally liable for any harm to the patient if the procedure is carried out with due care B) The nurse may lose his or her license by refusing to carry out the procedure C) The nurse can be held legally liable for any harm if the procedure is carried out without question D) The nurse can be held accountable for practicing medicine without a license

Ans: C Feedback: All nurses have personal liability, which means that every person is liable for his or her own conduct. None of the remaining options describes that liability or its outcomes accurately.

Protecting patient confidentiality respects the clients right to A) self-esteem B) self-defense C) self-determination D) self-incrimination

Ans: C Feedback: Confidentiality is a foundation of both medical and nursing ethics, and it respects the clients right to self-determination. While the other options are worthy of respect, they are not associated with confidentiality.

20. Malpractice or professional negligence is the failure of a person with professional training to act in a reasonable and prudent manner. How many components must be present for an individual to be found guilty of malpractice? A) Three B) Four C) Five D) Six

Ans: C Feedback: Five components must be present for a professional to be held liable for malpractice: duty to use care, failure to meet standard of care, foreseeability of harm, direct relationship between failure to meet the standard of care and injury can be proved, and injury.

14. What element must be included in the process of securing informed consent? A) A timeline of when the treatment is expected to occur B) Written information on what the post procedure outcomes will be C) Information regarding the risks involved in the proposed procedure D) An explanation of the nature of all associated treatment provided by the nurse

Ans: C Feedback: Informed consent can be given only after the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it. Timeline and nursing responsibilities are not components that are included. Outcomes are identified as expected or desired; no guarantees are given.

8. Which characteristics are required of a reasonable and prudent nurse? A) Years of clinically focused nursing experience B) Specialized nursing skills C) Average nursing judgment and skills D) Earned advanced nursing degree

Ans: C Feedback: Reasonable and prudent generally means the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. The other options describe qualifications not required of a reasonable and prudent nurse.

Much of the difficulty people have in making ethical decisions results from a lack of formal education about problem solving. Research at the University of Pennsylvania found what percentage of the nurses and social workers reported having no ethics training? A) 15 B) 20 C) 25 D) 30

Ans: C Feedback: Research done at the University of Pennsylvania found that nearly 25% of the nurses and social workers reported having received no ethics training.

Patients were often denied basic human rights until when? A) 1940s B) 1950s C) 1960s D) 1970s

Ans: C Feedback: Until the 1960s patients had few rights; in fact, patients before then often were denied basic human rights. Conditions improved by the 1970s.

Who plays a primary role in ensuring that workers have reasonable, working schedules? A) Unions B) Top administrators C) Managers D) Federal government

Ans: C Feedback: In workplace advocacy, the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates. The other options play a role in such situations but the manager has the primary responsibility.

23. Which statement is true regarding the implications of a Good Samaritan law for a registered nurse? Select all that apply. A) A nurse has a legal responsibility to provide emergency services B) Such laws are universally worded so as to minimize state-to-state differences C) In order for protection to apply, the nursing care cannot be considered negligent D) A nurse who provided out-of-scope care is not protected by the Good Samaritan law

Ans: C, D Feedback: Nurses are not required to stop and provide emergency services as a matter of law, although most health-care workers feel ethically compelled to stop if they believe they can help. Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. However, not being paid for your services alone will not provide Good Samaritan law protection. Good Samaritan laws apply only if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. Protection under Good Samaritan laws varies tremendously from state to state. In some states, the law grants immunity to RNs but does not protect LVNs or LPNs. Other states offer protection to anyone who offers assistance, even if they do not have a health-care background. Nurses should be familiar with the Good Samaritan laws in their state.

5. How is the legal expansion of nursing roles accomplished? A) The expansion of job descriptions in an agency B) Written contracts between the nurse and the client C) A written agreement between the nurse and the physician D) Revision of the Nurse Practice Act

Ans: D Feedback: RN scope of practice is always determined by the Nurse Practice Act and any expansion of roles must occur through legislated changes in that statute. None of the remaining options are sufficient to expand nursing roles legally.

Which statement regarding ethical decision making is true? A) Outcomes are the basic criterion for evaluating ethical decision making B) Only desirable alternatives are identified when solving ethical dilemmas C) Critical ethical decisions are made quickly so the situation does not worsen D) Accepting some ambiguity and uncertainty are a part of ethical decision making

Ans: D Feedback: Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. The remaining options are not true statements regarding the ethical decision-making process.

Which statement best describes ethics? A) How our lives and relationships are led in our reality B) How people make decisions they see as legally and morally appropriate C) The conflict, power, and interdependency associated with the way we live D) What our conduct and actions should be regarding what is right and good

Ans: D Feedback: Ethics is the systematic study of what a persons conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a persons life and relationships should be, not necessarily what they are.

Which ethical framework involves an individualized decision-making framework? A) Duty based B) Rights based C) Utilitarian D) Intuitionist

Ans: D Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Utilitarian provides the greatest good for the greatest number of people. Duty based is a duty to do something to refrain from doing something. Rights- based individuals have basic inherent rights that should not be interfered with.

The practice of allocating organs for transplantation based on a persons "worth to society" is an example of what ethical principle for decision making? A) Autonomy B) Beneficence C) Utility D) Justice

Ans: D Feedback: Justice: Seek fairness, treat iequalsi equally, and treat iunequalsi according to their differences. Autonomy: Promotes self-determination and freedom of choice. Beneficence: Actions are taken in an effort to promote good. Utility: The good of the many outweighs the wants or needs of the individual.

What is an ethical dilemma? A) A problem that can be solved using empirical data B) A situation that has clearly delineated facts for decision making C) A problem that when handled effectively has a mutually agreed-upon solution D) A situation that requires choosing between two or more undesirable alternatives

Ans: D Feedback: The most difficult of all moral issues is termed a moral or ethical dilemma, which may be described as being forced to choose between two or more undesirable alternatives. The problem is not generally solved with a solution that is mutually satisfying nor does it lend itself to empirical or delineated facts.

The Patient's Bill of Rights established by which body has the most legal authority? A) A health-care organization B)A professional medical organization C) A regulation professional nursing organization D) A specific state

Ans: D Feedback: A bill of rights that has become law or state regulation has the most legal authority because it provides the patient with legal recourse. A bill of rights issued by health-care organization and professional associations is not legally binding but may influence federal or state funding and certainly should be considered professionally binding.

6. Which situation is a reality for whistle-blowers? A) Retaliation against them is illegal B) Fellow workers are supportive of them C) Federal and State law protects them D) They are often afraid to speak out

Ans: D Feedback: Although whistle-blower protection has been advocated for at the federal level and has been passed in some states, many employees are reluctant to report unsafe conditions for fear of retaliation. Nurses should check with their state association to assess the status of whistle-blower protection in their state. Retaliation and resentment still exist against these individuals in many situations.

What statement is true concerning nurses as a political body? A) They are very committed to both their profession and the political process B) Many are active members of the American Nurses Association (ANA) C) Their primary focus is to speak out on consumer health-related issues D) They have not yet recognized the full potential of political activity

Ans: D Feedback: As a whole, the nursing profession has not yet recognized the full potential of collective political activity. Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes. The remaining options are not true of nurses in general.

Even after a lengthy discussion concerning the ramifications, a patient wants to leave the hospital against medical advice (AMA). What would the nurse do in the role of patient advocate? A) Encourage the patient to wait until morning to leave the hospital B) Ask family members to help talk the patient out of the decision C)Call the security guard to escort the patient off hospital property D) Make sure the patient has appropriate follow-up appointments

Ans: D Feedback: As advocate for this patient, you have made sure he is informed of the ramifications of leaving AMA; however, it is a patient's right to refuse treatment. The other options fail to recognize the patient's right to make autonomous choices.

Which standard of the American Nurses Association (ANA) Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients? A) II B) III C)IV D) V

Ans: D Feedback: Standard V of the ANA Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients. This issue is not addressed in the other options.

12. What component of professional negligence is represented when a patient experiences a seizure resulting from a medication error? A) Duty to use due care B) Failure to meet standard of care C) Foreseeability of harm D) A causal relationship

Ans: D Feedback: A direct causal relationship between failure to meet the standard of care (breach) and injury can be proved when a patient is harmed because proper care is not given. None of the remaining options are relevant to this criterion.

Which term is used to identify a persons feelings of powerlessness to stop unethical behavior in another person or institution? A) Moral conflict B) Moral outrage C) Ethical relativism D) Ethical universalism

B

Which ethical principle associated with an adult child is legally given the right to make medical decisions for a cognitively impaired parent? A) Justice B) Fidelity C) Paternalism D) Beneficence

C

13. What component of professional negligence is represented when a nurse fails to look up an unfamiliar medication before administering it? A.) Duty to use due care B.) Failure to meet standard of care C.) Foreseeability of harm D.) A direct relationship between failure to meet the standard of care (breach) and injury can be proved

C Feedback: The nurse must have reasonable access to information about whether the possibility of harm exists not fulfilling this responsibility may result in a foreseeable harm to the client. None of the remaining options are relevant to this criterion.

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a leadership role? A) Uses a systematic approach to problem solving and decision making when facedwith management problems with ethical ramifications B) Identifies outcomes in ethical decision making that should always be sought oravoided C) Uses established ethical frameworks to clarify values and beliefs D) Role models ethical decision making, which is congruent with the AmericanNurses Association Code of Ethics and Interpretive Statements and Professional standard

D

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a management function? A) Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings B) Accepts that some ambiguity and uncertainty must be a part of all ethical decision making C) Accepts that negative outcomes occur in ethical decision making despite high- quality problem solving and decision making D) Identifies outcomes in ethical decision making that should always be sought or avoided

D Feedback: Management function identifies outcomes in ethical decision making that should always be sought or avoided. Leadership roles include the following: Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings; accepts that some ambiguity and uncertainty must be a part of all ethical decision making; accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making.

The only treatment alternative left for a patient diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. The insurance company refuses to authorize payment for the $200,000 procedure, arguing that the money could be better spent providing well-baby screening for 2,000 residents in the service area. What does this decision by the insurance company reflect? A) Unethical conduct B) Maleficence C) Paternalism D) Utility

D The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficence behavior on the part of the insurance company. Paternalism would be characterized by the insurance company making treatment decision without the patient having input.