Ethics

A nursing instructor asks a nursing student to describe accountability. Which statement by the student indicates an inaccurate description of accountability? A) Accountability can be delegated B) It carries legal implications for task performance C) One must answer for the care that one asks others to complete D) It refers to the process of answering or being responsible for what occurs

A) Accountability can be delegated Rationale: Accountability refers to the process of answering or being responsible for what occurs and carries legal implications for task performance. Accountability can't be delegated; one must answer for the care given and for the care one asks others to complete

The interdisciplinary team discusses a conflict in care-planning ideals between parents of an ill child. Which action should the interdisciplinary team first try to navigate this ethical issue? A) Developing a therapeutic relationship with the child and parents B) Asking a judge for guardianship of the child C) Calling the police D) Contacting the hospital ethics committee

A) Developing a therapeutic relationship with the child and parents Rationale: The team would first develop a therapeutic relationship with the child and parents to discuss options and plan treatment. There is no indication that the police are needed. The ethics committee may be involved if the desires of the parents and child significantly diverge. Legal action would be taken if the parents were making poor decisions regarding the care of the child.

An older client without cognitive impairment refuses culture of a seeping wound. Which action should the nurse take? A) Respecting the client's decision B) Asking the client about withdrawing blanket consent C) Discharging the client for noncompliance D) Restraining the client so that the culture can be taken

A) Respecting the client's decision Rationale: The older adult has the right to refuse​ treatment, and the nurse is legally and ethically bound to respect this decision. The client would not be discharged by the nurse for refusing the culture. Restraining the client so that the culture can be taken is against the law. The client is allowed to refuse treatment under blanket consent.

The nurse is caring for a client on a med-surg. unit. The client tells the nurse that the HCP has refused to treat the client further if the client continues to be noncompliant with the HCP's recommendations. Which is the priority nursing action in this situation? A) Take the issue to the hospital ethics committee B) Advise the client to sue the HCP C) Have the client contact a consumer agency D) Notify the HCP of the client's complaints

A) Take the issue to the hospital ethics committee Rationale: Acting as a client advocate and protecting the client's rights, the nurse should enlist the help of the hospital ethics committee. The nurse never advises a client to sue but assists the client to find help resolving the issue. A consumer agency is not appropriate because this is an ethical matter. The nurse should act on behalf of the client, and the best way to do that is by taking the issue to the hospital ethics committee, not to the healthcare provider.

The nurse manager is concerned about how the stress of ethical dilemmas is affecting the nurses of the unit. Which intervention should the nurse plan for the staff to help them cope with the ethical dilemmas? SATA A) Modeling coping behaviors B) Creating a network for peer support C) Encouraging time at the bedside to foster immersion in the dilemma D) Planning education for coping E) Acquiring resources to ease the impact of future stressors

A, B, D, E Rationale: The nurse manager can use the framework from risk management to help combat the impact of ethical issues in the workplace. This includes modeling coping​ behaviors, planning education​ sessions, creating a support​ network, and acquiring resources. The nurse manager would want to encourage the nurses to spend free time away from the unit as a means of relieving pressure.

The nurse is discussing ethical end-of-life care for an older adult client with the interdisciplinary team. Which issue of care should the nurse include in the conversation? SATA A) Autonomy B) Ability to pay for care and funeral expenses C) Risks and benefits of treatment D) Cognitive impairment E) Presence of depression

A, C, D, E Rationale: Autonomy, cognitive​ decline, depression, and understanding of the risks and benefits of treatment are common ethical issues in​ end-of-life care. Financial status is not included.

The nurse is discussing the consent for care with a 16yo client who doesn't want to involve the parents in care. For which health condition may the minor seek care without parental consent? SATA A) Prenatal care B) Asthma C) Substance Abuse D) Birth Control E) Sexually Transmitted Infections

A, C, D, E Rationale: Depending on state​ law, minors may obtain birth​ control, prenatal​ care, substance abuse​ counseling, and treatment for sexually transmitted diseases without parental consent. Parental consent is required for the​ long-term care of asthma.

The nurse is caring for a client who is awaiting the results of an MRI to determine the extent of a malignant brain tumor. The results are posted in the medical record and indicate the prognosis is not good, but the HCP hasn't seen the report yet. The client asks the nurse about the results. Which is the nurse's best response under the principle of veracity? A) "I don't know whether the results have been posted. The HCP will need to give you that info." B) "The results have been posted on your chart, and your HCP will come speak to you after reviewing them." C) "Your brain tumor has gotten worse and spread to other areas. Your condition is definitely worsening." D) "I'm not allowed to tell you your test results."

B) "The results have been posted on your chart, and your HCP will come speak to you after reviewing them." Rationale: Applying the principle of veracity requires the nurse to be​ truthful, but it is not in the scope of practice for a nurse to disclose information about test results or diagnoses. Acknowledging that results are available and that the healthcare provider will discuss them with the client is truthful. Disclosing the diagnosis is not permitted under the scope of practice of nursing. Saying that the nurse is not allowed to report results may be a true​ statement, but it is not supportive or client centered. Stating that the results are unknown is not a true statement.

The nurse delegates vital signs to a UAP. The UAP reports the vital signs to the nurse, which indicate hypotension and bradycardia. The nurse then assesses the client. Which moral principle is exhibited by the nurse? A) Beneficence B) Accountability C) Nonmaleficence D) Fidelity

B) Accountability Rationale: Under the principle of​ accountability, the nurse is responsible for the outcomes of care rendered and the care given by trainees and subordinates. Fidelity is faithfulness to an agreement. Beneficence is the act of doing well. Nonmaleficence is the avoidance of causing harm.

A nurse is caring for an older client with terminal cancer. The client's family wants to continue treatment but the client would like to discontinue treatment and go home. The nurse agrees to be present while the client tells the family. Which principle is the nurse supporting? A) Beneficence for the client B) Autonomy for the client C) Non-maleficence for the client D) Justice for the client

B) Autonomy for the client Rationale: Autonomy refers to the right to make one's own decisions. The nurse is supporting this principle by supporting the client in his decision. Nonmaleficence is the duty to "do no harm." Justice is often referred to as fairness. Beneficence means "doing good."

The nurse promises to bring a client a requested hand towel, but an hour later, the nurse has not returned. Which moral principle has this nurse violated? A) Justice B) Fidelity C) Autonomy D) Veracity

B) Fidelity Rationale: Fidelity is a faithful agreement or​ promise, which has been broken in this situation. Justice is equal treatment of all clients. Veracity is​ truth-telling. Autonomy is respecting the​ client's decision making.

The nurse is caring for a client with a broken arm. On assessment, the nurse notes bruising that isn't consistent with the story of a fall presented by the client. The client is withdrawn when the client's significant other comes to the bedside. Which action should the nurse take? A) Completing the discharge and releasing the client B) Following legal reporting obligations for suspected domestic violence C) Asking the significant other about the cause of the bruising D) Calling the police

B) Following legal reporting obligations for suspected domestic violence Rationale: The nurse has both moral and legal obligations to act on suspected or confirmed abuse and would follow the applicable law to report suspected domestic violence. The immediate action is any step indicated by state​ law, not necessarily calling the police immediately. The nurse would investigate the bruising with the significant other away from the bedside before releasing the client. The nurse would not break the confidentiality of the​ client's medical information by discussing findings with the significant other

A nurse educator is talking to a student about how to deal with an ethical dilemma in practice. Which does the nurse educator explain to the student as important regarding actions during an ethical dilemma? A) Examining all conflicts in the situation B) Investigating all aspects of the situation C) Relying on nursing judgement D) Making a decision based on the policy of the agency

B) Investigating all aspects of the situation Rationale: To avoid making a premature decision, the nurse plans to investigate all aspects of the dilemma before deciding. Overconfidence can lead to poor decision making. Reading the agency policy regarding the matter addresses only one aspect of the situation. Examining the conflicts surrounding the issue is only one aspect of the situation to consider.

*Possible exam question* Which statement accurately describes the purpose of the American Nurse's Association's Code of Ethics for Nurses? A) It serves as a statement of nurses' personal values and standards B) It serves as the professions' nonnegotiable ethical standard C) It serves as an announcement of nurses' commitment to the profession D) It serves as a standard protocol for performing nursing procedures

B) It serves as the professions' nonnegotiable ethical standard Rationale: The ANA Code of Ethics for Nurses serves as a statement of nurses' ethical obligations and duties (not their personal values and standards), as the profession's nonnegotiable ethical standard, and as the nursing profession's statement of commitment to society (not the nurse's commitment to the profession). Nurses should refer to the ANA Code of Ethics for Nurses to direct how they perform their duties in daily practice, but it does not provide standard protocols for performing nursing procedures.

Every year the nurse attends a nursing conference and takes several continuing education courses to help maintain licensure. Which section of the ICN Code of Ethics does this uphold? A) Nurses and people B) Nurses and practice C) Nurses and the profession D) Nurses and co-workers

B) Nurses and practice Rationale: The nurses and practice section of the ICN Code of Ethics states that nurses carry the professional responsibility and accountability for nursing practice and for maintaining competence by continual learning. The other sections of the ICN Code of Ethics do not address continuing education for nurses.

*Possible Exam Question* The nurse is caring for a client in the ICU who was in a motor vehicle crash. The HCP asks the nurse to extubate the client because there is no communication between the brain and body. The family agrees with the decision of the HCP, but the nurse is uncomfortable pulling the tube. Which is the reason the nurse is experiencing difficulty with this task? A) An ethical conflict B) Personal values C) Legal issue D) Cultural values

B) Personal Values Rationale: The nurse is distressed because of personal values, which are in conflict with causing the client's death. The decision is within ethical principles. Cultural values are not in evidence in this instance. Extubating this client would not be a legal decision.

The nurse in the ER greets and treats a variety of clients with the same level of care. Which professional nursing value is demonstrated by this nurse? A) Integrity B) Social justice C) Autonomy D) Altruism

B) Social Justice Rationale: Social justice is the equal treatment of all clients without regard to cultural or socioeconomic​ background, ethnicity,​ gender, religion,​ disability, or sexual orientation. Altruism is a concern for the welfare of others. Integrity is practicing in an honest and ethical manner. Autonomy is supporting the independent decision making of others.

A nurse is volunteering time in a local free clinic that provides care to the underinsured population. By volunteering time to work in this clinic, this nurse is demonstrating which professional value? A) Human dignity B) Social Justice C) Integrity D) Autonomy

B) Social Justice Rationale: Social justice is upholding fairness on a social scale. This value is demonstrated in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality healthcare. Human dignity is respect for the worth and uniqueness of individuals and populations. Autonomy is respecting the client's right to make decisions about their healthcare. Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice.

The nurse on an organ transplant unit is saddened by the death of a client and reflects on the many issues surrounding organ transplantation. Which issue is the nurse most likely to identify as the primary ethical concern in organ transplantation? A) The nursing shortage B) The lack of organs for those needing transplant C) The cost of organ transplant D) The high risk of transplant surgery

B) The lack of organs for those needing transplant Rationale: These issues all influence the running of an organ transplantation​ program, but the primary ethical concern of organ transplantation is the lack of donor organs for those who need​ transplants, leading to difficulty in ethical decision making regarding who should receive these precious resources.

Two dialysis clinic nurses are discussing the recent death of a client with end-stage renal disease. One nurse believes that the client's decision to end treatment was correct. The other nurse thinks the client should have continued treatment long enough to allow the client to talk to an estranged child. Which nurse is exhibiting client advocacy? A) Both nurses are advocates; they are proposing choices that the client could have made B) The nurse who believes that the client's decision to end treatment was correct is exhibiting advocacy. C) Neither nurse is an advocate; the client had no real choice and would have died soon anyway D) The nurse who thought that the client should have had a chance to reconcile with a child is exhibiting advocacy

B) The nurse who believes that the client's decision to end treatment was correct is exhibiting advocacy Rationale: An advocate defends the cause of another​ individual, so the nurse supporting the​ client's decision to end treatment is an advocate. The nurse who gave the opinion that family reconciliation was a priority was not supportive of the client. Advocacy is not limited by the amount of time left in life. An advocate does not propose choices that the client could have made in the face of choices actually made.

The grandmother of a child in need of medical treatment tells a nurse that the parents are withholding consent for necessary care and asks whether this is legal.Which is the nurse's best response? A) "The parents ultimately make the decision." B) "I cannot discuss issues about potential clients." C) "Withholding treatment could be viewed as child abuse." D) "If you kidnap the child to get treatment, we'll treat the child."

C) "Withholding treatment could be viewed as child abuse." Rationale: Withholding necessary treatment of a child if the case is not futile is child abuse under the Child Abuse and Treatment Act of 1984. The nurse would teach the concerned grandmother and connect her with the needed resources to ensure the proper care of the child. The nurse would not focus on the consent of the parents or potential care of the child or encourage the grandmother to kidnap the child.

An ER nurse is contacted by a friend whose father is a long-term care resident in a nursing facility that has had a fire. The friend describes the father and asks to be informed if he arrives in the ER. As those injured in the fire beginning to arrive, the nurse spots a man matching the description given by the friend. Which action should the nurse take? A) Taking a picture of the man, posting it on social media, and tagging the friend. B) Telling the friend that nothing can be done C) Identifying the man and confirming his emergency contact D) Calling the friend and saying that the father has arrived

C) Identifying the man and confirming his emergency contact Rationale: The best action by the nurse is to confirm the identity of the client and the​ client's contact information to see whether the friend is the emergency contact. If there is no way to confirm that the friend is related or should be​ contacted, there is nothing the nurse can do. The nurse would not notify the friend without the​ client's consent. The nurse should never post information about clients to social media.

A nurse whose brother was killed by a drunk driver is assigned to admit a client who has been in a car crash. The client is in police custody after being arrested for driving drunk for the third time. Which action on the part of the nurse aligns with the professional code of ethics for nurses? A) The nurse refuses care of the client B) The nurse provides minimal care to keep the client alive C) The nurse cares for the client in the same manner as for other clients D) The nurse delegates all care of the client to an assistant

C) The nurse cares for the client in the same manner as for other clients Rationale: The professional ethics code for nursing care aligns with the equal effort of care delivery to all clients despite differences in moral agreement between the client and the nurse. Refusal of​ care, purposeful delegation for the avoidance of​ care, and poor effort in equal care delivery do not align with the professional code of ethics for nurses.

The nurse delivering a seminar about ethics and nursing asks the audience to describe an issue that could lead to ethical conflict in the workplace. Which response indicates an issue that may give rise to an ethical conflict? A) "Focusing on palliative treatment and emphasizing the nurse's role leads to ethical conflicts in nursing." B) "Personnel issues are not a valid source of ethical conflict because they're usually rooted in personality clashes." C) "Because of more stringent cost-containment methods, allocation of resources is becoming a less urgent ethical issue." D) "Staffing shortages are a critical ethical concern because research shows a link between staffing and safe client care."

D) "Staffing shortages are a critical ethical concern because research shows a link between staffing and safe client care." Rationale: Staffing shortages represent a critical​ concern; many studies link adequate staffing and safe client care. Personnel issues can give rise to ethical conflicts in the nursing workplace. Because of increasingly stringent​ cost-containment methods, resource limitations are especially urgent issues. Another source of ethical conflict is the traditional healthcare power​ structure, including the focus on providing curative rather than palliative treatment and emphasizing the healthcare​ provider's role.

A client is being evaluated as a potential kidney donor for a family member. The donor asks the nurse why a different team of people other than the team working with the potential recipient is doing the evaluation. Which response should the nurse give to the client? A) It helps reduce the cost of the pre-op workup B) It saves the client and recipient valuable pre-op time C) A sufficient number of people have to review the case so that no information is overlooked D) A conflict of interest by the team evaluating the recipient and the team evaluating the donor is avoided

D) A conflict of interest by the team evaluating the recipient and the team evaluating the donor is avoided Rationale: Both the kidney donor and recipient need thorough medical and psychological evaluation before transplant surgery. To avoid conflict of interest, evaluation of the donor is done by a team different from that caring for the recipient.

The nurse administers morphine to a client ater surgery to help manage pain even though morphine has a risk of creating dependence and addiction. What ethical principle does the nurse apply in this situation when planning care? A) Veracity B) Justice C) Autonomy D) Beneficence

D) Beneficence Rationale: Beneficence requires that the actions one takes should promote good. This includes giving treatments that have some risks when the nurse and others involved in client care have determined that the benefits outweigh the risks. Autonomy is the right to self-determination. Justice means treating all clients fairly. Veracity is the principle of always telling the truth.

The nurse is reading a news article in which the ethical dilemma posed by end-of-life suffering is discussed. The article describes how a HCP delivered a requested lethal dose of pain medication to a client with a terminal illness. Which end-of-life issue does this article address? A) Advance directives B) Assisted suicide C) DNR Order D) Euthanasia

D) Euthanasia Rationale: The administration of a lethal medication to a client is euthanasia. A DNR order is an example of an advance​ directive, a document that lets caregivers know the desires of the client regarding​ care, especially​ end-of-life care. In assisted​ suicide, the client is provided a lethal dose of medication for​ self-administration.

The nurse is working with a client with a progressive, debilitating muscle disease. The client is struggling with treatment and end-of-life decision making, so the nurse begins the process of clarifying values. Which is the first step in this process? A) Examining possible consequences B) Acting with a pattern C) Choosing a course of action D) Listing alternatives

D) Listing alternatives Rationale: Values clarification is a​ seven-step process that begins with listing the alternatives. The next steps are examining possible consequences of​ choices, freely choosing a course of​ action, feeling good about the​ choice, affirming the​ choice, acting on the​ choice, and acting with a pattern.

The nurse is part of a committee charged with the moral dilemma of deciding how to spend a $50,000 donation from the estate of a former client. Which action on the part of the committee demonstrates utilitarianism? A) Building a new front entrance named for the donor to support the relationship with the family B) Investing the donation in a high-risk stock to attempt to increase the money available C) Covering the medical expenses of a single client who can't afford needed treatment D) Securing vaccination stock to provide no-cost vaccines to approximately 2000 children

D) Securing vaccination stock to provide no cost vaccines to approximately 2000 children. Rationale: Utilitarianism aims to provide the most good for the greatest number of​ people, which is exemplified here by the provision of vaccinations to children. Investing the money is a​ high-risk option with unknown benefit. Covering expenses for a single client and supporting the relationship with the​ donor's family do not benefit the largest number of people.

A client has a rare form of pancreatic cancer and qualifies to join a clinical trial of a new investigational drug. The nurse provides the client with complete risk info before the client signs up to become a research participant. Which principle of ethical decision making did the nurse honor? A) Justice B) Beneficence C) Autonomy D) Veracity

D) Veracity Rationale: Veracity is the principle behind giving complete information before obtaining a​ client's informed consent. Autonomy is the right of​ self-determination. Justice ensures fair treatment. Beneficence means taking action to promote​ good, but because the nurse has no experience with the new​ drug, it is not known whether it will be good for the client.