139 Chapter 6 Questions

11. A nurse provides client care within a philosophy of ethical decision-making and professional expectations. What is the nurse using as a framework for practice? A. Code of ethics B. Standards of care C. Definition of nursing D. Values clarification

A Rationale: A professional code of ethics provides a framework for making ethical decisions and sets forth professional expectations. Codes of ethics inform both nurses and society of the primary goals and values of the profession. The standard of care for nurses is defined as that of what a reasonable and prudent nurse would do when caring for a same or similar client in the same or similar circumstances. The definition of nursing is the practice of providing care for the sick and infirm. Values clarification is a technique that can often help an individual increase awareness of any values that may have a bearing on lifestyle decisions and actions. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 125

30. A nurse has had, on several occasions, the opportunity to share personal prescriptions with family members when they were in need of pain medication or antibiotics. Which set of rules should govern this moral decision? A. Ethics B. Administrative law C. Common law D. Civil law

A Rationale: Although all of the options may affect a nurse's decision, moral decisions are guided by ethics, which are an internal set of principles and values that guide the behavior of a person. If a nurse shared medications prescribed to the nurse with other people—including family members—this would be considered unethical. It is important to distinguish ethics from law, religion, custom, and institutional practices. For example, the fact that an action is legal or customary does not in itself make the action ethically or morally right. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 121

29. A home health nurse performs a careful safety assessment of the home of a frail older adult client to prevent harm to the client. The nurse is acting in accord with which principle of bioethics? A. Nonmaleficence B. Advocacy C. Morals D. Values

A Rationale: Nonmaleficence is a principle of bioethics and is defined as the obligation to prevent harm. Advocacy, morals, and values are not principles of bioethics. An effective advocate is a nurse who is willing to act on behalf of a client and can work well with other members of the healthcare team. A moral is a person's standard of behavior or belief concerning what is and is not acceptable to do. A value is one's judgment of what is important in life. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

21. A nurse is caring for a client who is a practicing Jehovah's Witness. The health care provider prescribes two units of packed red blood cells based on the client's low hemoglobin and hematocrit levels. The nurse states to the health care provider that it is unethical to go against the client's beliefs even though the client's blood counts are very low. What is the best description of the nurse's intentions? A. Acting in the client's best interest B. Siding with the client over the health care provider C. Observing institutional policies D. Being legally responsible

A Rationale: 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. In this case, the nurse is aware of the client's belief that it is wrong to receive a blood transfusion and acts to protect the right of the client to self-determination in care, thus acting in the client's best interest. The nurse is not simply taking the client's side against the health care provider, as the nurse is observing the ethical principle of autonomy. Although the nurse may be also observing institutional policy and being legally responsible in this act, the nurse's primary commitment is to the client. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 136

5. A client age 56 years is experiencing withdrawal from alcohol and is placing themselves at risk for falls by repeatedly attempting to scale the bedrails. Benzodiazepines have failed to alleviate the client's agitation and the nurse is considering obtaining an order for physical restraints to ensure client safety. The nurse should recognize that this measure may constitute: A. paternalism. B. deception. C. harm. D. advocacy.

A Rationale: Paternalism involves the violation of a client's autonomy in order to maximize good or minimize harm (injury), 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. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 132

19. Which is an example of nonmaleficence? A. protecting clients from a health care provider under the influence of an opioid B. performing dressing changes to promote wound healing C. providing emotional support to clients who are anxious D. administering pain medications to a client in pain

A Rationale: Protecting clients from a health care provider who is under the influence of an opioid 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. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

14. A nurse is sitting with friends in a coffee shop while working on a plan of care for a client. The client's name is written at the top of the plan. Which ethical responsibility is the nurse violating? A. Confidentiality B. Accountability C. Trust D. Informed consent

A Rationale: The nurse is violating confidentiality. Confidentiality is violated when clients are identified by name on written documents available to those who are not directly responsible for their care. Accountability is a willingness to accept responsibility for one's actions, such as a nurse notifying the charge nurse that the nurse made a dosing error. Trust is assured reliance on the character, ability, strength, or truth of someone or something. The client can trust the nurse to deliver the plan of care. Informed consent is the permission granted in the knowledge of the possible consequences. An informed consent is usually provided by the surgeon to a client needing surgery. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 134

1. A nurse in a physician's office has noted on several occasions that one of the physicians frequently obtains forms for writing prescriptions for controlled substances. The physician reports that the physician's spouse has chronic back pain and requires pain medication. One day the nurse enters the physician's office and sees the physician take a pill out of a bottle. The physician mentions having migraines and that the spouse's pain medication alleviates the pain. What type of nurse-physician ethical situation is illustrated in this scenario? A. Unprofessional, incompetent, unethical, or illegal physician practice B. Disagreements about the proposed medical regimen C. Conflicts regarding the scope of the nurse's role D. Claims of loyalty

A Rationale: The physician is demonstrating unprofessional, incompetent, unethical, or illegal physician practice. Claims of loyalty and conflicts regarding the nurse's role are not included in this situation. There is no disagreement with the medical regimen as the physician is not supporting the spouse in obtaining prescriptions from a different provider. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 134

3. A group of nurse researchers has proposed a study to examine the efficacy of a new wound care product. Which aspect of the methodology demonstrates that the nurses are attempting to maintain the ethical principle of nonmaleficence? A. The nurses are taking every reasonable measure to ensure that no participants experience impaired wound healing as a result of the study intervention. B. The nurses have organized the study in such a way that the foreseeable risks and benefits are distributed as fairly as possible. 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 have completed a literature review that suggests the new treatment may result in decreased wound healing time.

A Rationale: The principle of nonmaleficence dictates that nurses avoid causing harm. In a research 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. 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. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

2. A client diagnosed with diabetes 3 years ago has failed to integrate regular blood glucose monitoring or dietary modifications into the client's lifestyle. The client 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 personal values. Which action most clearly demonstrates that this client is engaging in the step of prizing within the valuing process? A. The client expresses pride over now having the knowledge and skills to take control of diabetes management. B. The client states an intention to check the blood glucose level before each meal and at bedtime. C. The client is now able to explain how the client's choices have contributed to renal failure. D. The client expresses remorse at how a failure to make lifestyle changes has adversely affected the client's health.

A Rationale: Within the valuing process, expressions of pride and happiness are considered to be indications of prizing. Resolving to make changes such as checking the blood glucose level is an aspect of choosing. Expressing insight about the client's role in contributing to the current diagnosis (such as explaining how food choices have contributed to renal failure) and remorse for the failure to make lifestyle changes demonstrate that the client is desiring to re-examine personal values. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 120

33. Nurses are working in an emergency department (ED). Which nurses are acting in a moralizing manner? Select all that apply. A. The client frequently visits the ED for various reports of pain. The nurse tells another nurse, "That client is drug seeking." B. The client is found to be at fault in a motor vehicle accident in which others are injured. The nurse delays treatment for this client. C. The client with a chronic illness was home ill for several days and says, "I thought I would get better on my own." The nurse replies, "I'm going to do an assessment. We're going to take care of you now." D. The client is a young child who may have been abused by one of the parents. The nurse answers the parent's questions truthfully about the child and the care posed by the parent. E. The client has been seen frequently in the ED for the past several weeks for various issues. The nurse obtains a thorough history.

A, B Rationale: Moralizing provides little opportunity to weigh other values. Examples are the nurse who states the client is drug seeking and the nurse who delays treatment. The nurse who is answering the parent's questions is keeping an open mind to other possibilities, as is the nurse who obtains a thorough history. The nurse is not being judgmental and is providing reassurance to the client who had been at home sick for several days by stating, "We're going to take care of you now." Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 119

26. A nurse exemplifies the professional value of altruism. Which behaviors recognized by others demonstrate this concept? Select all that apply. A. The nurse arranges for an interpreter for a client who does not speak the dominant language. B. The nurse notifies the health care provider that a client reports pain medication to be ineffective. C. The nurse provides information for a client to participate in care planning. D. The nurse reviews a client chart to determine who may be informed of the client's condition. E. The nurse documents client care accurately and reviews the entry to ensure there are no errors.

A, B Rationale: The altruistic nurse demonstrates understanding of cultures, beliefs, and perspectives of others, advocates for clients, and takes risks on behalf of clients and colleagues. The nurse who is demonstrating the professional value of altruism is the nurse who arranges for an interpreter and the nurse who notifies the physician about ineffective pain relief. The professional practice reflects autonomy when the nurse respects clients' rights to make decisions about their health care. This is the nurse who provides information to the client. Human dignity is reflected when the nurse values and respects all clients and colleagues by preserving their confidentiality. This is the nurse who determines who may be informed of the client's condition. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. The is the nurse who documents accurately and honestly. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 120

36. The nurse has performed the following activities during the shift. Which activities are violations of client privacy and/or confidentiality? Select all that apply. A. Discussing the client's HIV status over lunch with a friend, a nurse on another team located on the same nursing unit B. Answering questions from a client's visitor before verifying the visitor has permission to receive the information C. Removing a printed report of a client from the hospital premises to write a case study for a staff meeting D. Responding to the client's questions about the plan of care with a visitor present in the room E. Leaving the mobile computer screen, which contains client information, open when a visitor asked questions

A, B, C, E Rationale: Violations of client privacy and/or confidentiality include discussing the client's HIV status with another health professional who does not need to know this information, answering questions from someone who may not be entitled to the information, removing client information from the hospital premises, and leaving the computer screen open with visible client information when another person may see it. Implied consent is given when the client asks questions of the nurse with a visitor present. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 134

40. Which nurses are acting as an advocate for the client? Select all that apply. A. The nurse informs the family of a terminally ill client that the client does not want further treatment and wants to go to hospice care. B. The client is taking oxycodone/acetaminophen for pain and reports the pain is unrelieved. The nurse states, "There is nothing else we can do for your pain." C. The postoperative client expresses an inability to void in the urinal in bed. The client believes that standing would allow the client to void. The nurse assists the client to a standing position. D. The primary care provider (PCP) informed the client about needing to have a surgical procedure performed. After the PCP left, the nurse asked the client, "What are you feeling after being told you need surgery?" E. The stable client is hospitalized on a religious holy day and requests to talk to a minister. The nurse states to the client, "The ministers are too busy to see you today. I'll request the minister to see you tomorrow."

A, C, D Rationale: When a nurse acts as an advocate, the nurse facilitates the client's own decision-making. Nurses interpret findings for their clients, provide information, help the clients verbalize their feelings, obtain help from other people, and help clients assess all of their options. The nurse who informs the family of the client who wants hospice is being an advocate for the client. Though a simple act, the nurse assisting the client to void is also being an advocate. The nurse is helping the client to make a decision regarding the client's own care. Another advocate is the nurse who asks the client to verbalize feelings. The nurse who states "there is nothing else we can do for you" is not advocating for the client. There are other options available for the client. The nurse who does not request the minister to see the client on a religious holy day is not being an advocate. The nurse is making an assumption that the ministers are too busy to see the client. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 137

39. The client experienced cardiac arrest, was resuscitated, and has now been on a ventilator for several days. The client had a written advance directive, which the spouse brought from home. The primary care provider (PCP) is encouraging the spouse to consent for placement of a percutaneous endoscopic gastrostomy (PEG) tube, which is contrary to the client's advance directive. After the PCP leaves, the spouse states, "I wish I knew what my spouse wanted." What is the best reply by the nurse? A. "You will now have to make the decision." B. "Your spouse did tell you in the advance directive." C. "The PCP only wants what is best for your spouse." D. "Your spouse will live with the PEG tube but die without it."

B Rationale: The client has an advance directive in which the client's wishes are expressed for certain situations. The nurse directs the spouse to that document to adhere to the client's wishes when the client can no longer express these wishes. The other options either ignore the advance directive or place the spouse in a conflicting situation without appropriate guidance. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 137

17. 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. Imaginal skills B. Interpersonal skills C. Instrumental skills D. Systems skills

B Rationale: The scenario reflects the nurse's interpersonal skills. It shows how a person relates with others. The nurse shows imaginal skills when envisioning 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. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Reference: p. 121

20. A dying client expresses to the nurse a desire to not see family to avoid causing them more sadness. Which action by the nurse is most appropriate? A. Arrange a meeting between the family and the client. B. Help the client clarify personal values. C. Educate the client on the concepts of death and dying. D. Allow the client time for quiet reflection.

B Rationale: Values clarification is a method of self-discovery by which people identify their personal values and value rankings. The client's value of family may be obscured because of the client's overwhelming need to protect the family. Arranging a meeting between the family and client would be inappropriate, as it would go against the client's wishes and thus would violate the principle of autonomy. Neither educating the client on the concepts of death and dying nor allowing the client time for quiet reflection would address the client's need to clarify personal values. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 120

24. A client aged 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. The nurse communicates the client's wish to the family and health care team. This is an example of what ethical principle? A. Nonmaleficence B. Veracity C. Autonomy D. Justice

C Rationale: Autonomy is the ethical principle of respecting the right of clients to make their own decisions about their health care. Nonmaleficence refers to preventing or not causing harm to clients. Veracity refers to telling the truth. Justice refers to fairness and treating clients with equal dignity. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 123

28. What is the primary ethical dilemma posed when using restraints on an older adult client in a long-term care setting who is confused? A. It limits personal safety. B. It increases confusion. C. It threatens autonomy. D. It prevents self-directed care.

C Rationale: Because older adult clients who are confused can pose safety risks, this is a common ethical problem in long-term care settings, as well as other healthcare settings. Restraints limit the individual's autonomy by restricting the client's ability to move voluntarily. When used properly, restraints increase, not limit, personal safety. Although restraints may increase confusion and prevent self-directed care, the primary ethical dilemma is the limiting of the client's autonomy, because this is held by nurses to be a basic client right. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Safety and Infection Control Integrated Process: Nursing Process Reference: p. 122

22. A client who experienced a cesarean birth rates pain as a 9 on a 10-point scale. The nurse medicates the client for pain. This is an example of the nurse practicing which ethical principle? A. Justice B. Fidelity C. Beneficence D. Nonmaleficence

C Rationale: Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good. Justice refers to treating clients fairly and impartially. Fidelity refers to keeping one's promises and acting faithfully. Nonmaleficence refers to preventing or not causing harm to the client. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

12. A client nearing the end of life requests that the client be given no food or fluids. The physician orders the insertion of a nasogastric tube to feed the client. What is the primary concern of the nurse providing care? A. The nurse must follow the physician's orders. B. The nurse is unable to provide care for the client. C. The nurse faces an ethical dilemma about inconsistent courses of action. D. The physician's order creates a barrier to establishing an effective nurse-client relationship.

C Rationale: In an ethical dilemma, two or more clear moral principles apply but support mutually inconsistent courses of action. In this case, the nurse must decide what to do based on ethical decision-making and take action that can be justified ethically based on that process. The nurse does not need to follow the physician's order in this case as the nurse knows the client's wishes. Although the physician's order may create a barrier to the nurse-client relationship, this concern is secondary to the ethical dilemma it poses to the nurse. The nurse should continue to provide care. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 127

23. A home care nurse visits a client who is confined to bed and is cared for by an adult child with substance use disorder. The home is cluttered and unclean, and the nurse notes that the client is wet with urine, has dried feces on the buttocks, and shows signs of dehydration. After caring for the client, the nurse contacts the health care provider and reports the incident to Adult Protective Services. What ethical principle is the nurse practicing? A. Justice B. Autonomy C. Nonmaleficence D. Fidelity

C Rationale: In this scenario the nurse is practicing nonmaleficence. The principle of nonmaleficence means to avoid doing harm, to remove harm, and to prevent harm. Autonomy means to respect the rights of clients or their surrogates to make healthcare decisions. Justice means to treat client fairly and equitably. Fidelity means to keep promises. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 123

16. A client is questioning the need for surgery. The client asks the nurse, "What should I do?" Which answer by the nurse is based on advocacy? A. "If I were you, I would not have this surgical procedure." B. "You should ask some of the more experienced nurses this question." C. "Tell me why you do not want the surgery." D. "Let me talk to your doctor, and I will let you know what I find out."

C Rationale: Nurses as advocates must realize that they do not make ethical decisions for their clients. Rather, they facilitate clients' decision-making by interpreting findings, informing clients of various aspects to be considered, and helping clients verbalize and organize their feelings. Calling in others involved in the decision making (e.g., close family and friends) and not other nurses may be helpful. In addition, a nurse should help clients assess all their options in relation to their beliefs and not the nurse's belief. Advocating by talking to the healthcare provider is not appropriate in this situation because the client needs to discuss the concerns with the healthcare provider. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 136

27. A nurse has a duty of nonmaleficence. Which action would be considered a contradiction to that duty? A. Providing comfort measures for a terminally ill client B. Assisting the client with activities of daily living C. Refusing to administer pain medication as prescribed D. Providing all information related to procedures

C Rationale: The duty not to inflict harm, as well as prevent and remove harm, is termed nonmaleficence. Refusing to administer pain medication is inflicting unnecessary pain and harm. Providing comfort measures for a terminally ill client and assisting a client with activities of daily living are examples of fulfilling the duty of beneficence. Providing information related to procedures is an example of fulfilling the duty of ensuring the client's autonomy. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

18. A nurse is caring for a client who is a celebrity in the area. A person claiming to be 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: A. veracity. B. fidelity. C. confidentiality. D. autonomy.

C Rationale: 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. Information 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 one making one's own decisions. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Communication and Documentation Reference: p. 134

7. Which mode of value transmission is most likely to lead to confusion and conflict? A. Modeling B. Moralizing C. Laissez-faire D. Responsible choice

C Rationale: Those who use the laissez-faire approach for value transmission leave children to explore values on their own (no one set of values is presented as best for all) and to develop a personal value system. This approach often involves little or no guidance and can lead to confusion and conflict. In modeling, the client learns new skills by imitating another person, such as a parent or therapist, who performs the behavior to be acquired. Children learn from parents and peers by modeling. Moralizing is to reflect on or express opinions about something in terms of right and wrong, especially in a self-righteous or tiresome way. By moralizing, parents can teach a child the right way to act. Responsible choice is an approach in which parents teach their children to weigh the costs and benefits of various options when choosing, so as to make a responsible choice. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 119

38. The client was admitted for diagnostic testing and found to have terminal cancer. Which statements by the client would alert the nurse that the ethics committee may need to be contacted? Select all that apply. A. "I would like information about not being resuscitated if I die." B. "I do want to continue treatment but want to limit certain treatments if I stop breathing." C. "I want to sign an advance directive. However, my primary care provider says it is not necessary." D. "My family will request that I be resuscitated and have everything done for me, contrary to my wishes when I can no longer voice my desires." E. "I will discuss my plan with my family and friends and ensure they know my wishes."

C, D Rationale: The nurse may need to refer this case to the ethics committee if the terminally ill client is requesting an advance directive and the primary care provider says it is not necessary. The ethics committee may also need to be contacted if the family requests resuscitation against the client's wishes. The other situations—wanting more information, wanting to specify certain treatments, and discussing with family and friends—are typical events in the hospital, and the ethics committee would not be needed to address these issues. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 135

35. Which scenario(s) exemplifies shared decision-making? Select all that apply. A. The client has been diagnosed as having breast cancer. The health care provider informs the client a radical mastectomy is the only surgical procedure available for a good outcome. B. The client in the emergency department tells the health care provider only an intravenous dose of morphine 10 mg will relieve the back pain. C. The client expresses a desire to be treated at home but agrees to hospitalization for intravenous antibiotics for cellulitis. D. The nurse demonstrates to a receptive family member the proper steps to change the leg dressing when the client is at home. E. The nurse asks the postoperative client which route of opioid medication is preferred for pain relief.

C, D, E Rationale: A model of shared decision-making respects the client and uses the preferences of the client as well as the expertise and judgment of the health care provider. The client agreeing to the recommended hospitalization, the nurse demonstrating a dressing change, and the nurse asking about the route of opioid medication are examples of shared decision-making. The health care provider informing the client who has breast cancer of only one treatment option is an example of paternalistic model. The client informing the health care provider a particular medication, route, and dose is an example of client sovereignty model. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 132

15. A nurse is concerned about the practice of routinely ordering an extensive series of laboratory tests for clients who are admitted to the hospital from a long-term care facility. An appropriate entity for addressing this ethical dilemma would be: A. a client's family. B. the admitting physician. C. the nurse in charge of the unit. D. the institutional ethics committee.

D Rationale: Many healthcare institutions have developed ethics committees, whose functions include education, policy-making, case review, and consultation. These committees are multidisciplinary and provide a forum where divergent views can be discussed without fear of repercussion. Thus, an institutional ethics committee would be an appropriate entity for addressing this ethical dilemma. A client's family would not likely be able to determine whether routine laboratory testing was necessary and therefore ethical and, in any case, would not be objective. The physician and charge nurse would not be objective, either, as they might be implicated in establishing or maintaining this practice. However, the physician and charge nurse could be helpful to the ethics committee by explaining why these tests are necessary and the current and projected care of the client. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 135

13. Two children need a kidney transplant. One is the child of a famous sports figure, whereas the other child comes from a family living below the federal poverty threshold. What ethical consideration is relevant to the nurse as an advocate for these clients? A. the relationships between nurses and clients B. norms of family life C. considerations of power D. cost-effectiveness and allocation

D Rationale: The increasing awareness of how difficult it is to make valued and scarce health resources available to all in need has resulted in a new appreciation for the moral relevance of cost-effectiveness. Much ethical distress for nurses results from the strong conviction that they owe individual clients more than their work environments allow nurses to deliver, which is the relationship between nurses and clients. Norms of family life relate to the ways a client's illness impacts family members and significant others. There is not enough information provided to know how this ethical principle applies in this scenario. Considerations of power relates to abuse of power by health care providers. Again, this scenario does not present information suggesting this is occurring. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 132

31. The new nurse is being oriented to the unit and is assigned an experienced nurse to work with during the orientation. What are positive modeling experiences for the new nurse? Select all that apply. A. The nurse organizes the day by obtaining reports, completing assessments, charting the assessments, and administering 0900 medications starting at 0830. B. The nurse does not respond to the call light of the client who frequently requests medications for unrelieved pain. C. The nurse contacts the primary care provider to clarify a new prescription for a medication dose. D. The nurse enters the room to administer medications and interrupts the hospice intake nurse providing information to a terminally ill client and family. E. The experienced nurse tells the new nurse, "I do all my charting at the end of the shift. Point-of-care charting takes too much time away from my clients."

A, C Rationale: Through modeling, one learns high and low values by observing others. Modeling can lead to acceptable and unacceptable behaviors. Positive modeling experiences are the nurse organizing the day and clarifying a prescription. Negative modeling experiences are not responding to the call regarding unrelieved pain, interrupting the conversation with the hospice nurse, and doing all the charting at the end of the shift. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 119

8. While at lunch, a nurse sitting alone heard other nurses at a nearby table talking about a client they did not like. When the group asked the solo nurse for their thought, the solo nurse politely refused to join in the conversation. What value was the solo nurse demonstrating? A. the importance of food in meeting a basic human need B. basic respect for human dignity C. that gossip with the group of peers has a role in society D. a low value on collegiality and friendship

B Rationale: Nurses who feel uncomfortable gossiping with other nurses about clients realize that gossiping contradicts a basic respect for human dignity. This respect is a value that allows one to choose freely to believe in the worth and uniqueness of each individual. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 119

37. The beginning nurse is managing a team alone for the first time. Several ethical situations have occurred throughout the day that have caused the nurse to question the nurse's career choice. What actions should the nurse take to build resilience? Select all that apply. A. Cultivate relationships with other people who are supportive. B. Adhere strictly to a time schedule that does not allow for change. C. Recognize that each crisis that occurs during the day is out of the nurse's control. D. Question each decision that the nurse made throughout the day. E. Ensure that the nurse takes entitled breaks and a lunch during the shift.

A, E Rationale: Events occur throughout the day that cause the nurse to be stressed. Resilience is the ability to adapt to challenging events. Ways for the nurse to build resilience include cultivating good relationships and taking care of oneself—such as ensuring breaks throughout the day. Ways that inhibit the nurse from building resilience include adhering to a strict schedule that does not allow for change, believing each crisis is out of the nurse's control, and questioning each decision the nurse made. Question format: Multiple Select Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Psychosocial Integrity Integrated Process: Nursing Process Reference: p. 127

25. A nurse states to the client that the nurse will keep the client free of pain. However, the client's family wishes to try a treatment to prolong the client's life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle? A. Fidelity B. Veracity C. Justice D. Autonomy

A Rationale: In this case, the nurse's promise to keep the client pain-free is the best example of the principle of fidelity means being faithful to one's commitments and promises. Veracity refers to telling the truth. Justice refers to treating clients fairly and equitably. Autonomy refers to respecting the client's right to self-determination. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

6. A parent always thanks clerks at the grocery store. The parent's child, age 6 years, echoes the thank you. The child is demonstrating what mode of value transmission? A. modeling B. moralizing C. reward and punishment D. responsible choice

A Rationale: Through modeling, children learn of high or low value by observing parents, peers, and significant others. Modeling can thus lead to socially acceptable or unacceptable behaviors. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Through rewarding and punishing, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Caregivers who follow the responsible-choice mode of value transmission encourage children to explore competing values and to weigh their consequences. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 119

34. The nurse participates in a religion that prohibits abortion. The nurse is to provide care to a client who is seeking an abortion because continuing the pregnancy will threaten the client's life. Place in order the steps the nurse should use to guide ethical decision-making. Use all options. A. Assess the client's overall situation. B. Identify the nurse's ethical problem. C. List options and weigh consequences. D. Implement one's decision. E. Evaluate one's decision.

A, B, C, D, E Rationale: The steps of the nursing process may be used to guide ethical decisions. The nurse assesses the situation, identifies the ethical problem, and then identifies options and weighs consequences. The nurse next implements the decision. Finally, the nurse evaluates the decision. Question format: Drag and Drop Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 130

32. The nurse is leading a discussion with a group of adolescents about what to do "if a friend shows you a gun at school in a backpack." The nurse is encouraging the adolescents to explore consequences of their actions for decisions made. What value transmission is the nurse demonstrating? A. Modeling behavior B. Laissez-faire approach C. Rewarding and punishing D. Responsible choice

D Rationale: The responsible choice mode of value transmission encourages others to explore and weigh consequences. Modeling is demonstrating values by exhibiting them oneself. The laissez-faire approach encourages others to develop a personal value system with little or no guidance. Rewarding is providing a positive benefit for demonstrating values held by the provider, and punishing is providing a penalty for demonstrating values not held by the provider. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Reference: p. 119

9. A client who is having increasing difficulty breathing reports never exercising, eating fast food regularly, and smoking two packs of cigarettes a day. The client tells the nurse practitioner that the client wants to make lifestyle changes. Which would be the most appropriate means of helping the client change behaviors? A. Ethical change strategy B. Values neutrality choices C. Values transmission D. Values clarification

D Rationale: Values clarification is a process by which people come to understand their own values and value system. When nurses understand the values that motivate clients' decisions and behaviors, they can tap these values when teaching and counseling clients. The nurse's role is to help the client determine what the client's values are, not transmit them to the client. Ethical change strategy is not pertinent to the client, as the client not undergoing an ethical issue. Values neutrality choices is not relevant to the client, as the client has identified a desire to change. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 120

10. A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as? A. Nonmaleficence B. Justice C. Fidelity D. Autonomy

A Rationale: The principle-based approach to ethics combines elements of both utilitarian and deontologic theories and offers specific action guides for nursing practice. The Beauchamp and Childress principle-based approach to bioethics (2001) identifies four key principles: autonomy (promote self-determination), nonmaleficence (avoid causing harm), beneficence (benefit the client), and justice (act fairly). Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Remember Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Nursing Process Reference: p. 123

4. A client with a diagnosis of colorectal cancer has been presented with the treatment options, but wishes to defer any decisions to an uncle, who acts in the role of a family patriarch within the client's culture. The client's right to self-determination is best protected by: A. respecting the desire to have the uncle make choices on the client's behalf. B. revisiting the decision when the uncle is not present at the bedside. C. educating the client about the right to autonomy. D. holding a family meeting and encouraging the client to speak on the client's own behalf.

A Rationale: The right to self-determination (autonomy) means that actions should never be forced on anyone. The client has the autonomous right to defer decision-making to another individual if the client freely chooses to do so. Revisiting the issue with the client, educating on the right to autonomy, or having a family meeting is disrespectful to the client and the client's wishes. Question format: Multiple Choice Chapter 6: Values, Ethics, and Advocacy Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Integrated Process: Caring Reference: p. 137