Chapter 2: Ethics and Standards of Practice Issues

2. A patient at 33 weeks gestation with a first pregnancy arrives at the labor and delivery unit with contractions. After monitoring the patient, the nurse determines the woman is in active labor and calls the health care provider (HCP), who prescribes a sleeping medication and sends the patient home. Which action does the nurse take? 1. Questions the HCP's prescribed treatment 2. Administers the medication and keeps the patient 3. Calls another HCP for a different prescription 4. Follows the HCP's instructions as prescribed

ANS: 1 This is correct. According to the ANA Code of Ethics, the nurse promotes, advocates for, and strives to protect the health, safety, and rights of all patients. The nurse needs to question the HCP's prescribed treatment.

14. The nurse works in a postpartum maternal-newborn unit and notices a newborn who is exhibiting signs of distress. Through investigation, the nurse learns the newborn's mother has a history of abusing street drugs. Which facility system does the nurse report as being deficient? 1. Risk management 2. Newborn monitoring 3. Patient information 4. Admission process

ANS: 1 This is correct. Of the options given, the deficiency is one related to risk management. A successful risk management program avoids preventable adverse outcomes and decreases the risk of liability through the use of appropriate, timely care, which accurately reflects maternal/fetal status before, during, and after interventions occur.

5. The nurse is experiencing an ethical dilemma when confronted with a situation in which either the mother or fetus is predicted to die. The nurse feels bound by the ANA Code of Ethics to protect both patients. Which aspect of care during an ethical dilemma will guide the nurse? 1. Maternity nurses are bound to advocate first and foremost for the well-being of the mother. 2. The nurse is ethically bound to provide the best care for both the mother and fetus. 3. If the fetus is viable and healthy, its survival is the priority of the maternity nurse. 4. Survival of the mother is solely based on both patient and family decision making.

ANS: 1 This is correct. Practice dictates that the primary advocacy role of maternity nurses is on the behalf of the mother.

4. The nurse is employed in a NICU. With each new admission, the neonate is classified in a specific category regarding care. The nurse is in the process of admitting a neonate at 22 weeks gestation with multiple life-threatening conditions involving both cardiac and respiratory systems. In which category of care does the nurse expect the neonate to be placed? 1. The category where aggressive care is probably futile. 2. The category where aggressive care is mostly uncertain. 3. The category where aggressive care is likely to be beneficial. 4. The category of "wait and see" to determine possible survival.

ANS: 1 This is correct. The neonate is notably premature with complex issues involving two major, life-sustaining body systems. Aggressive care is probably futile, and the prognosis for a meaningful life is extremely poor or hopeless.

6. The nurse on a maternity unit is an Orthodox Jew whose rabbi teaches that pregnancy terminations are permitted only to save the life of the mother. Which situation becomes possible if the nurse puts aside personal values and assists with elective terminations? 1. Moral distress 2. Legal actions 3. Loss of spirituality 4. Professional dilemma

ANS: 1 This is correct. When a nurse puts aside values and carries out an action believed to be wrong, it creates a situation of moral distress.

Which factors will facilitate the integration of evidence-based practice (EBP) in the maternity- newborn clinical setting? Select all that apply. 1. Frame clinical questions in PICOT format. 2. Collect the best and most relevant evidence. 3. Cultivate a spirit of inquiry in the workplace. 4. Encourage the use of trial and error methods. 5. Base practical decisions on nursing consensus.

ANS: 1, 2, 3 1. This is correct. The PICOT question format will encourage unit nurses to think in scientific terms as they approach their daily work. The PICOT approach includes the important factors that need to be considered when implementing EBP information into the clinical setting. 2. This is correct. Collecting the best, most relevant evidence will facilitate implementing EBP research into the clinical setting. 3. This is correct. A spirit of inquiry is essential for fostering a desire to do things the right, evidence-based way.

10. A nurse is suspended for refusal to participate in the performance of an elective termination of a pregnancy. Which specific group's standards does the nurse use for job reinstatement? 1. American Nurses Association (ANA) 2. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) 3. State board of nursing 4. Facility ethics committee

ANS: 2 This is correct. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) supports the protection of an individual nurse's right to choose to participate or decline in any reproductive health care service or research. The nurse needs to seek specific support from this group.

8. The nurse is assisting a patient in the use of an ethical decision-making model related to quality of life. Which question is inappropriate when using this model? 1. What are the prospects for a normal life? 2. Are arrangements made for prolonging life? 3. Which type of deficits for the patient are likely? 4. Does a present or future condition make life undesirable?

ANS: 2 This is correct. When using the ethical decision-making model for quality of life, the question needs to address if there are plans for comfort or palliative care. It is inappropriate to question about the prolongation of life.

The nursing department of a large facility is interested in improving clinical care with the introduction of EBP. Which barriers to EBP does the nursing department expect within the facility? Select all that apply. 1. Changes in nursing academia to include how to integrate research into practice 2. Outdated facility politics and policies that do not embrace research-based change 3. A general lack of information addressing nursing-focused research and change 4. Limited resources available to clinical care providers from nursing administration 5. Resistance by other health care professionals to providing nursing with autonomy

ANS: 2, 4 2. This is correct. Many health care facilities have outdated political and policies, which can be a barrier to EBP. Nurses need the support, approval, and process by which to make EBP changes. This barrier can be managed within the facility. 4. This is correct. A very real barrier to EBP at the clinical setting is the possibility of nursing administration failing to provide the resources needed to make changes in clinical care delivery. EBP may include provisions for resources, personnel, and training.

The labor and delivery nurse is providing care to a patient in active labor. The nurse notes EFM changes that suggest fetal distress and monitors the fetus for an additional 20 minutes before calling the health care provider. The health care provide determines that an emergency cesarean delivery is required. During transport, EFM is interrupted and not resumed due to expectations of an emergent procedure. A stillborn fetus is delivered. For which actions can the nurse be held legally responsible? Select all that apply. 1. Inappropriate use of oxytocin, causing fetal distress. 2. Lack of appropriate response to fetal compromise. 3. Inability to initiate resuscitation to a compromised fetus. 4. Delayed communication resulting in a delay of cesarean. 5. Performance of a technical error related to monitoring.

ANS: 2, 4, 5 2. This is correct. The nurse can be held legally responsible for the lack of an appropriate response to fetal compromise. The nurse needs to immediately report indications of fetal compromise to colleagues, charge nurses, and/or health care providers. 4. This is correct. Communication was delayed by at least 20 minutes of additional monitoring, which prolonged fetal distress. The nurse can be held legally responsible for the delay in emergency care. 5. This is correct. EFM was interrupted during transport and not reestablished for continued monitoring. The nurse can be held legally responsible for a technology error.

15. An experienced OB nurse has accepted a position in labor and delivery of an inner-city hospital providing care for multicultural clients. Which action by the nurse is most helpful in preparation for this position? 1. Reviewing quantitative research focused on current birth procedures 2. Comparing facility policies with recent research recommendations 3. Intensely studying qualitative research focused on practice enhancement 4. Obtaining access to the department's recent research of evidence-based practice

ANS: 3 This is correct. The most helpful action by the nurse is to be aware of how the new workplace will affect the nurse's practice. It is important that the nurse review quantitative research addressing multicultural attitudes, understanding, and practices during childbirth. This is the most helpful action for preparation related to this job.

13. The nurse manager in the labor and delivery unit decides that all unit nurses are to take a course in electronic fetal monitoring (EFM) as recommended by AWHONN. Which is the most important issue related to EFM the nurse manager is expecting to address? 1. Eliminate the amount of litigation related to fetal injury. 2. Strengthen the staff's level of confidence with monitoring. 3. Reduce failure to accurately assess maternal and fetal status. 4. Improve the lack of communication with health care providers.

ANS: 3 This is correct. The most important issue the nurse manager expects to address with an EFM course is to reduce or eliminate the failure of nursing staff to accurately assess maternal and fetal status.

9. The nurse in an obstetrician's office is discussing a patient's request for legally terminating an unwanted pregnancy after the fetus tests positive for Down syndrome. The woman and her spouse have five children from ages 11 to 17 years, and the family lives in an isolated rural area. Which action does the nurse take? 1. Inform the patient of programs to meet the needs of special children. 2. Share that children with Down syndrome can be high functioning. 3. Tell the physician of contextual factors identifying an ethical dilemma. 4. Inquire about the presence of an extended family support system

ANS: 3 This is correct. The situation includes conditions that cause an ethical dilemma. The nurse will inform the health care provider about the patient's request in regard to the ethical decision-making model related to contextual features.

11. The nurse in an OB's office is evaluating a patient who exhibits vaginal bleeding at 30 weeks gestation. The patient is prescribed bedrest at home and instructed to avoid lifting. The patient states, "I cannot go to bed, I have an 18-month-old at home." On which topic of the Jonsen model for ethical decision making will the nurse focus? 1. Contextual features 2. Quality of life 3. Patient preferences 4. Medical indications

ANS: 4 This is correct. Medical indications involve medical facts, including diagnosis, prognosis, treatment options, and how the patient can benefit, if at all, from the prescribed treatment. Of all four topics, this is the one that specifically addresses the well-being of the patient and the fetus.

7. The nurse works in the maternal-newborn unit dedicated to management of high-risk pregnancy and delivery. A patient has delivered two children who died from a genetic disorder. The current pregnancy tests positive for the same disorder. Which ethical decision-making model will the nurse use with this patient? 1. The model that focuses on medical treatment 2. The model that focuses on patient preference 3. The model that focuses on religion and culture 4. The model that focuses on the quality of life

ANS: 4 This is correct. The most appropriate decision-making model in this scenario is the one that considers the quality of life. The important considerations involve the well-being of both the patient and the unborn fetus.

1. The nurse is providing care for a patient in active labor. The patient continuously asks the nurse for medication to "stop the pain." Which ethical principle does the nurse use when replying, "We need to protect the baby from being overmedicated. Let me help you with some breathing and relaxation techniques"? 1. Veracity 2. Beneficence 3. Nonmaleficence 4. Fidelity

ANS: 2 This is correct. Beneficence is the ethical principle related to doing good. The nurse is describing why additional medication is not given but is also offering to assist with other methods of pain management.

Parents of a neonate are grieving over their child's life-threatening disabilities. The neonate's course of treatment has changed three times in the last 24 hours due to irrational parenteral decisions. Which interventions will the NICU nurse implement in order to fulfill nursing responsibility to both the parents and the neonate? Select all that apply. 1. Inform the parents as to realistic expectations. 2. Use neonate's status with parenteral counseling. 3. Elicit parenteral input regarding medical care. 4. Advocate for medical support of the neonate. 5. Inform parents they are the final decision makers.

ANS: 1, 2, 4 1. This is correct. The neonatal nurse has a responsibility to be truthful to the parents regarding realistic expectations for their neonate. The nurse also has a responsibility to cause no additional harm to the neonate. The ethical principle is for veracity. 2. This is correct. Again, the ethical principle of veracity (truthfulness) is important when counseling the parents of the neonate. The nurse is mindful of fulfilling nursing responsibility for both the parents and the neonate. 4. This is correct. The nurse has a responsibility to both the parents and the neonate to advocate for appropriate medical care of the neonate. Ethically, the nurse needs to do no harm.

3. The nurse is providing care for a patient in labor. The unborn fetus was diagnosed with severe microcephaly at 20 weeks' gestation. The patient tells the nurse, "We want everything done to save our baby who has as much right to a good life as anyone else." Which ethical approach does this represent? 1. Autonomy 2. Libertarianism 3. Egalitarianism 4. Utilitarianism

ANS: 3 This is correct. Egalitarianism is the ethical principle being expressed by the patient. The principle focuses on the belief that all people are equal and resources should be distributed according to need. The focus is to protect the marginal or vulnerable members of society.

12. The nurse works in the labor and delivery department. Which action by the nurse indicates a breach in the nursing care principles outlined by AWHONN? 1. Assists with an emergency delivery of a woman in a homeless shelter 2. Informs employer of religious beliefs against pregnancy termination 3. Suggests a nurse care for a patient who speaks the same native language 4. Declines a patient assignment because of a history of illegal drug use

ANS: 4 This is correct. An AWHONN principle states that the nurse should not abandon a patient or refuse to provide care based on prejudice or bias. The nurse's action is a breach of this principle.