Chapter 6

Ethical Principles

standards of what is right/wrong with regard to important social values and norms

What would be an example of the nurse practicing fidelity? The nurse:

stays with a client during death as promised.

ethical agency

the ability to behave in an ethical way; to do the ethically right thing because it is the right thing to do

Bioethics

the ethics of medical and biological research

values

the ideas, beliefs, and attitudes about what is important that help guide the way you live

veracity

truthfulness, honesty

A nurse arrives on the medical unit wearing large, dangling earrings. This is an example of which type of conduct?

unprofessionalism

Socialization into the nursing profession may have the most significant effect on:

values

A nurse is preparing a client for discharge from the cardiac unit and observes cigarettes in the client's belongings. The nurse asks the client to consider the client's health and that of the client's spouse. This is an example of:

values clarification.

A nurse who is infected with human immunodeficiency virus (HIV) accidentally gets a cut while debriding a wound, exposing the client to possible HIV infection. Failure of the nurse to report this incident violates which ethical principles? Select all that apply.

Nonmaleficence Veracity Fidelity

A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?

Paternalism

What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?

Peers

A client requests that the nurse allow the client 15 minutes two times a day for prayer during hospitalization. What value does this represent?

Foundation value

Which action most clearly demonstrates a nurse's commitment to social justice?

Lobbying for an expansion of healthcare resources and benefits to those in poverty

Nonmaleficence

duty to do no harm

value clarification

Process of becoming conscious of and identifying ones values

A nurse is reviewing The International Council of Nurses (ICN) Code of Ethics for Nurses. Based on this code, the nurse would identify which responsibilities as being fundamental? Select all that apply.

Promoting health Preventing illness Restoring health Alleviating suffering

justice

includes an effort to fairly distribute benefits and to minimize discrimination, even when circumstances make this difficult to achieve.

Ethical distress is:

knowing the correct action but being unable to perform it due to constraints.

ethical distress

occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action

A female client is brought to the emergency room with matted hair, bruising, and malnutrition. The nurse suspects physical abuse and neglect. The nurse states, "This happens to many women." Which type of ethical approach is the nurse exhibiting?

Feminist

What is the term for the beliefs held by the individual about what matters?

Values

A nurse who has worked on a unit for 8 years is conflicted about asking to meet with the charge nurse about staffing ratios. Which question(s) reflect the professional value of altruism in this decision? Select all that apply.

"Am I able to provide safe and efficient care to my clients?" "Am I willing to take this risk to help protect my fellow nurses?" "Will less experienced nurses on the unit learn from my actions?"

Which statement by the nurse is an example of deception?

"This injection of procaine will feel like a little pinch."

Which best defines value clarification?

A process by which people come to understand their own values and value systems

Which scenario is an example of the laissez-faire approach to value transmission?

Allowing a child to decide not to have an intravenous line inserted

Which are professional values that the nurse should incorporate into practice? Select all that apply.

Altruism Autonomy Human dignity Social Justice

A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee?

Assist in decision making based on the client's best interests.

A nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of the shift. Which ethical principle is the nurse attempting to practice?

Justice

The nurse has identified an ethical dilemma that has the potential to interfere with a client receiving optimal care. The nurse discussed this issue with the charge nurse on the unit. What action should the nurse choose next?

Monitor for resolution of the problem.

A nurse works in a nursing care facility that has a policy of regularly using restraints on clients that the nurse believes is unethical. However, the nurse feels obligated to follow the policy because of a fear of being fired. This is an example of which type of ethical situation?

Moral distress

When analyzing an ethical dilemma according to the ethical framework, what is most important for the nurse to take into consideration?

Standards of conduct

A nurse uses the utilitarian action guiding theory when deciding how to handle the following ethical conflict: A 13-year-old client with anorexia refuses to eat food despite slowly starving to death. The parents insist that the nurse use a feeding tube to feed the client. Which statement is an example of this theory in practice?

The nurse forces food via an eating tube because the end result is good in that it will save the client's life.

beliefs

specific ideas that people hold to be true

utilitarian action guiding theory

The rightness and wrongness of an action depends on the consequences of the action

Nurses who value client advocacy follow what guideline?

They give priority to the good of the individual client rather than to the good of society in general.

nursing ethics

a subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments

Which word is best described as protection and support of another's rights?

advocacy

To practice ethically, the nurse should avoid:

allowing the nurse's own judgment to guide practice.

deontologic

an action is right or wrong independent of its consequences

A nurse working on a critical care unit was informed by a client with multiple sclerosis that the client did not wish to be resuscitated in the event of cardiac arrest. Now the client is no longer able to express wishes, and the family has informed the physician that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve:

ethical distress.

Fidelity

faithfulness

roles

patterns of behavior that are representative of a person's social status

A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:

personal values

A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:

personal values.

A nurse is providing care to an older adult client who was just diagnosed with cancer. The client together with the immediate family discuss their preferences with the health care providers involved. The health care providers offer their clinical recommendations about possible treatments. Utlimately, the group arrives at a decision. The nurse interprets this decision-making process as reflecting which type?

shared

It is time for a nurse to renew licensure. The nurse says, "I need some really easy and quick continuing education hours. I don't understand why we have to do these every year." What is the nurse's coworker's best response?

"Life-long learning is part of the code for nurses."

A nurse is caring for a client with a complete spinal cord injury that has caused paraplegia. The client is very distraught and asks the nurse, "Are they sure, even with therapy, I will never walk again?" Which statement made by the nurse demonstrates veracity?

"You have a complete injury, which results in a total loss of movement and sensation below the level of injury."

Code of Ethics for Nurses

1. It is succinct statement of the ethical obligations and duties of every individual who enters the nursing profession 2. It is the profession's nonnegotiable ethical standard 3. It is an expression of nursing's own understanding of its commitment to society.

The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards?

International Council of Nurses

A school nurse interviewing parents of a child who is doing poorly in school determines that the parents practice a laissez-faire method of discipline. What are examples of this form of value transmission? Select all that apply.

A teenage girl tries alcohol at a party with her friends. A teenage boy explores religions of friends in hopes of developing his own faith.

An illegal immigrant with no health insurance sustained life-threatening injuries in an automobile accident. Which action in this case demonstrates the ethical principle of justice?

Airlifting the client to a local trauma center for emergency surgery

Beauchamp and Childress's Principle

Autonomy Nonmaleficence Beneficence Justice Fidelity

Which ethical principle refers to the obligation to do good?

Beneficence

Beneficence

Doing good or causing good to be done; kindly action

A nurse learns to adopt behavior modeled by a charge nurse. What ethical principle or behavior is the nurse most likely to learn through this process?

Ethical conduct

A nurse who is caring for a new mother realizes that the woman is not prepared to go home with her newborn after a hospital stay of only 24 hours. However, hospital policy dictates that the mother be discharged. This nurse may be faced with which moral problem?

Ethical distress

Which nursing action demonstrates the principle of fidelity?

Filing an incident report after making a medication error

A parent of a 17-year-old high school student is allowing the child to decide which college the child will attend. When the child requests direction from the parent in making this decision, the parent responds by stating, "You will need to make this decision on your own." What type of value transmission is the parent displaying?

Laissez-faire

A nurse working in a critical care unit has experienced personal tragedy, extreme shortage of staff in the work environment, and health issues. The nurse has overcome much of these hardships and is now mentoring other nurses in similar situations. What behavior is this nurse demonstrating?

Moral resilience

A nurse is caring for an older adult who has cancer and is experiencing complications requiring a revision of the plan of care. The nurse sits down with the client and the family and discusses their preferences while sharing the nurse's own judgments based on the nurse's expertise. Which type of healthcare decision making does this represent?

Shared decision making

Which nursing actions best describe the use of the professional value of human dignity? Select all that apply.

The nurse includes the client in developing the plan of care. A nurse provides privacy for an older adult client. A nurse plans individualized nursing care for clients. A nurse refuses to discuss a client with a curious friend.

Ethical practice is evaluated as a portion of the nurse's annual review. Which practice(s) would cause the evaluator to reduce the nurse's score on this section of the review? Select all that apply.

The nurse is frequently late to work. The nurse often speaks harshly to cleaning staff and transport workers.

fidelity

faithfulness; loyalty

A client rings the call bell to request pain medication. On performing the pain assessment, the nurse informs the client that the nurse will return with the pain medication. After a few moments, the nurse returns with the pain medication. The nurse's returning with the pain medication is an example of which principle of bioethics?

fidelity

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?

Integrity

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that the nurse has made. The nurse is most clearly demonstrating which professional value?

Integrity

The nurse has been educating a young adult client about living with type 1 diabetes and the importance of adhering to a strict dietary regimen. The client is repeatedly admitted and is not following the prescribed plan. What statement made by the nurse may facilitate values clarification for the client?

"Rank the three most important things in your life."

A nurse's friend states, "I admire you so much. I would love to be a nurse, but I don't think I have the courage." Which response will the nurse make?

"You can work on being more courageous as you learn to be a nurse."

Which example best describes feminist ethics?

An approach critiquing existing patterns of oppression and domination in society

A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision?

Autonomy

A nurse is providing care to a client with end-stage cancer. After weighing the alternatives, the client decides not to participate in a clinical trial offered and is requesting no further treatment. The nurse advocates for the client's decision based on the understanding that the client has the right to self-determination, interpreting the client's decision as reflecting which ethical principle?

Autonomy

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle?

Fidelity

A nurse is having lunch in the break room and overhears the other nurses talking about a difficult client in an inappropriate way. The nurses attempt to engage her in the conversation. Which response by the nurse would best represent behavior that supports the value of human dignity in nursing practice?

Saying that this discussion is inappropriate and disrespectful to the client and that the nurse does not want to be a part of it

Nurses must maintain the privacy of clients. Which example is a breach in privacy and would pose an ethical problem?

Taking a picture of a client with the nurse's cell phone

The principle of autonomy by a client is applied in which situation?

The client has decided to stop chemotherapy treatments.

Which is the best definition of ethics?

The formal, systematic study of moral beliefs

Which action would cause a charge nurse to have concerns about a nurse's moral agency?

The nurse was seen at a grocery store after calling in sick.

Which is a characteristic of the care-based approach to bioethics?

The promotion of the dignity and respect of clients as people

Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply.

Trustworthiness Humility Compassion

What are standards for decision-making that endure for a significant time in one's life?

Values

The foundation for decisions about resource allocation throughout a society or group is based on the ethical principle of:

justice

utilitarian

the rightness or wrongness of an action depends on the consequences of the action

ethical dilemma

two or more clear moral principles apply but support mutually inconsistent courses of action

feminist ethics

type of ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor

A client is brought to the emergency department by an adult child, who states, "I am unable to care for my parent anymore. Although I would like to, financially and physically I can't do it anymore." What ethical problem is the adult child experiencing?

Distress

Which statement best conveys the concept of ethical agency?

Ethical practice requires a skill set that must be conscientiously learned and nurtured.

A hospice nurse is caring for a client with terminal cancer. The family would like the client to continue aggressive therapy to treat the cancer, but the client has voiced to the nurse that no further pursuit of treatment is desired. The nurse speaks to the family about the client's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation?

Ethical principles

Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when reflecting on the decision-making process and the role it will play in making future decisions?

Evaluating

A charge nurse has implemented staff education on nursing values. The nurse would determine that further education is required when which statement(s) are overheard? Select all that apply.

"I can't believe the client is giving that precious baby up for adoption." "The gonorrhea test was positive. That's what the client gets for sleeping around." "If that was my mother, I sure wouldn't agree to a no-code."

Which example most accurately depicts the ethical principle of autonomy?

Describing a surgery to a client before the consent is signed

Which ethical principle is related to the idea of self-determination?

Autonomy

Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing?

Care-based ethics

When examining values, a nurse notes that one country allows physician-assisted suicide and another outlaws it, making it punishable by imprisonment. Which factors best explain the differences in values between these two countries?

Cultural

Which nursing situation is an example of an ethical dilemma?

Deciding whether to perform cardiac compressions against a client's wishes

Nursing practice consistent with the Code of Ethics for Nurses includes which actions? Select all that apply.

Delivering culturally safe care Acknowledging that the client is the focus and center of care and remains a part of the treatment team Protecting the client's right to confidentiality and privacy

A nurse is involved in ethical decision-making. Place the steps in the order that the nurse would follow to achieve an ethical decision.

Describe the situation and factors associated with the ethical problem. Clarify that the issue is ethical in nature. Identify options and explore short- and long-term consequences. Make the decision. Determine the effectiveness of the decision and implications for the future.

professional value of human dignity

Is respect for the inherent worth and uniqueness of individuals and populations. The nurse values and respects all patients and colleagues.