Chapter 6 Practice Questions

A client age 46 years has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This client is utilizing which ethical principle in making his decision?

Autonomy Autonomy entails the ability to make a choice free from external constraints. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality relates to the concept of privacy. Justice states that like cases should be treated alike.

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

the promotion of the dignity and respect of clients as people The care-based approach to bioethics focuses on the specific situations of individual clients, and characteristics of this approach include promoting the dignity and respect of clients and people. The need to emphasize the relevance of clinical experience and the need for an orientation toward service are part of the criticisms of bioethics. The deontologic theory of ethics says that an action is right or wrong independent of its consequences.

Which statement by the nurse is an example of deception?

"This injection of procaine will feel like a little pinch." Telling a client that an injection of procaine will feel like a little pinch is not being truthful, and is defined as a deception. Telling a client that pain medicine will be administered when it is time is being truthful. Telling a client to get out of bed also supports a nursing intervention. Teaching a client how to give an injection is important for the client to take care of himself or herself.

Which example best describes feminist ethics?

An approach critiquing existing patterns of oppression and domination in society Feminist ethics offer an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guidelines for practice. The care-based approach directs attention to the specific situation of individual clients viewed within the context of their life narratives. The formal study of ethical issues that arise in the practice of nursing describes nursing ethics.

A nurse is caring for a woman 28 years of age who has delivered a baby by Cesarean section. She describes her pain as a 9. The nurse medicates her for pain. This is an example of which ethical framework?

Beneficence Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good.

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 Central to the care-based approach to ethics is the nurse's relationships with clients and the nurse's "being," or character and identity. Deontology is the study of the nature of duty and obligation. Utilitarianism is the doctrine that actions are right if they are useful or for the benefit of a majority. Principle-based ethics each prioritize goals and principles that exist beyond the particularities of the nurse-client relationship.

A client is scheduled to have an elective surgical procedure performed and cannot decide if he wants to go forward with the procedure or cancel. He asks the nurse to help him make the decision because he does not feel that he knows enough about the procedure. Which action by the nurse is the best way for this nurse to advocate for the client?

Facilitate the client's decision by allowing him to verbalize his feelings and by providing information to help him assess his options. Nurses as advocates must realize that they do not make decisions for their clients, but they can facilitate decision making by allowing the client to verbalize his feelings and by providing information to help him assess his options. This is not an appropriate time to call in the surgeon or the social worker. Refusing to help the client is not the best example of client advocacy performed by a nurse.

A nurse knows the ethical term "Do not cause harm" is an example of:

Nonmaleficence Nonmaleficence is the conduction of procedures and interventions in a safe manner so that no harm is caused to the client. Justice is the idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Fidelity is demonstrated by continuing loyalty and support to a client. Beneficence requires that the procedure be provided with the intent of doing good for the client involved.

A nursing faculty member is discussing laissez-faire values with students. Which scenario is an example of those values?

Parents allowing a child to decide not to have an intravenous line inserted A laissez-faire environment is one that allows others, especially children, to make decisions without guidance, resulting in a decision that may not be a sound one. Teaching a child about right and wrong behavior is a more active learning strategy. Modeling or role modeling is leading by example—in this case, not smoking electronic cigarettes to show the teenagers good behavior. Telling the child about the injection feeling like a pinch shows empathy, as the nurse has described a feeling the child has experienced before.

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 her judgments based on her expertise. Which type of health care decision making does this represent?

Shared decision making Shared decision making is recommended by most ethicists and involves the client's preferences and the nurse's expertise to make the best decision. The paternalistic model involves the clinician making the decisions. The client sovereignty model involves the client making all the decisions without input from the clinician.

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

Values Values are ideals and beliefs held by an individual or group; values act as a standard to guide one's behavior. Ethics are moral principles and values that guide the behavior of honorable people. A moral is a standard for right and wrong. Bioethics is related to ethical questions surrounding life and death, as well as questions and concerns regarding quality of life as it relates to advanced technology.

To practice ethically, the nurse should:

avoid allowing her judgment to guide practice Personal convictions apply only to situations and decisions pertaining to the individual. In ethical practice, nurses avoid allowing personal judgments to bias their treatment of clients.

A parent teaches his or her children not to drink and drive; however, the parent does drink and drive. This action causes

Failure to reflect own values Many role models fail to reflect on their own values and, as a result, model conflict and confusion.

A nursing student states he is able to put himself in his client's shoes. He states he understands the situation of the ill client. This is considered to be an act of:

empathy The experience of empathy is an immediate projection of self to the situation of others, causing strong emotional reactions and motivation, and either appropriate caring behavior and/or related reflection.

A nurse working on a critical care unit was informed by a client with multiple sclerosis that she did not wish to be resuscitated in the event of cardiac arrest. The client is no longer able to express her 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 The nurse is involved in a situation that involves ethical distress. 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. Paternalism is acting for clients without their consent to secure good or prevent harm. Deception and confidentiality can result in ethical problems for nurses when there is a conflict between the client's and nurse's values/interests. In this scenario, the nurse is aware of the client's wishes, but the conflict lies with the family and thus the nurse will experience ethical distress.

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

Compassion Trustworthiness Humility Trustworthiness, humility, and compassion are all examples of professional virtues, as well as cultivated dispositions of character and conduct, that motivate and enable us to be good human beings. Deception and conflict are negative traits that do not exemplify professional virtues.

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." Veracity means the duty to be honest and avoid deceiving or misleading a client. Personnel demonstrate respect for this right by explaining to the client the status of his or her health problem, the benefits and risks of treatment, alternative forms of treatment, and consequences if the treatment is not administered. The other statements are not providing the truth about the client's condition, or are avoiding telling the truth.

A nurse has completed four hours of his eight-hour shift on a medical-surgical unit when he receives a phone call from the nursing supervisor. The nursing supervisor informs him that he needs to give a report to the other two nurses on the medical-surgical unit and immediately report to the telemetry unit to assist with staff needs on that unit. The nurse informs the supervisor that he has been busy with his client assignment and feels this will overwhelm the nurses on the medical-surgical unit. The supervisor informs the nurse that the need is greater on the telemetry unit. This is an example of which type of ethical problem?

Allocation of scarce nursing resources This is a clear example of ethical issues surrounding the allocation of scarce nursing resources and involves distributing nursing care. Advocacy in a market-driven environment nor conflicts concerning new technology are not related to the presented situation. Deception is the action of deceiving someone and the nursing supervisor is not deceiving the nurse.

A nurse believes that abortion is an acceptable option if a pregnancy results from a situation of rape. What is the best description of this belief?

Personal morality Personal morality is the set of beliefs about the standards of right and wrong that helps a person determine the correct or permissible action in a given situation.

A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability?

filling out an occurrence report and notifying the health care provider When an untoward occurrence occurs, the nurse will be considered to be accountable when the proper actions are taken. In this instance, an occurrence form is filled out for follow-up, and the provider is notified as this may change outcomes in the client's condition. Administering the medications with the other evening medications may double up the dose or have unexpected adverse effects with the other medications. Telling the client that the medication will be administered the following day is not acceptable as the nurse is suggesting next actions without the provider's knowledge. Documenting in the chart in a narrative about the occurrence does not allow for the health care provider to be notified and aware of a change in the client's condition.

Which word is best described by the following: the protection and support of another's rights?

Advocacy Advocacy is the protection and support of another's rights. Nurses who value client advocacy make sure their loyalty to an employing institution or colleague does not compromise their primary commitment to the client; give priority to the good of the individual client rather than to the good of society in general; and carefully evaluate the competing claims of the client's autonomy and client well-being. Paternalism is acting for clients without their consent to secure good or prevent harm. Autonomy is respecting the rights of clients or their surrogates to make health care decisions; it is also known as self-determination. Ethics is the formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing.

A nurse volunteers to serve on the hospital ethics committee. Which indicates that the nurse knows the purpose of an ethics committee?Assist in decision making based on the client's best interests.

Assist in decision making based on the client's best interests An ethics committee will meet when a client is unable to make an end-of-life decision and the family cannot come to a consensus. The committee members are there to advocate for the best interest of the client and to promote shared decision making between the client (or surrogates if decisionally incapacitated) and the clinicians. The committee would not convince, decide, or present options about the type of care. This is not the role of an ethics committee.

A nursing student reports to the instructor that a medication due at 9 am was omitted. Which principle is the student demonstrating?

Integrity The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the student reported the occurrence of the missed medication to the clinical faculty. The definition of altruism is concern for others; it can best be explained by a nurse concerned about how a client will care for himself after discharge. Social justice is a concept of fair and just relations between the individual and society and is related to wealth and distribution of goods in a society. Autonomy is the right to self-determination or acting independently and making decisions.

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

The client has decided to stop chemotherapy treatments The principle of autonomy respects the client's right to make his or her own decisions, and is reflected in the client who decides to stop chemotherapy treatments. The family of a client discussing care does not reflect autonomy, because the client is not making the decisions but the family. An order for an antibiotic is placed by a prescriber and does not reflect the client's right to make his or her own decision about taking the prescribed antibiotic. A hospice consult is placed by the nurse reflects the nurse's autonomy to make a decision about the client.

A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for clients in a long-term care facility. Which nursing actions best exemplify this principle?

The nurse performs regular client assessments for pressure injuries. The nurse follows "medication rights" when administering medicine to clients. The concept of nonmaleficence refers to the avoidance of causing harm. Examples of nonmaleficence include the nurse performing regular client assessments for pressure ulcers. Nonmaleficence would also include the nurse following "medication rights" when administering medicine to clients. The other options listed are not true examples of the nurse incorporating the principle of nonmaleficence.

A nurse is caring for a client who is a practicing Jehovah's Witness. The physician orders two units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the client's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions?

acting in the client's best interest 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.

A nursing faculty is presenting a lecture on ethics. The correct definition of ethical distress is:

knowing the correct action, but unable to perform due to constraints Knowing the correct action but being unable to perform the action due to constraints is the definition of moral or ethical distress. Being aware of knowing what is right and wrong is the first step of having an ethical conscience. Supporting a client during a hospitalization is an ethical principle of doing what is right and the focus of client centered care. Self worth is the understanding that a nurse's has value or worth as a nurse and to know that the actions that a nurse performs is imperative to the nursing profession.

An adolescence is in the process of value formation. What does the nurse determine that will be the greatest influence in the child's formation of values in this developmental stage?

peers In adolescence, peer groups are a major source of value formation. The attitudes, beliefs, and behaviors that grow out of peer group relationships are powerful. It is generally accepted that the influence of peers exceeds that of school administration, work life or the awareness of other cultures.

Which actions by the nurse demonstrate the ethical principle of fidelity? Select all that apply.

performing an intervention for a client at the time that was promised taking an extra client assignment so that client will be cared for maintaining current nursing registration and meeting continuing education requirements Fidelity is being faithful to the promise a nurse made to the public to be competent and to be willing to use competence to benefit the clients entrusted to his or her care. Following through on promises, maintaining professional standards, and taking on extra workload to preserve clients' interests are examples of fidelity. They demonstrate the promise to be competent and faithful to clients. Taking breaks on time is beneficial, but is not an direct example of fidelity. Calling in sick due to lack of sleep is not an acceptable practice in most cases.

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

stays with the client during his death as promised Fidelity requires the nurse to keep promises made and to be faithful to one's commitments.