ETHICAL PREP U WITH RATIONALE
The nurse notes that a placebo has been prescribed when a client requests pain medication. Which statement is most accurate about the use of placebos in the client's plan of care? A. Placebos may be used whenever the nurse believes the client is not really experiencing pain. B. The use of placebos violates the client's right to ethical care. C. It is appropriate to substitute placebos when the client requests frequent doses of pain medication. D. Placebos should be used when it is suspected that the client is addicted to the pain medication.
B The client has a right to accurate information and participation in decision making about treatment options. The use of placebos is misleading to the client and unethical because it does not represent full disclosure about the treatment the client is receiving. Placebos should not be substituted for pain medication, even if the client requests frequent doses. Placebos should not be used even if the nurse suspects that the client is addicted to the medication. The nurse cannot determine whether a client is in pain; pain is what the client says it is.
An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which offense has the nurse committed? A. Negligence of duty B. Invasion of privacy C. Unintentional tort D. Defamation of client
B The nurse has committed the tort of invasion of privacy. Personal names and identities are concealed or obliterated in case studies or research work. Invasion of privacy is a type of intentional tort. Defamation is an act in which untrue information harms a person's reputation, and is therefore not applicable here. Negligence is the harm that results because a person did not act reasonably.
The nurse is counseling a woman who states: "I'm never going to find a husband, every time I start dating I end up getting hurt. I'm not even going to try anymore." This woman is in what stage of Carol Gilligan's theory of moral development? A. Level 2—goodness B. Level 1—selfishness C. Level 3—nonviolence
B This woman is in Level 1 of Gilligan's theory of moral development. In Level 1, the focus is on one's own needs. In Level 2, moral judgment is based on shared norms and expectations, and societal values are adopted. In Level 3, a changed understanding of self and a redefinition of morality allow reconciliation of selfishness and responsibility. Nonviolence (the injunction against hurting) governs all moral judgments and actions.
A client is refusing to take the prescribed oral medication. Which of the following measures by the nurse can be used to get the client to take the medication? Select all that apply. A. Crushing the medication and hiding it in apple sauce B. Asking the client the reason for not taking the medication C. Explaining the purpose of the medication to the client D. Suggesting a liquid form of the medication instead of a pill E. Having a family member give the medication
B C D The correct answers provide an alternative solution for the client and provide the client an opportunity to consent to taking the medication in another form, neither of which would be considered abuse. Providing health education regarding the medications to ensure the client has all the information needed to make an informed consent would be appropriate. Hiding medication or disguising it in food knowing that the client has refused the medication would be considered abuse. The client has the right to refuse care, including medication, and a family member should not be placed in a position of having to give the medication.
Which of the following is a true statement about a living will? A. It is legal consent. B. It is a type of financial attainment. C. It states the client's wishes regarding healthcare if terminally ill. D. It specifies information regarding non-treatment only.
C A living will states the client's wishes regarding healthcare if terminally ill. It does not specify information regarding nontreatment only, it is not a legal consent, and it is not a type of financial attainment.B
Several times, family members have asked a nurse to share personal prescriptions when they were in need of pain medication or antibiotics. Which type of rules or standards should govern the nurse's moral decision? A. civil law B. administrative law C. ethics D. common law
C Although all of the options may affect the decision, moral decisions are guided by ethics (moral principles and values that guide the behavior of honorable people). Ethical standards dictate the rightness or wrongness of human behavior. Laws are written rules for conduct and actions. They are binding for all citizens and ensure the protection of rights.
A client with cancer of the stomach tells the nurse, "I cannot bear the pain anymore. Please give me some poison to free myself from this agonizing pain." The nurse faces a value conflict. Which of the following is true in such a condition? A. The nurse should solely consider the values of the client. B. Values conflict is always destructive in nature. C. Human need may affect the values conflict. D. Value conflict has no effect on the client's compliance.
C Human need may affect values conflict. Though the client is refusing further treatment, the nurse should be aware that the client needs the treatment. The nurse should not consider only the values of the client. When faced with a values conflict, nurses should examine their own values regarding the conflict. Value conflict may affect the client's compliance. Values conflict is not always destructive in nature. At times, it may even be constructive.
A nurse is caring for a client with hypertension whose blood pressure has increased from 154/78 mm Hg to 196/98 mm Hg with a heart rate of 110 beats per minute during the past hour. The nurse goes to lunch without reporting the change to the healthcare provider, and the client suffers a cardiac arrest. What principle has the nurse violated? A. battery B. veracity C. negligence D. fidelity
C Negligence, such as not reporting a change in a client condition, is harm that results because a person did not act reasonably. Based on the definition of negligence, harm resulted due to the nurse's lack of action (omission). Battery, veracity, and fidelity did not occur in this scenario.
To practice ethically, the nurse should: A. ask the family their views on caring. B. allow a committee to guide her practice. C. avoid allowing her judgment to guide practice. D. review past cases before guiding practicE
C 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 nurse in a hospice facility cares for clients with terminal illnesses and witnesses a great deal of pain and emotional distress. Which factor that affects healthcare ethics determines how the nurse must respond when a client asks for help in ending his or her suffering? A. healthcare reform B. advances in technology C. legislative and judicial decisions D. advances in scientific research
C Society's struggles with ethical issues result in legislative and judicial decisions that affect ethical decisions. Nurse practice acts prohibit nurses from assisting clients to die. The other options are factors that do not affect the nurse's ethical position.
In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? A. Human dignity. B. Altruism. C. Integrity. D. Social justice.
C The nurse is demonstrating integrity, which is defined as acting in accordance with an appropriate code of ethics and accepted standards of practice. Seeking to remedy errors made by self or others is an example of integrity. Altruism is a concern for the welfare and being of others. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the inherent worth and uniqueness of individuals and populations.
An inmate from a correctional facility is admitted to the hospital wearing handcuffs. The nurse caring for the client needs to provide morning care and notices the two correctional officers socializing with the nursing staff at the desk. What is the best action by the nurse in this situation? A. Ask one of the officers to remove the handcuffs. B. Perform morning care while the client is handcuffed. C. Ask another nurse to accompany the nurse into the room. D. Insist that the officers stay in the room at all times.
D A correctional officer should be with the inmate/client at all times. To protect the safety of the nurse and the client, the nurse should refuse to administer care without an officer present. The other options put the nurse and the client at risk.
A nurse caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism? A. Old age begins at age 65. B. Most older adults are ill and institutionalized. C. Intelligence declines with age. D. Personality is not changed by chronologic aging.
D Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronologic aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age. Old age does not begin at age 65.
A client with esophageal cancer decides against placement of a jejunostomy tube. Which ethical principle is a nurse upholding by supporting the client's decision? A. Fidelity B. Veracity C. Nonmaleficence D. Autonomy
D Autonomy refers to an individual's right to make his own decisions. Fidelity is equated with faithfulness. Nonmaleficence is the duty to "do no harm." Veracity refers to telling the truth.
During the introductory phase of interviewing for the purpose of obtaining information for the nursing history, the nurse should: A. review literature pertinent to the client's attributes. B. assess personal feelings regarding similar clinical situations. C. implement supportive nursing interventions. D. inform the client of the maintenance of confidentiality.
D During the introductory phase, the nurse should inform the client how the information will be used and that confidentiality will be maintained.
A nurse is called to a deposition for a malpractice charge that has resulted in the death of a client. As the chart is reviewed, the prosecuting attorney questions the nurse about several defaming comments written in the medical record about the client. What charges can be filed against the nurse due to these comments? A. slander B. negligence C. malpractice D. libel
D Libel is damaging statements written and read by others. Since there were defaming comments written in the chart, libel charges could be appropriate. Malpractice, slander, and negligence are not charges in this scenario.
When the nurse informs a client's employer of his autoimmune deficiency disease, the nurse is committing the tort of: A. Assault B. Battery C. Breach of contract D. Invasion of privacy
D Nurses have access to information recorded in the medical record, information shared or observed through care or interactions with friends and family, and through access to the client's body. A loss of privacy occurs if others inappropriately use their access to a person.
A team leader chooses to apply the participative leadership style in managing the team of nurses. What value does this reflect? A. Equality. B. Justice. C. Altruism. D. Freedom.
D The principle of nonmaleficence dictates that nurses avoid causing harm. In this 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 and 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.
Nurse researchers have proposed a study to examine the efficacy of a new wound care product. Which of the following aspects of the methodology demonstrates that the nurses are attempting to maintain the ethical principle of nonmaleficence? A. The nurses have completed a literature review that suggests the new treatment may result in decreased wound healing time. B. The nurses have given multiple opportunities for potential participants to ask questions and have been following the informed consent process systematically. C. The nurses have organized the study in such a way that the foreseeable risks and benefits are distributed as fairly as possible. D. The nurses are taking every responsible measure to ensure that no participants experience impaired wound healing as a result of the study intervention.
D The principle of nonmaleficence dictates that nurses avoid causing harm. In this 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 and 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.
A client scheduled to have a 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. Systems skills. B. Instrumental skills. C. Imaginal skills. D. Interpersonal skills.
D The scenario reflects the nurse's interpersonal skills. It shows how a person relates with others. The nurse shows imaginal skills when he or she envisions 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.
The nurse is teaching a group of unlicensed personnel new to psychiatry about balance in a therapeutic milieu. Which statement by a member of the group indicates the need for further teaching? A. "We need to think of clients' rights as we provide care." B. "Balance includes safe and effective treatment for all clients." C. "We do not fix clients but help them solve their problems." D. "Controlling clients helps them feel more comfortable."
D The statement, "Controlling clients helps them feel more comfortable," does not reflect an understanding of the concept of balance in a therapeutic milieu. Balance is the careful negotiation of the conflict between dependency and independency in a therapeutic milieu. Clients are dependent when admitted to care but are allowed and encouraged to become independent as they are able to assume responsibility for self. Staff may find it easier to care for the client when they can control the client and may feel needed when the client is dependent on them. In a therapeutic milieu, staff do not solve the clients' problems for them. Rather, they work with the clients to gradually allow independent behaviors and decision making. Understanding clients' rights, legal issues, and ethical concerns is crucial for the skilled use of balance.
Which theory of ethics prioritizes the nurse's relationship with clients and the nurse's character in the practice of ethical nursing? A. Care-based ethics B. Deontology C. Principle-based ethics D. Utilitarianism
A 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.
Priority setting is based on the information obtained during reassessment. Priority setting is used to rank nursing diagnoses. Each of the following contributes to priority setting except which of the following? A. Finances of the client B. Time and resources C. The client's condition D. Feedback from the family
A Each of these factors contributes to the prioritization of nursing diagnoses except the client's finances. The nursing code of ethics states that clients receive the same treatment regardless of their ability to pay.
A client rings a call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? A. Fidelity. B. Nonmaleficence. C. Justice. D. Autonomy.
A Fidelity is keeping one's promises and never abandoning a client entrusted to care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make healthcare decisions. Nonmaleficence is avoiding causing harm. Justice involves giving each his or her due and acting fairly.
A nursing student is making notes that include client data on a clipboard. Which statement by the nursing instructor is most appropriate? A. "Clipboards with client data should not leave the unit." B. "You can get an electronic print out of client lab data to take with you." C. "Be sure to put the client's name and room number on all paperwork." D. "Be sure to write down specific information for your clinical paperwork."
A HIPAA has created several changes that protect client confidentiality and affect the workplace. One such change is that the names of clients on charts can no longer be visible to the public, and clipboards must obscure identifiable names of clients and private information about them. Therefore, writing down clinical information, taking the data off the unit, and including client identifiers are inappropriate statements.
The nursing student talks with her family about an AIDS client from the clinical experience. Which tort has the student committed? A. Invasion of privacy B. Assault C. Fraud D. Slander
A Invasion of privacy involves a breach of keeping client information confidential. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Slander is oral defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent.
A nurse knows the ethical term "Do not cause harm" is an example of: A. Nonmaleficence B. Beneficence C. Fidelity D. Justice
A 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.
Which example may illustrate a breach of confidentiality and security of client information? A. The nurse provides information over the phone to the client's family member who lives in a neighboring state. B. The nurse provides information to a professional caregiver involved in the care of the client. C. The nurse informs a colleague that she should not be discussing client information in the hospital cafeteria. D. The nurse accesses client information on the computer at the nurse's station then logs off before answering a client's call bell.
A Providing information over the phone to a family member without knowing whether the client wants the family member to know the information is a breach of confidentiality and security of client information. Providing information to a caregiver involved in the care of a client is not a breach in confidentiality, while providing information to a professional not involved in the care of the client is a breach in confidentiality. Client information should not be discussed in public areas, such as elevators or the cafeteria. Logging off a computer that displays client data is an appropriate method of protecting client confidentiality and information.
A medical-surgical client is in the radiology department. The client's cousin arrives on the medical-surgical unit and asks to speak with the nurse caring for his cousin. The visitor asks the nurse to provide a brief outline of the client's illness. Which response, if given by the nurse, would demonstrate application of legal safeguard in her practice? A. "I cannot give you that information due to client confidentiality." B. "Do you have any identification proving you are related to the client?" C. "I will call the client and ask his permission." D. "I'm busy right now, but can talk later."
A Sharing a client's information without his or her consent is an invasion of privacy. The nurse cannot give out the information even if the client proves a relationship or at a later time without the client's consent. It is inappropriate to call the client to ask for permission.
The nurse notes that a placebo has been prescribed when a client requests pain medication. Which statement is most accurate about the use of placebos in the client's plan of care? A. The use of placebos violates the client's right to ethical care. B. It is appropriate to substitute placebos when the client requests frequent doses of pain medication. C. Placebos may be used whenever the nurse believes the client is not really experiencing pain. D. Placebos should be used when it is suspected that the client is addicted to the pain medication.
A The client has a right to accurate information and participation in decision making about treatment options. The use of placebos is misleading to the client and unethical because it does not represent full disclosure about the treatment the client is receiving. Placebos should not be substituted for pain medication, even if the client requests frequent doses. Placebos should not be used even if the nurse suspects that the client is addicted to the medication. The nurse cannot determine whether a client is in pain; pain is what the client says it is.
A nursing student reports to the instructor that a medication due at 9 am was omitted. Which principle is the student demonstrating? A. Integrity B. Altruism C. Autonomy D. Social justice
A 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.
A home care nurse is planning to visit a 60-year-old client diagnosed with heart failure for the first time. Which of the following would be most appropriate for the nurse to do? A. Telephone the client to obtain permission to visit. B. Obtain information about the client's health insurance. C. Contact the client to say that the nurse is coming out to visit. D. Ask the client if he lives alone or with someone else.
A When planning an initial visit, it is imperative that the nurse contact the client and obtain permission to visit first. The home care nurse is a guest in the client's home and must have permission to visit and give care. During this contact, the nurse would also schedule a time for the visit and verify the home address. Additionally, the nurse could also check with the client about his living situation in case special arrangements need to be made to enter the home. Obtaining information about health insurance would be done during the initial visit.
A female client who has diagnosis of borderline personality disorder is manipulative and very disruptive on the hospital unit. She is not dangerous to herself or others, but is clearly not making any therapeutic progress. She consistently refuses any medications. The nurse realizes that legally this client has which option? A. Be medicated if her family signs permission for treatment. B. Refuse treatment. C. Be guided to accept treatment recommendations by threatening loss of privileges. D. Receive forced treatment if the nursing team concurs.
B A client who has not been deemed a danger to self or others or who has not been declared incompetent retains the right to refuse treatment. Legal protocols need to be followed to initiate treatment against an adult client's wishes, even if the family wishes treatment to occur. Punitive threats of retaliation or loss of privileges are ethically unacceptable in administering treatment.
A nursing faculty member is discussing laissez-faire values with students. Which scenario is an example of those values? A. Telling a child an injection will feel like a pinch before the nurse gives the injection B. Parents allowing a child to decide not to have an intravenous line inserted C. Teaching children right from wrong and telling them the reason behind a bad action D. Modeling healthy behaviors for teenagers, such as not smoking electronic cigarettes
B 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 caring for older adults in a long-term care facility is teaching a novice nurse characteristic behaviors of older adults. Which statement is not considered ageism? A. Most older adults are ill and institutionalized. B. Personality is not changed by chronologic aging. C. Intelligence declines with age. D. Old age begins at age 65.
B Ageism is a form of prejudice, like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different; therefore, they do not experience the same desires, needs, and concerns as other adults. The statement not considered ageism would be that personality is not changed by chronologic aging. Most older adults are not ill and institutionalized. Intelligence does not decline with age. Old age does not begin at age 65.
Which ethical principle focuses on the duty to do no harm? A. Autonomy B. Nonmaleficence C. Beneficence D. Justice
B Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness. Beneficence refers to one's duty to benefit or promote good for others.
The depressed client is deciding which type of treatment would be beneficial. The nurse would document that the client is utilizing which ethical principle in this situation? A. Beneficence B. Autonomy C. Veracity D. Justice
B The American Nurses Association identified four primary principles to guide ethical decisions. These principles include the client's right to autonomy, the right to beneficence (doing good) by the nurse, the right to justice or fair treatment, and the right to veracity (the truth) regarding the client's condition and treatment.
A parent teaches his or her children not to drink and drive; however, the parent does drink and drive. This action causes A. Failure to reflect own values B. Conflict with society C. Disruption in consistency D. Insecurity and lack of safety
A Many role models fail to reflect on their own values and, as a result, model conflict and confusion.
The term used to guide the cultural aspects of nursing care and respect individual differences is: A. ethnicity nursing. B. diversity nursing. C. transcultural nursing. D. family nursing.
C Transcultural nursing is the nursing care method that is guided by cultural aspects and respects individual differences.
The charge nurse in an extended-care facility knows that the new nurse understands ageism when she says which of the following? A. "Neither intelligence nor personality normally decline because of aging." B. "Most older adults are lonely." C. "Older adults don't mind how they look." D."Older adults have incontinence."
A Although the response time may be prolonged from a longer processing time, neither intelligence nor personality normally decreases because of aging. Loneliness results from losses, just as it does for people of all ages. Many adults are active in their communities. Incontinence is not a normal part of aging and requires medical attention. Older adults want to be attractive to others.
A nurse is of the Catholic faith and votes pro-life. He is considered to have: A. legal obligations. B. personal morality. C. ethics. D. personal values.
D Personal values are ideas or beliefs a person considers important and feels strongly about.
Telling the truth (veracity) is one of the basic principles of North American culture. Three ethical dilemmas in clinical practice can directly conflict with this principle. Choose the three from the list below. A. Revealing a diagnosis to people other than the client with the diagnosis B. Discussing a client's health information with the physician on call C. Using placebos D. Teaching a client how to perform self care measures E. Not revealing a diagnosis to a client
A C E Three ethical dilemmas in clinical practice that can directly conflict with the principle of veracity are using placebos (nonactive substances used for treatment), not revealing a diagnosis to a client, and revealing a diagnosis to people other than the client with the diagnosis. All involve the issue of trust, which is an essential element in the nurse-client relationship. Speaking with any health care professional who is directly involved with the care of the client is acceptable.
Which ethical principle is related to the duty to do good? A. Autonomy B. Beneficence C. Confidentiality D. Nonmalificence
B Beneficence is the duty to do good to benefit others and the active promotion of benevolent acts. Autonomy refers to self-rule. Confidentiality related to the concept of privacy. Nonmalificence is the duty not to inflict harm as well as to prevent and remove harm.
A day-shift nurse gives a client an injection of pain medication. The nurse forgets to document the injection on the medication administration record (MAR). The day-shift nurse tells the evening-shift nurse that she gave the client 4 mg of morphine at 2 p.m. for postoperative pain but didn't document the injection. The evening-shift nurse puts the day-shift nurse's initials and the date and time the dose was administered in the appropriate area of the MAR. The evening-shift nurse's action is considered to be which type of documentation error? A. Improper correction B. Late entry C. Unauthorized entry D. Omission
C This action is an unauthorized entry. A nurse shouldn't document for another nurse, except for an authorized entry in an emergency. Omission is a documentation error in which information is missing from the medical record. In this scenario, the day-shift nurse omitted documenting her administration of pain medication. A late entry refers to an entry made later than it should have been. The nurse should identify a necessary late entry as a "late entry" and document the reference date and time. An improper correction is an entry corrected in an improper manner, such as by erasing, using correction fluid, or obliterating the error with a marking pen. The nurse should always follow her facility's documentation guidelines.
A nurse is administering evening medications and notices that a medication was omitted during the day shift. Which statement demonstrates the principle of accountability? A. administering the medication with the other evening medications B. documenting in the chart a narrative note about the occurrence C. filling out an occurrence report and notifying the health care provider D. telling the client that the medication will be given the following morning
C 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.
