Ethics and End-of-Life Care

Samantha's assessment of Mary reveals that Physician Orders for Life-Sustaining Treatment (POLST) would be beneficial. How should Samantha best address Mary's need for POLST? A. Assess Mary's ability to have an informed dialogue about POLST. B. Contact Dr. Gonzalez and request that he discuss POLST with Mary promptly. C. Ask Mary to explain her preferences for end-of-life care and medical interventions. D. Ask Betty to provide input based on her previous interactions with Mary.

A. Assess Mary's ability to have an informed dialogue about POLST.

Samantha is applying the American Nurses Association Code of Ethics for Nurses when planning the next steps of Mary's care. When applying the principles of the Code, Samantha should prioritize what factor? A. Ensuring Mary's right to be free from pain, distress, or uncertainty B. Protecting and promoting Mary's rights, dignity, and well-being C. The need to collaborate professionally with Dr. Gonzalez and other members of the care team D. Her scope of practice as defined in her state's nurse practice act (NPA)

B. Protecting and promoting Mary's rights, dignity, and well-being

Samantha has approached Dr. Gonzalez in an effort to discuss Mary's care, and it is clear that they disagree about the necessary approach. What should Samantha do in order to promote a collaborative approach to conflict management? A. Identify a trusted mediator who can speak separately with Samantha and Dr. Gonzalez. B. Discuss Mary's situation with Dr. Gonzalez and try to agree on a common goal for her care. C. Negotiate with Dr. Gonzalez on the basis of their individual scopes of practice and expertise. D. Defer decision making to a third party who is familiar with Mary's needs, such as Betty.

B. Discuss Mary's situation with Dr. Gonzalez and try to agree on a common goal for her care.

An elderly patient is admitted to the cardiac floor for worsening congestive heart failure. As the nurse is obtaining baseline vital signs, the patient states, "My neighbor is in the ICU on one of those machines that keep people breathing forever. I never want to end up like that." Which response by the nurse is best? A. I can ask the social worker to meet with your family if you would like. B. It sounds likes you have given this a lot of thought. Would you like me to arrange for you to complete an advance directive and share this with your family? C. I will make sure there is a note in your chart that you do not want to be placed on a ventilator. D. Your lawyer can help you fill out the necessary paperwork.

B. It sounds likes you have given this a lot of thought. Would you like me to arrange for you to complete an advance directive and share this with your family?

The nurse manager on the unit where Mary is receiving care is applying Crisham's (1985) MORAL decision-making model to Mary's care planning. What is the nurse manager's best initial action? A. Educate members of the care team about the major principles of ethical reasoning. B. Assess Mary's orientation, judgment, and insight. C. Gather as much specific information about Mary's status and circumstances as possible. D. Speak with Dr. Gonzalez to clarify Mary's health history and most likely prognosis.

C. Gather as much specific information about Mary's status and circumstances as possible.

Samantha recognizes the need to adhere to the ethical principle of beneficence when addressing this challenge in Mary's care. Samantha can best promote beneficence in Mary's care by: A. ensuring that Mary's best interests inform any decisions that are made. B. eliciting input from Betty and other staff who are familiar with Mary's circumstances. C. speaking with Dr. Gonzalez to confirm his rationale for the proposed transfer. D. identifying each of the alternatives when choosing how to address Mary's care.

A. ensuring that Mary's best interests inform any decisions that are made.

A new nurse is working in the operating room suite. The nurse notices that the surgeon uses inappropriate humor concerning the patient while the patient is under anesthesia. What is the nurse experiencing? A. Moral uncertainty B. Moral indifference C. Moral outrage D. Moral distress

C. Moral outrage

The nurse must get a consent signed by the patient regarding their upcoming surgery. She notes in the chart that the patient was medicated for pain one hour ago with hydromorphone. Ethically, what should the nurse do? A. Ask the provider on call if they can assess the patient. B. Get a second witness and have the patient sign the form. C. Withhold the consent until another time. D. Have the patient sign the consent.

C. Withhold the consent until another time.

A nurse is travelling to work on the highway. The nurse sees a car get hit from the rear. The car spins out of control and hits the median. The nurse stops to help at the scene. Legally, the nurse may do this based on the Good Samaritan Law. What ethical framework is the Good Samaritan Law based upon? A. Rights based B. Intuitionist C. Utilitarian D. Duty based

D. Duty based

The nurse is caring for a patient whose vital signs are not stable and who seems to be nearing the end of life. The provider orders the patient to be placed on life-sustaining treatments, but the nurse questions this order. The nurse is operating within which type of ethical framework? A. Rights based B. Intuitionist C. Utilitarian D. Duty based

A. Rights based