Chapter 6 Course Points
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? a.Fidelity b. Autonomy c. Nonmaleficence d. Justice
Fidelity Fidelity is keeping one's promises and never abandoning a client entrusted to one's care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make healthcare decisions. Nonmaleficence is preventing harm from being done to a client. Justice involves meeting the needs of each client equitably and acting fairly.
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. a. "I can't believe the client is giving that precious infant up for adoption." b. "The gonorrhea test was positive. That's what the client gets for sleeping around." c. "If that was my mother, I sure wouldn't agree to a no-code." d. "If you are going to have extramarital sex, please protect yourself by using a condom." e. "Smoking has been shown to be a risk for many illnesses, including heart disease and cancer."
a. "I can't believe the client is giving that precious infant up for adoption." b. "The gonorrhea test was positive. That's what the client gets for sleeping around." c. "If that was my mother, I sure wouldn't agree to a no-code." Being judgmental, as in the options about adoption, gonorrhea, and code-status, does not reflect the values desired in a nurse. Professional nurses do not assume that their personal values are more correct than those of their clients. Nurses are obligated, however, to provide health information such as recommending condom use and smoking cessation.
Which word is best described as protection and support of another's rights? a. Advocacy b. Paternalism c. Autonomy d. Ethics
a. Advocacy
An undocumented immigrant with no health insurance sustained life-threatening injuries in an automobile accident. Which action in this case demonstrates the ethical principle of justice? a. Airlifting the client to a local trauma center for emergency surgery b. Avoiding treating the client so as to not do any additional harm c. Filing the paperwork for the client to receive retroactive health insurance d. Telling the client honest information about the client's medical condition and prognosis
a. Airlifting the client to a local trauma center for emergency surgery
The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy? a. Limiting visitors due to the client reporting pain b. Administering pain medication when the pain level reaches 9 on a pain scale of 0 to 10 c. Changing the channel on the television while providing care d. Turning and positioning the client every 4 hours
a. Limiting visitors due to the client reporting pain Advocating for clients is a nursing responsibility and is performed with the best interest and welfare of the client in providing safe, competent, and comforting care. Limiting visitors is an example of advocacy. The nurse recognizes that the client is in pain; therefore, limiting the visitors allows for the nurse to advocate for additional measures to allow the client to rest and recover. Administering pain medication and turning and the client every 4 hours are important and necessary interventions for a postoperative client, but this is not advocacy. Changing the channel on the television while providing care also does not promote advocacy.
A nurse has completed 4 hours of an 8-hour shift on a medical-surgical unit when the nursing supervisor calls. The nursing supervisor directs the nurse 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 the nurse has been busy with client assignments 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? a. Allocation of scarce nursing resources b. Advocacy in a market-driven environment c. Conflicts concerning new technology d. Deception
a. 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 and 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 volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee? a. Assist in decision making based on the client's best interests. b. Decide the care for a client who is unable to voice an opinion. c. Convince the family to choose a specific course of action. d. Present options about the type of care.
a. Assist in decision making based on the client's best interests. One reason an ethics committee convenes is when a client is unable to make an end-of-life decision and the family cannot come to a consensus. In this case, 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 the client is legally 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.
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. Utilitarianism d. Principle-based ethics
a. 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 prioritizes goals and principles that exist beyond the particularities of the nurse-client relationship.
A nurse is most likely to experience ethical distress in which client situation? a. Continuing intravenous fluids for a client who wants to die b. Administering pain medication as ordered c. Turning and positioning a client every hour d. Ambulating a client who is postoperative from a hip replacement
a. Continuing intravenous fluids for a client who wants to die Nurses sometimes have to legally continue orders despite what they feel is right or wrong. This can result in ethical distress, as in this scenario of continuing intravenous fluids. Administering pain medication is promoting comfort and not an ethical issue. Turning and positioning a client as well as ambulating a client will increase comfort, mobility, and healing of the client. Initially, these interventions may be difficult for a new nurse, but eventually the interventions will aid in healing of the client.
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? a. Evaluating b. Diagnosing c. Planning d. Implementing
a. Evaluating Evaluating an ethical decision involves reflecting on the process and evaluating those elements that will be helpful in the future. The nurse may also question how this experience can improve reasoning and decision making in the future. Diagnosing the ethical problem involves stating the problem clearly. Planning includes identifying the options and exploring the probable short-term and long-term consequences. Implementing includes the implementation of the decision and comparing the outcomes of the action with what was considered and hoped for in advance.
Which nursing action demonstrates the principle of fidelity? a. Filing an incident report after making a medication error b. Administering a vaccination c. Treating an uninsured client in the emergency department d. Witnessing a client signature on an informed consent
a. Filing an incident report after making a medication error Fidelity means being faithful to work-related commitments and obligations. The ethical principle is best demonstrated by the nurse following the employer's policies by completing the incident report following a medication error. Administering vaccines is an example of beneficence; treating an uninsured client in the emergency department is an example of justice; witnessing a client signature on an informed consent is autonomy.
The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards? a. International Council of Nurses b. Canadian Hospital Association c. Department of Health Professions d. World Health Organization
a. International Council of Nurses The American Nurses Association Code of Ethics for Nurses is the main source of the ethical principles that nurses must follow, and this is developed by the International Council of Nurses. The Canadian Hospital Association has not developed standards of ethical practice. Individual state boards of nursing through the department of health professions have laws and regulations that guide practice but not ethical and moral principles. The World Health Organization is a large organization that does not determine ethical practice for nurses.
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? a. Laissez-faire b. Modeling c. Moralizing d. Responsible choice
a. Laissez-faire This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values independently and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict. Through modeling, children learn that which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.
Which action most clearly demonstrates a nurse's commitment to social justice? a. Lobbying for an expansion of healthcare resources and benefits to those in poverty b. Ensuring that a hospital client's diet is culturally acceptable c. Answering a client's questions about care clearly and accurately d. Documenting client care in a timely, honest, and thorough manner
a. Lobbying for an expansion of healthcare resources and benefits to those in poverty Social justice is a professional value that encompasses efforts to promote universal access to health care, such as the expansion of publicly funded programs like Medicare. Culturally competent care is a reflection of human dignity. Answering clients' questions and documenting care accurately are expressions of the value of integrity.
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle? a. Paternalism b. Deception c. Confidentiality d. Conflict
a. Paternalism Making a decision for a client who is confused to prevent an injury is an example of paternalism. Deception occurs when the true nature or reason is concealed and the client is deprived of basic human rights. Confidentiality requires a health care provider to keep a client's personal health information private unless consent to release the information is provided by the client. Conflict is a disagreement or argument and does not represent the example in this question.
The nurse strives to uphold human dignity when providing care to clients. Which behaviors by the nurse would best exemplify this value? Select all that apply. a. Protects the privacy of the client b. Maintains confidentiality c. Promotes universal health care d. Provides culturally competent care e. Demonstrates accountability
a. Protects the privacy of the client b. Maintains confidentiality d. Provides culturally competent care Human dignity is defined by the right of a person to be valued and respected for one's own sake, and to be treated ethically. The nurse is exemplifying this by protecting privacy, maintaining confidentiality, and providing culturally competent care. Promoting universal health care would better exemplify the value of social justice and, in any case, would not be appropriate an appropriate action when providing care to clients. Demonstrating accountability is not a human dignity issue but is a core concept in the overall nursing care of a client.
x Which traits are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. a. Trustworthiness b. Humility c. Deception d. Conflict e. Compassion
a. Trustworthiness b. Humility e. Compassion 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.
Which ethical principle is related to the idea of self-determination? a. autonomy b. beneficence c. confidentiality d. nonmaleficence
a. autonomy Autonomy refers to self-rule, or self-determination; it respects the rights of clients or their surrogates to make healthcare decisions. Beneficence is the duty to do good and the active promotion of benevolent acts. Confidentiality is related to the concept of privacy. Nonmaleficence is the duty not to inflict harm, as well as to prevent and remove harm.
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? a. shared decision making b. the paternalistic model c. client sovereignty d. ethical decision making
a. shared decision making Shared decision making is recommended by most ethicists and involves considering both 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. Ethical decision making is that based on a personal or organizational code of ethics.
Which scenario is an example of the laissez-faire approach to value transmission? a. Teaching children right from wrong and telling them the reason behind a bad action b. Allowing a child to decide not to have an intravenous line inserted c. Modeling healthy behaviors for adolescents, such as not smoking electronic cigarettes d. Telling a child an injection will feel like a pinch before the nurse gives the injection
b. Allowing a child to decide not to have an intravenous line inserted A laissez-faire approach to value transmission 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, and reflects the moralizing approach to value transmission. Modeling or role modeling is leading (and transmitting values) by example—in this case, not smoking electronic cigarettes to show the adolescents good behavior. Telling the child about the injection feeling like a pinch is not an approach to value transmission.
Which ethical principle refers to the obligation to do good? a. Fidelity b. Beneficence c. Veracity d. Nonmaleficence
b. Beneficence Beneficence is the duty to do good and the active promotion of benevolent acts. Fidelity refers to the duty to be faithful to one's commitments. Veracity is the obligation to tell the truth. Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; however, there will be times when the action may cause "harm" to promote the "good" such as chemotherapy being used to treat and eliminate cancer, but it causes various adverse effects while trying to reach the ultimate goal..
A nurse pulls the curtains closed before changing the dressing of the surgical wound on the abdomen of a postsurgical client. What value is served? a. Accountability b. Dignity c. Freedom d. Altruism
b. Dignity The nurse values the dignity of the client and provides the client with privacy before changing the wound dressing. This incident does not serve the values of accountability, freedom, or altruism. A nurse values accountability when documenting nursing care accurately and honestly. The nurse values freedom when the client's right to refuse treatment is honored. The nurse shows value for altruism when showing concern for the client's welfare.
The focus of the unit where a nurse works is changing. The nurse has deeply held moral and religious objections to procedures that will be commonly performed on clients on this new unit. Which action(s) should the nurse take? Select all that apply. a. Resign before the new unit focus is implemented. b. Discuss the situation with the unit nurse manager. c. Be careful not to share objections with anyone. d. Plan to care only for clients who will not have these procedures. e. Do not compromise the nurse's own personal moral standards.
b. Discuss the situation with the unit nurse manager. e. Do not compromise the nurse's own personal moral standards. The nurse should discuss this situation with the nurse manager and should not compromise personal moral standards. The nurse can express conscientious objection to participating in activities that violate personal ethical beliefs. The nurse should not plan to care only for clients who will not have these procedures as all nurses on a unit are responsible for care in emergencies. Resigning before the new unit focus is implemented is unnecessary if the nurse can be transferred to a different unit.
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? a. Ethical uncertainty b. Ethical distress c. Ethical dilemma d. Ethical dissatisfaction
b. Ethical distress
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? a. Paternalism b. Feminist c. Values clarification d. Moralizing
b. Feminist A feminist approach is one in which the focus is on specific problems and concerns faced by women. The statement that "this happens to many women" is an example of a feminist approach. Paternalism is action limiting a person's or group's liberty or autonomy that is intended to promote their own good (e.g., if the nurse stated that "I must make all decisions about this client's care for her, as she's not in any shape to do so herself"). Values clarification is a self-assessment process that enables a person to discover the content and strength of the person's own system of values. An example of this would be if the nurse stated, "I feel bad for the client, as no one deserves this." Moralizing is to comment on issues of right and wrong, typically with an unfounded air of superiority. An example of this would be if the nurse stated, "If she was a good girl, this would have never happened to her."
Nurses who value client advocacy follow what guideline? a. They value their loyalty to an employing institution or to a colleague over their commitment to their clients. b. They give priority to the good of the individual client rather than to the good of society in general. c. They choose the claims of the client's well-being over the claims of the client's autonomy. d. They make decisions for clients who are uninformed concerning their rights and opportunities.
b. They give priority to the good of the individual client rather than to the good of society in general. Advocacy is the protection and support of another's rights. If the nurse values client advocacy, the nurse would give priority to the good of the individual client rather than to the good of society in general. The nurse would not be demonstrating advocacy if the nurse values the loyalty to an employing institution or to a colleague over the commitment to the client. The nurse demonstrating client advocacy would not choose the claims of the client's well-being over the claims of the client's autonomy. The nurse would not make decisions for clients who are uninformed concerning the client's rights and opportunities.
What is the term for the beliefs held by the individual about what matters? a.. Ethics b. Values c. Morals d. Bioethics
b. Values Values are ideals and beliefs held by an individual or group about what matters; 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.
A parent teaches a child not to drink and drive; however, the parent does drink and drive. This action results in: a. conflict with society. b. a failure to model one's own values. c. insecurity and a lack of safety. d. a disruption in consistency.
b. a failure to model one's own values. Many role models fail to model their own values and, as a result, cause conflict with and confusion in those who look up to them, such as children (not society, in general). The primary result of this action, which is saying one thing and doing another, is not so much insecurity and a lack of safety or a disruption in consistency as it is a failure to reflect one's own values.
A client tells the nurse that the client does not want to have a painful procedure. By respecting and supporting the client's right to make decisions, the nurse is demonstrating: a. confidentiality. b. advocacy. c. altruism. d. justice.
b. advocacy. Advocacy is the protection and support of another person's rights. Nurses have always been strong client advocates, carefully evaluating the competing claims of the client's autonomy (self-determination) and well-being. Altruism is the principle and moral practice of concern for happiness of other human beings, resulting in a quality of life both material and spiritual. Justice is concerned with moral rightness and fairness. Confidentiality is keeping or one's personal information secret or private.
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 cannot do it anymore." What ethical problem is the adult child experiencing? a. ethical dilemma b. moral distress c. ethical uncertainty d. dissatisfaction
b. moral distress
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 cannot do it anymore." What ethical problem is the adult child experiencing? a. ethical dilemma b. moral distress c. ethical uncertainty d. dissatisfaction
b. moral distress Moral distress is when someone wants to do the right thing but is not able. The adult child brings the parent to the emergency department to maintain the parent's safety, although the child needs to take care of the parent. Dilemma is a situation in which a difficult choice has to be made between two or more alternatives, especially equally undesirable ones. The client is not experiencing a dilemma. Uncertainty means a feeling of not knowing what will happen. The adult child is certain that he or she cannot care for the parent. Dissatisfaction implies a sense of dislike for, or unhappiness in, one's surroundings. Although the adult child is unhappy, this is not the primary ethical problem.
A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have: a. moral agency. b. personal values. c. ethics. d. legal obligations.
b. personal values. The only information given here tells us that this nurse has personal values on a particular issues. Personal values are ideas or beliefs a person considers important and feels strongly about. Moral agency is the ability to do the ethically right thing because one knows it is the right thing to do. Ethics is a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to conduct and human flourishing. Legal obligations are behaviors and actions required by law.
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? a. "There is lots of free continuing education online." b. "See if any of the classes we have to take at the hospital each year will count." c. "Life-long learning is part of the code for nurses." d. "It is hard to get enough hours since we work full time and have families."
c. "Life-long learning is part of the code for nurses." While all of these answers have some merit, the best is to remind the nurse that life-long learning is an expectation of nursing and is part of the American Nurses Association Code for Nurses.
Which statement by the nurse is an example of deception? a. "I will administer your pain medication as soon as it is due." b. "It is important to get out of bed to prevent pneumonia." c. "This injection of procaine will feel like a little pinch." d. "I am going to teach you how to give yourself insulin."
c. "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.
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. Telling the client that the medication will be given the following morning c. Filling out an occurrence report and notifying the healthcare provider d. Documenting in the chart a narrative note about the occurrence
c. Filling out an occurrence report and notifying the healthcare provider Accountability means that when an error occurs, the nurse takes the proper actions to address it. In this instance, the nurse should fill out an occurrence form for follow-up and notify the provider, as the error may change outcomes in the client's condition. Administering the missed medications with the other evening medications may double up the dose or cause 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.
A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating? a. Altruism b. Social justice c. Integrity d. Autonomy
c. Integrity The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the nurse reported the occurrence of the missed medication to the charge nurse. The definition of altruism is concern for others; it can best be explained by a nurse concerned about how a client will care for self 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.
Ethical distress is: a. being aware of the principles of right and wrong. b. supporting the rights of a client during hospitalization. c. knowing the correct action but being unable to perform it due to constraints. d. having trouble deciding which of two conflicting ethical principles to follow.
c. knowing the correct action but being unable to perform it due to constraints. Knowing the correct action but being unable to perform it 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 (beneficence) and the focus of client-centered care. An ethical dilemma is a situation in which a person has difficulty deciding which of two or more conflicting ethical principles to follow.
Which example best describes feminist ethics? a. A combination of elements of utilitarian and deontologic theories that offer specific action guidelines for practice b. Attention directed to the specific situation of individual clients viewed within the context of their life narratives c. The formal study of ethical issues that arise in the practice of nursing d. An approach critiquing existing patterns of oppression and domination in society
d. 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.
The nurse is attempting to clarify the values of an adolescent client. The nurse should identify what factor as having the greatest influence on an adolescent's value formation during this developmental stage? a. Educational institutions b. Organized religion c. Awareness of other cultures d. Peers
d. Peers In adolescence, peer groups have a major influence on 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, religion, or the awareness of other cultures during this developmental stage.
Which action would cause a charge nurse to have concerns about a nurse's moral agency? a. The nurse often must stay after shift change to complete documentation. b. A family member complained that the nurse was slow answering call lights. c. The nurse was unable to pass a required dosage calculation examination. d. The nurse was seen at a grocery store after calling in sick.
d. The nurse was seen at a grocery store after calling in sick. The only option with an ethical component possibility is the nurse being seen at the grocery store after calling in sick. It may be that the nurse had no other choice but to go to the grocery store, even if sick, but it would cause the charge nurse to be suspicious. The other options do not reflect an ethical issue because they did not lead to other unethical behaviors, just job performance issues.
