Chapter 6 (LR)
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."
Which nursing situation is an example of an ethical dilemma?
Deciding whether to perform cardiac compressions against a client's wishes Explanation: An ethical dilemma occurs when it is difficult for a decision to be made due to competing ethical principles. If there is no signed do not resuscitate order, then legally cardiac compressions must be started; however, if this is against the client's wishes, the nurse must weigh the ethical principles of beneficence and complying with the law against the ethical principle of autonomy. Administering pain medication as ordered, transferring a client to a step-down unit, and discussing the care of a comatose client with the family are all within the ethical scope of nursing practice.
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 Explanation: 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.
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 Explanation: 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.
Parents giving money to a child for receiving an exemplary report from school is an example of which type of value transmission?
Rewarding Explanation: Rewarding occurs when good behavior or an event is accompanied with money or a prize. Modeling is when a person exhibits proper behavior as an example for others to follow, such as a mother practicing good manners at the dinner table in front of children. Moralizing is an expression of opinions in terms of right or wrong. An example is when a parent explains to a child why an action is right or wrong. Laissez-faire is an attitude or behavior of letting things happen without interfering. An example is a parent allowing a child to explore physical surroundings without the interference of the parent.
Which is the best definition of ethics?
The formal, systematic study of moral beliefs Explanation: Ethics is a formal, systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to human conduct and human flourishing. "Morals" usually refers to personal or communal standards of right and wrong.
Which traits are examples of virtues that can exemplify character and conduct as a professional nurse?
Trustworthiness Humility Compassion Explanation: 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 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:
advocacy. Explanation: 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.
To practice ethically, the nurse should avoid:
allowing the nurse's own judgment to guide practice. Explanation: Personal convictions apply only to situations and decisions pertaining to the individual. In ethical professional practice, nurses should avoid allowing personal judgments to bias their treatment of clients. It is appropriate for nurses to allow an ethics committee, past cases, and the views of clients and their families to guide nursing practice
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 Explanation: 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 teenagers good behavior. Telling the child about the injection feeling like a pinch is not an approach to value transmission.
Which example best describes feminist ethics?
An approach critiquing existing patterns of oppression and domination in society Explanation: 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 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. Explanation: 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 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 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 Explanation: When respecting autonomy, the nurse supports the client's right to make decisions with informed consent. When promoting the client's well-being, the nurse acts in the best interests of the client. Advocacy is linked to the belief that making choices about health is a fundamental human right that promotes the individual's dignity and well-being. Beneficence is reflected by doing good and promoting what will benefit the client. Justice involves treating each client fairly. Fidelity involves being faithful and keeping promises.
Which ethical principle refers to the obligation to do good?
Beneficence Explanation: 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; it is more binding than beneficence.
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 Explanation: 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.
Which example most accurately depicts the ethical principle of autonomy?
Describing a surgery to a client before the consent is signed Explanation: Autonomy is the capacity to make an informed, uncoerced decision. Describing a surgery to a client before a consent is signed provides the client with all of the information needed to make an informed decision and thus an autonomous one. The nurse changing a dressing on a wound does not require the client to make an informed decision, nor does administering a morning dose of insulin or transporting a 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?
Evaluating Explanation: 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.
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 Explanation: 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.
The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy?
Limiting visitors due to the client reporting pain Explanation: 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 charge nurse is always careful to listen carefully to clients and to be respectful of their privacy and care needs. The nurse says, "I want the staff on this unit to see me interacting with clients in the manner I would like for them to interact with clients." The nurse is using which technique to guide value development of the staff?
Modeling Explanation: Modeling is a method of values transmission in which the "teacher" demonstrates desired behavior. If the charge nurse was using moralizing, a lecture or information would be presented and would allow little opportunity for the "learners" to weigh different values. Laissez-faire provides no guidance in value development. Responsible choice encourages the learners to explore competing values and to weigh their consequences.
While providing care to a client, a nurse encounters an ethical problem. The nurse knows the right thing to do, but the facility's policies interfere with the nurse's ability to follow through in doing the right thing. Which condition is the nurse experiencing?
Moral distress Explanation: Moral distress occurs when a nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. In an ethical dilemma, two (or more) clear moral principles apply but support mutually inconsistent courses of action. The capacity to recover, adapt, and even thrive in the face of threats, misfortune, or challenging times is termed resilience. Moral resilience is the developed capacity to respond well to morally distressing experiences and to emerge strong. Ethical agency involves the ability to always do the ethically right thing because we know it is the right thing to do.
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?
Paternalism Explanation: 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.
What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?
Peers Explanation: 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 administration, work life, or the awareness of other cultures during this developmental stage
A client continues to complain of pain despite receiving medication. The family states, "In our culture it is acceptable to complain out loud." What would be the best response by the nurse?
Tell me more about your cultural beliefs. Explanation: It is important for the nurse to learn about how culture affects the client's behavior. Asking the client to explain the client's cultural beliefs will help the nurse to use a care-based approach. Stating that the medication should have worked or stating that it is fine to complain out loud are not examples of a care-based approach. Also, describing the home situation would not be helpful in this instance.
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. Explanation: 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.
Ethical distress is:
knowing the correct action but being unable to perform it due to constraints. Explanation: 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.
A nurse shows client advocacy by:
offering a hospice consultation to a client who is terminally ill. Explanation: The definition of advocacy is to ensure that the client's best interests are being met. A hospice consult is an appropriate example. Insisting that a client take a medication does not reflect advocacy for the client because it violates the client's autonomy. Sending a client home with verbal discharge instructions is normal and customary practice and does not ensure that the client's best interests are being met. Refusing to allow a spouse to stay by the client's bedside is not likely to be in the best interests of the client.
What would be an example of the nurse practicing fidelity? The nurse:
stays with a client during death as promised. Explanation: Fidelity requires the nurse to keep promises made and to be faithful to one's commitments. Regulating visitors is a demonstration of the value of privacy. Withholding client's information as requested is an example of maintaining confidentiality. Providing continuity of care is an example of integrity and professionalism.
Which statement by the nurse is an example of deception?
"This injection of procaine will feel like a little pinch." Explanation: 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'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." Explanation: Courage is a virtue of nurses that can be learned or strengthened with work. Courage is a quality nurses should possess. Courage is not less important than being intelligent, compassionate, or humble.
The unit where a nurse works is undergoing structural changes along with changes in client load and managerial style. The nurse feels disorganized and stressed and is having difficulty sleeping. The nurse wonders if these feelings are related to the changes at work. What next step should the nurse choose in the 4A plan to address this issue?
Committing to self-care Explanation: In this scenario the nurse is Asking if the distress being felt is from changes at work. The next step is to Affirm that distress exists and commit to take care of self. The nurse affirms distress by validating feelings and perceptions with others. The third step is to Assess which includes determining the severity of the distress and analyzing the risks and benefits of acting on the distress. The fourth step is to Act which is implementing strategies to initiate changes to reduce distress.
A nurse arrives on the medical unit wearing large, dangling earrings. This is an example of which type of conduct?
Unprofessional Explanation: Nurses need to present and maintain a professional demeanor and image. Large dangling earrings are not appropriate or safe. Unethical conduct is conduct that is not morally correct, such as dishonesty. Incompetent conduct is conduct in which the nurse lacks the ability to perform satisfactorily. Illegal conduct is conduct forbidden by law.
A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:
personal values. Explanation: 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.
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?
-"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." Explanation: 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.
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 Explanation: There are three basic models of healthcare decision making. In the paternalistic model, clinicians decide what ought to be done to benefit the client, inform the client, and the client's role is to comply. In the client sovereignty model, clients or their surrogates, expressing their right to be autonomous, tell the clinician what they want, and the clinician's role is to comply. Most ethicists reject these models in their extremes and recommend a model of shared decision making, which respects and uses the preferences of the client and the expertise/judgment of the clinician. Clinical decision making is the process that results from the use of a healthcare decision-making model.
Nursing practice consistent with the Code of Ethics for Nurses includes which actions?
-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 Explanation: Nurses should always deliver culturally safe care, as well as protect the client's right to confidentiality and privacy in healthcare settings. Nurses also should put the client at the center of care and incorporate the client as a part of the healthcare team. As such, nurses must collaborate closely with other members of the healthcare team and include all healthcare professionals caring for the client. Nurses should not cross professional boundaries with their clients by establishing friendships.
Which actions by the nurse demonstrate the ethical principle of fidelity?
-Maintaining current nursing registration and meeting continuing education requirements -Performing an intervention for a client at the time that was promised -Taking an extra client assignment so that the client will be cared for Explanation: 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 the nurse's 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 a direct example of fidelity. Calling in sick due to a lack of sleep is not an acceptable practice in most cases.
Which word is best described as protection and support of another's rights?
Advocacy Explanation: 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.
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 Explanation: 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 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 Explanation: 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."
A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle?
Paternalism Explanation: 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
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. Explanation: 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.
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. Explanation: 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.
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?
Allocation of scarce nursing resources Explanation: 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 reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?
Integrity Explanation: 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.
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 Explanation: 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.
The principle of autonomy by a client is applied in which situation?
The client has decided to stop chemotherapy treatments. Explanation: The principle of autonomy respects the client's right to make the client's 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 the client's own decision about taking the prescribed antibiotic. A hospice consult is placed by the nurse and reflects the nurse's autonomy, not the client's, to make a decision about the client.
