Chapter 6: Values, ethics, and advocacy PREPU

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating?

Integrity

A nurse is preparing a client for discharge from the cardiac unit and observes cigarettes in the client's belongings. The nurse asks the client to consider the client's health and that of the client's spouse. This is an example of:

values clarification. explanation

A nurse is of the Catholic faith and votes pro-life. This nurse is considered to have:

personal values

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

A nurse who has worked on a unit for 8 years is conflicted about asking to meet with the charge nurse about staffing ratios. Which question(s) reflect the professional value of altruism in this decision? Select all that apply.

"Am I able to provide safe and efficient care to my clients?""Am I willing to take this risk to help protect my fellow nurses?""Will less experienced nurses on the unit learn from my actions?"

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.

"If that was my mother, I sure wouldn't agree to a no-code." "The gonorrhea test was positive. That's what the client gets for sleeping around." "I can't believe the client is giving that precious baby up for adoption."

Which statement by the nurse is an example of deception?

"It is important to get out of bed to prevent pneumonia."

Which example best describes feminist ethics?

An approach critiquing existing patterns of oppression and domination in society

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

Which nursing situation is an example of an ethical dilemma?

Deciding whether to perform cardiac compressions against a client's wishes

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

The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards?

International Council of Nurses explanation: 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 nurse is providing care for three clients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute client still receives a reasonable amount of time, attention, and care during the course of the shift. Which ethical principle is the nurse attempting to practice?

Justice

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. Reference:

Which are professional values that the nurse should incorporate into practice? Select all that apply

Social Justice Human dignity Autonomy Altruism

When analyzing an ethical dilemma according to the ethical framework, what is most important for the nurse to take into consideration?

Standards of conduct

Which is the best definition of ethics?

The formal, systematic study of moral beliefs

Which nursing action(s) best demonstrate the ethical principle of autonomy? Select all that apply.

The nurse documents that a client refused a new medication. The nurse checks to ensure an informed consent document is signed prior to transferring the client for a surgical procedure.

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.

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

Values explanation: values act as a standard to guide one's behavior

Which best defines value clarification?

a process by which people come to understand their own values and value systems

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

A nurse is providing care for a client with cancer. The client's spouse requests that the client not be told that the client is terminal. The nurse complies with this request. The nurse's action is a breach of which ethical principle?

fidelity

Ethical distress is:

knowing the correct action but being unable to perform it due to constraints.

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."

A nurse practices the ethical principle of autonomy when providing nursing care for clients. Which nursing actions best describe the use of this value? Select all that apply.

A nurse reads The Patient Care Partnership to a visually impaired client.A nurse asks the surgeon to further explain details of a surgery to a client before obtaining informed consent.

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.

A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision?

Autonomy

Nursing practice consistent with the Code of Ethics for Nurses includes which actions? Select all that apply.

Delivering culturally safe care Acknowledging that the client is the focus and center of care and remains a part of the treatment team

Which example most accurately depicts the ethical principle of autonomy?

Describing a surgery to a client before the consent is signed

Which statement best conveys the concept of ethical agency?

Ethical practice requires a skill set that must be conscientiously learned and nurtured.

A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for clients in a long-term care facility. Which nursing action(s) exemplify this principle? Select all that apply.

Evaluating

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

A nurse is providing care to a client and is preparing the client for breakfast. The nurse assists the client out of bed to the chair and then helps the client open the items on the breakfast tray. The client begins to eat breakfast. The nurse tells the client, "I'll be back in about 10 minutes to check on you. In the meantime, here is your call light in case you need me." About 10 minutes later, the nurse returns to check on the client. The nurse is demonstrating which ethical principle?

Fidelity

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

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

Personal moral

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?

Laissez-faire EXPLANATION: 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.

The nurse is managing the care for a postoperative client. How does the nurse demonstrate advocacy?

Limiting visitors due to the client reporting pain

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

The nurse has identified an ethical dilemma that has the potential to interfere with a client receiving optimal care. The nurse discussed this issue with the charge nurse on the unit. What action should the nurse choose next?

Monitor for resolution of the problem.

A nurse knows that the expression "Do not cause harm" refers to which ethical principle?

Nonmaleficence

What is likely to have the greatest influence on an adolescent's formation of values during this developmental stage?

Peers

Ethical practice is evaluated as a portion of the nurse's annual review. Which practice(s) would cause the evaluator to reduce the nurse's score on this section of the review? Select all that apply.

The nurse is frequently late to work. The nurse often speaks harshly to cleaning staff and transport workers.

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

The promotion of the dignity and respect of clients as people explanation:

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.

A nurse arrives on the medical unit wearing large, dangling earrings. This is an example of which type of conduct?

Unprofessional

What are standards for decision-making that endure for a significant time in one's life?

Values

To practice ethically, the nurse should avoid

allowing the nurse's own personal judgment to guide practice

To practice ethically, the nurse should avoid:

allowing the nurse's own personal judgment to guide practice.

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.

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

compassion trustworthiness

A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches the principle of:

ethical conduct

A nurse working on a critical care unit was informed by a client with multiple sclerosis that the client did not wish to be resuscitated in the event of cardiac arrest. Now the client is no longer able to express wishes, and the family has informed the physician that they want the client to be resuscitated. Aware of the client's wishes, the nurse is involved in a situation that may involve:

ethical distress

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?

moral distress

An older adult was just diagnosed with stage 4 pancreatic cancer. The client states, "I am so overwhelmed and I feel like everyone has already decided that I need to be put in hospice care." The nurse upholds the principle of autonomy by

offering to answer questions the client may have about care and treatment options providing the client with the information needed to obtain a second opinion

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

stays with a client during death as promised.

An illegal immigrant with no health insurance sustained life-threatening injuries in an automobile accident. Which action in this case demonstrates the ethical principle of justice?

Airlifting the client to a local trauma center for emergency surgery The ethical principle of justice mandates that clients be treated impartially without discrimination according to age, gender, race, religion, socioeconomic status, weight, marital status, or sexual orientation. An immediate airlift to the local trauma center demonstrates that this client is being treated impartially. Avoiding causing the client additional harm would demonstrate nonmaleficence. Attempting to help the client obtain health insurance would demonstrate beneficence and advocacy. Telling the client the truth about the client's medical condition and prognosis would demonstrate integrity and honesty (veracity).

Six teenagers were killed in an accident following a night of drinking. The older brother of one of the victims bought beer for the group because none of them was old enough to purchase alcohol. Which statement(s) regarding the brother's action reflect customs rather than communal or personal ethical standards? Select all that apply.

* Big brothers often introduce their younger siblings to alcohol.* Drinking alcohol is a rite of passage. explanation: The ethical statements are that people should not provide alcohol to underage persons (communal standard), underage persons should not drink alcohol (communal standard), and people should not drink alcohol (personal standard). Communal standards are often the basis of law. Personal standards are specific to the person holding the value. The nurse must distinguish ethical statements from customs such as drinking as a rite of passage and big brothers introducing younger siblings to alcohol.

Which word is best described as protection and support of another's rights?

Advocacy

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 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.

When examining values, a nurse notes that one country allows physician-assisted suicide and another outlaws it, making it punishable by imprisonment. Which factors best explain the differences in values between these two countries?

Cultural Explanation : Daily living is expressed in many traditions and customs; understanding these differences is cultural value orientation. Because it is primarily culture that determines a society's values, cultural factors best explain the differences in values between these two countries. Although economic, spiritual, and ethical factors may be involved in value formation, a society's value system is most influenced by culture.

A hospice nurse is caring for a client with terminal cancer. The family would like the client to continue aggressive therapy to treat the cancer, but the client has voiced to the nurse that no further pursuit of treatment is desired. The nurse speaks to the family about the client's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation?

ethical principles explanation: 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. In this case, the nurse is practicing the ethical principle of autonomy, which is the client's right to self-determination related to choices about care. The nurse's action is not primarily motivated by legal responsibility, nursing education principles, or advanced practice licensure guidelines.