Pearson Ethics
An older client without cognitive impairment refuses culture of a seeping wound. Which action should the nurse take? A. Discharging the client for noncompliance B. Respecting the client's decision C. Restraining the client so that the culture can be taken D. Asking the client about withdrawing blanket consent
Answer: B Rationale: The older adult has the right to refuse treatment, and the nurse is legally and ethically bound to respect this decision. The client would not be discharged by the nurse for refusing the culture. Restraining the client so that the culture can be taken is against the law. The client is allowed to refuse treatment under blanket consent.
The nurse is obtaining a medical history from a patient who has come from a corrupt background. The nurse quickly identifies that the patient is lacking in moral development. Which is the best approach to assessing the patient? A. Maintaining a calm, nonjudgmental attitude and ask open-ended questions B. Documenting that the results of the interview are invalid because the patient cannot participate responsibly C. Taking opportunities to correct the patient when he says something that is incorrect D. Refraining from asking any further questions as part of the assessment
Answer: A A patient who has been exposed to a corrupt environment may not be able to fully participate in an assessment interview or develop a trusting nurse-patient relationship. Therapeutic communication may be difficult. The nurse can facilitate better communication by showing a nonjudgmental attitude and asking open-ended questions. Correcting the patient or setting moral standards will hinder the development of a trusting relationship. The interview may be valid, and documenting otherwise is not accurate. The interview should be continued but with a great deal of patience on the part of the nurse.
The nurse is documenting the care of a 16-year-old girl who has just discovered that she is pregnant. The patient is tearful as she reports that her boyfriend broke up with her 2 weeks ago and states that her life has truly been ruined. Which nursing diagnosis is appropriate in this situation? A. Noncompliance B. Self-Esteem, Situational Low, Risk for C. Health Behavior, Risk-Prone D. Social Isolation
Answer: B A 16-year-old patient who discovers being pregnant is likely at risk for Self-Esteem, Situational Low, Risk for. This is compounded by the fact that their relationship has ended. Social Isolation is not identified but will be a risk if the patient becomes a single teen mother. Noncompliance has not been established and cannot be assumed. There is no actual knowledge of any Health Behavior, Risk-Prone, but the situation raises the possibility.
A woman who is 6 months pregnant is involved in a motor vehicle crash and sustains massive head injuries. The patient is kept alive on a ventilator until the baby can be delivered 2 months later. Which factor describes the ethical dilemma posed by this situation? A. The mother's right to patient autonomy versus the fetus's survival B. The mother's obvious desire for the baby to be born verses the baby's being born early C. Lack of family decision making in this process D. Whether it was ethical to keep the mother alive using medical technology
Answer: A Because the mother is not able to consent or make decisions, she has lost patient autonomy and has no say in what care is provided to or withheld from the fetus. In these situations, the family may be consulted, but laws vary from state to state. The mother's desires cannot be assumed or established. Medical technology and its capacity to extend life is a different ethical dilemma; this relates to quality of life issues. The family's involvement is unknown in this situation, but family input would be critical.
A child is taught early in life that it is wrong to take things from others. This process carries over to behavior later in life. Which process does this exemplify? A. Moral development B. Cultural relativism C. Utilitarianism D. Responsibilities
Answer: A Moral development is the process of learning to tell right from wrong and learning what should and should not be done. Responsibilities are specific obligations associated with the performance of specific duties or a particular role. Cultural relativism is the idea that people's beliefs and behaviors are rooted in their particular cultures. Utilitarianism is the application of a consequence-based theory to provide the greatest benefit to the largest number of people.
The nurse administers blood to a patient without verifying the patient's identity. As a result, the patient receives the wrong type of blood and has a severe reaction. Which principle of ethical decision making is demonstrated by the nurse's failure to verify the correct blood? A. Nonmaleficence B. Justice C. Beneficence D. Veracity
Answer: A Nonmaleficence requires that nurses protect the safety of their patients and do no harm. The nurse failed to protect the safety of the patient by not conducting a safety check before performing an action that carried risk. Justice refers to treating all patients fairly and equally. Beneficence requires that actions done promote good and benefit the patient. Veracity refers to telling the truth.
A patient who feels that they have been treated badly during an emergency department visit asks the nurse where to find relevant information to report this. Which is the appropriate response by the nurse? A. Asking the patient whether there is any specific issue they'd like to discuss and providing the information for reporting a complaint in the Patient's Bill of Rights B. Asking the patient whether they are planning to file a lawsuit and notifying risk management C. Asking the patient to please not report the facility or they may not be able to return for care D. Telling the patient that the information is available online but that the hospital will not provide it to them
Answer: A The Patient's Bill of Rights gives patients the right to easily report complaints to the appropriate agency. This information should be posted visibly in the hospital and accessible by all patients. The right to file a complaint should never be challenged, and the patient should never feel pressured not to. It is a good idea to notify risk management if a patient is likely to file a complaint, but this should not be done in an attempt to prevent the patient from filing the complaint. It is never appropriate to threaten to withhold care if a patient files a complaint.
A patient with advanced metastatic cancer is receiving frequent doses of pain medications and is unresponsive. The family agrees that life-sustaining measures be withdrawn. Pain medications are administered and the patient dies the next day. Which observation of the family indicates that the nursing interventions were successful and the family members are satisfied that the best decision was made? A. The family is talking easily about funeral arrangements and is being supported by a clergy member. B. The family has become quiet and withdrawn and is having difficulty choosing a funeral home. C. The family asks the nurse whether they did the right thing. D. The family is visibly grief-stricken and refusing to leave the room.
Answer: A The evaluation of a patient or family faced with a decision that poses a threat to morality should be based on whether the patient or family appears to be at peace with the decision and is not showing regret or second-guessing. Any sign of dysfunctional grieving or a change of heart should be evaluated further and support provided.
The nurse is approached by the parents of a teen admitted with a uterine hemorrhage. The father asks, "Is my daughter pregnant?" Which response by the nurse is appropriate? A. "I cannot discuss her medical condition with you. All of our patients have privacy rights." B. "I don't think you have anything to worry about. She's a lovely young woman." C. "I know that this situation must be hard for you to deal with. I'll let you know when I find out." D. "You can ask the admitting physician. I'm sure she'll discuss your daughter's condition with you."
Answer: A The nurse must uphold the right of the patient to privacy, even if the patient is not an adult. The nurse cannot legally promise to disclose private information at a later time. The nurse cannot legally promise that the emergency physician will disclose private information. The nurse should not dismiss the concerns of the father.
The nurse is assisting with the informed consent process for a patient who is to undergo an elective procedure. The surgeon has spoken to the patient, and the nurse brings the consent form for the patient to sign. The patient states, "I've changed my mind. I don't want to do this." Which is the most appropriate action for the nurse to take? A. Telling the patient that they do have the right to refuse the procedure, then notifying the healthcare provider that the patient is refusing B. Telling the patient that they should have told the healthcare provider before the consent form was prepared C. Informing the patient that they have the right to refuse the procedure and discharging the patient home after documenting the refusal D. Informing the patient that the healthcare provider has already obtained verbal consent and that they must now sign the form
Answer: A The patient has the right to refuse treatment at any point during the process, and the informed consent must state that right. The nurse should be aware of that right but must also tell the physician that the patient is refusing. The nurse should not try to talk the patient into the procedure or incorrectly tell the patient that it is too late to refuse. If the patient does refuse, which is within their rights, the healthcare provider should have the opportunity to speak to the patient before they are discharged home.
A 48-year-old warehouse worker has been admitted to the cardiology unit with chest pain. The patient reports a strong family history of heart attacks before age 50 before expressing excitement at the birth of their first grandchild. Asked about work, the patient says, "I can load a pallet faster than men half my age." The healthcare provider advises the patient to begin a program of regular exercise, but the patient is reluctant, saying, "I'm already strong!" Which behavior on the part of the patient may indicate unclear values? A. Ignoring the doctor's advice to exercise regularly B. Having a family history of heart disease C. Looking forward to the birth of his grandchild D. Loading a pallet faster than anyone else
Answer: A The patient's ignoring of the doctor's advice to exercise regularly may indicate unclear values. Looking forward to the birth of a grandchild is a clear family value. Having a family history of heart disease is a genetic risk, not a behavior. Loading a pallet quickly is a career value.
A patient is soon to be pronounced brain dead, and the family has been approached about organ donation. When the family returns the next day, the son mentions reading about organ donation on the internet and learning that hospitals charge the families of donors for the organ donation. The son announces that the family has decided to refuse organ donation. Which course of action by the nurse is most ethical? A. Providing the family with information from the organ procurement agency and asking that a representative of the agency speak with the family B. Informing the family that this information is completely untrue and that the family must be careful of what they see on the internet C. Trying to talk the family into reconsidering because so many donor organs are needed D. Documenting the family's decision that organ donation will be refused
Answer: A The position of the family must be respected, but the nurse should make every attempt to provide the family with factual information. The beliefs of the family should not be belittled or ridiculed, but evidence-based information should be provided. All conversations with the family should be documented, but this is not the only course of action. After providing information and making themselves available to answer questions and address concerns, the nurse must ultimately respect the wishes of the family.
A 9-year-old patient undergoing chemotherapy for leukemia tells the nurse that they have decided to refuse any future chemotherapy treatments because they make him so sick. Which is the most ethical action for the nurse to take in response to this statement? A. Approaching the parents and telling them that the child is worried about future chemotherapy treatments, then helping facilitate a family discussion B. Telling the child that they are making a very bad decision and that refusing chemotherapy will likely result in death C. Advising the parents to cancel future chemotherapy sessions because the child will refuse the treatment. D. Telling the child that it is not their decision because they are a minor and do not have the right to refuse care
Answer: A When a minor makes a statement about refusing necessary medical treatment, the nurse should share the information with the family in a sensitive way and try to facilitate further discussion. The family should be made aware of the statement, but it is up to the parents to make the decision. The nurse should not dismiss the child's statements; telling them that they do not have the right to refuse treatment or that refusing will lead to their death will likely contribute to feelings of helplessness and hopelessness.
Two dialysis clinic nurses are discussing the recent death of a client with end-stage renal disease. One nurse believes that the client's decision to end treatment was correct. The other nurse thinks that the client should have continued treatment long enough to allow the client to talk to an estranged child. Which nurse is exhibiting client advocacy? A. The nurse who believes that the client's decision to end treatment was correct is exhibiting advocacy. B. The nurse who thought that the client should have had a chance to reconcile with a child is exhibiting advocacy. C. Both nurses are advocates; they are proposing choices that the client could have made. D. Neither nurse is an advocate; the client had no real choice and would have died soon anyway.
Answer: A Rationale: An advocate defends the cause of another individual, so the nurse supporting the client's decision to end treatment is an advocate. The nurse who gave the opinion that family reconciliation was a priority was not supportive of the client. Advocacy is not limited by the amount of time left in life. An advocate does not propose choices that the client could have made in the face of choices actually made.
The nurse promises to bring a client a requested hand towel, but an hour later, the nurse has not returned. Which moral principle has this nurse violated? A. Fidelity B. Autonomy C. Veracity D. Justice
Answer: A Rationale: Fidelity is a faithful agreement or promise, which has been broken in this situation. Justice is equal treatment of all clients. Veracity is truth-telling. Autonomy is respecting the client's decision making.
A client has a rare form of pancreatic cancer and qualifies to join a clinical trial of a new investigational drug. The nurse provides the client with complete risk information before the client signs up to become a research participant. Which principle of ethical decision making did the nurse honor? A. Veracity B. Justice C. Beneficence D. Autonomy
Answer: A Rationale: Veracity is the principle behind giving complete information before obtaining a client's informed consent. Autonomy is the right of self-determination. Justice ensures fair treatment. Beneficence means taking action to promote good, but because the nurse has no experience with the new drug, it is not known whether it will be good for the client.
The nurse is discussing consent for care with a 16-year-old client who does not want to involve the parents in care. For which health condition may the minor seek care without parental consent? (Select all that apply.) A. Sexually transmitted infections B. Prenatal care C. Birth control D. Substance abuse E. Asthma
Answer: A, B, C, D Rationale: Depending on state law, minors may obtain birth control, prenatal care, substance abuse counseling, and treatment for sexually transmitted diseases without parental consent. Parental consent is required for the long-term care of asthma.
The nurse is discussing ethical end-of-life care of an older adult client with the interdisciplinary team. Which issue of care should the nurse include in the conversation? (Select all that apply.) A. Risks and benefits of treatment B. Autonomy C. Ability to pay for care and funeral expenses D. Presence of depression E. Cognitive impairment
Answer: A, B, D, E Rationale: Autonomy, cognitive decline, depression, and understanding of the risks and benefits of treatment are common ethical issues in end-of-life care. Financial status is not included.
The nurse is assessing patients at a hospice care facility. Which patient will most likely have the greatest challenges with regard to moral development? A. A person who has experienced multiple losses B. A child who is the victim of years of child abuse and neglect C. A child who has learning disabilities D. An adult who has never faced a moral decision
Answer: B A child who is repeatedly exposed to abuse or neglect has likely not undergone healthy moral development. Learning disabilities do not necessarily impair moral development. A person who has experienced multiple losses may have dysfunctional coping skills, but this is not a matter of moral development. It is unlikely that any adult in society has never faced a moral decision.
Which program was specifically designed to increase patient engagement and set forth patient rights? A. American Hospital Association Bill of Rights B. The Joint Commission's Speak Up Campaign C. The Patient Self-Determination Act D. American Nurses' Association Code of Ethics
Answer: B The Joint Commission's Speak Up Campaign is designed to help patients learn and understand their rights and provides guidance on how to apply those rights during the course of care. The American Nurses' Association Code of Ethics also covers patient rights, but this is a very broad code and not directly applicable to patients. The Patient Self-Determination Act provides a guide to healthcare workers about the rights of patients; it is not a guide for patients. The American Hospital Association Patient Bill of Rights outlines patient rights and responsibilities but does not elaborate on how to apply or engage those rights.
Which statement describes the application of utilitarianism? A. A physician practice adds a second provider to help increase the number of patients in the practice. B. A behavioral health agency closes three small rural clinics to expand and improve services provided in their busiest facilities. C. A hospital expands its emergency department services in order to provide more efficient care. D. A nurse leaves a job in home hospice because of morality issues tied to providing pain medications.
Answer: B Utilitarianism is the concept under which an act that provides the greatest benefit to the largest number of people is the correct action. Expansion of an emergency department and addition of a new provider to an office are responses to increasing volume, not examples of the application of moral theory. A nurse leaving a job for reasons of morality is not acting within the concept of utilitarianism.
The nurse in the emergency department greets and treats a variety of clients with the same level of care. Which professional nursing value is demonstrated by this nurse? A. Autonomy B. Social justice C. Altruism D. Integrity
Answer: B Rationale: Social justice is the equal treatment of all clients without regard to cultural or socioeconomic background, ethnicity, gender, religion, disability, or sexual orientation. Altruism is a concern for the welfare of others. Integrity is practicing in an honest and ethical manner. Autonomy is supporting the independent decision making of others.
The nurse is caring for a client with a broken arm. On assessment, the nurse notes bruising that is not consistent with the story of a fall presented by the client. The client is withdrawn when the client's significant other comes to the bedside. Which action should the nurse take? A. Asking the significant other about the cause of the bruising B. Following legal reporting obligations for suspected domestic violence C. Calling the police D. Completing the discharge and releasing the client
Answer: B Rationale: The nurse has both moral and legal obligations to act on suspected or confirmed abuse and would follow the applicable law to report suspected domestic violence. The immediate action is any step indicated by state law, not necessarily calling the police immediately. The nurse would investigate the bruising with the significant other away from the bedside before releasing the client. The nurse would not break the confidentiality of the client's medical information by discussing findings with the significant other.
The interdisciplinary team discusses a conflict in care-planning ideals between parents and an ill child. Which action should the interdisciplinary team first try to navigate this ethical issue? A. Asking a judge for guardianship of the child B. Developing a therapeutic relationship with the child and parents C. Calling the police D. Contacting the hospital ethics committee
Answer: B Rationale: The team would first develop a therapeutic relationship with the child and parents to discuss options and plan treatment. There is no indication that the police are needed. The ethics committee may be involved if the desires of the parents and child significantly diverge. Legal action would be taken if the parents were making poor decisions regarding the care of the child.
The nurse is part of a committee charged with the moral dilemma of deciding how to spend a $50,000 donation from the estate of a former client. Which action on the part of the committee demonstrates utilitarianism? A. Covering the medical expenses of a single client who cannot afford the needed treatment B. Securing vaccination stock to provide no-cost vaccines to approximately 2,000 children C. Building a new front entrance named for the donor to support the relationship with the family D. Investing the donation in a high-risk stock to attempt to increase the money available
Answer: B Rationale: Utilitarianism aims to provide the most good for the greatest number of people, which is exemplified here by the provision of vaccinations to children. Investing the money is a high-risk option with unknown benefit. Covering expenses for a single client and supporting the relationship with the donor's family do not benefit the largest number of people.
The nurse manager is concerned about how the stress of ethical dilemmas is affecting the nurses of the unit. Which intervention should the nurse plan for the staff to help them cope with ethical dilemmas? (Select all that apply.) A. Encouraging time at the bedside to foster immersion in the dilemma B. Acquiring resources to ease the impact of future stressors C. Modeling coping behaviors D. Planning education for coping E. Creating a network for peer support
Answer: B, C, D, E Rationale: The nurse manager can use the framework from risk management to help combat the impact of ethical issues in the workplace. This includes modeling coping behaviors, planning education sessions, creating a support network, and acquiring resources. The nurse manager would want to encourage the nurses to spend free time away from the unit as a means of relieving pressure.
The nurse is caring for an 66-year-old older woman who has identified her next-door neighbor as her advocate and support person. Which is the appropriate action by the nurse under The Joint Commission's Speak Up Campaign guidelines? A. Documenting that no next of kin is available B. Informing the neighbor that the patient is likely confused and thinks she is a family member C. Respecting the patient's wishes and allowing the neighbor to serve as the patient's advocate D. Informing the patient that the support person or advocate must be a relative
Answer: C According to The Joint Commission's Speak Up Campaign, the patient may select an advocate and support person of his or her choice during hospitalization, regardless of whether this person is a relative. A family member may or may not be available, but the patient has the right to select someone else to serve as advocate during hospitalization.
The nurse taking a certification class becomes aware that a colleague enrolled in the same class is practicing academic dishonesty. The nurse is trying to decide what to do about the situation. Which is the first step that the nurse should take in making an ethical decision? A. Waiting until there is more evidence B. Asking another trusted student what to do C. Identifying a range of actions with potential outcomes D. Making a decision and sticking to it
Answer: C In ethical decision making, the first step is to identify possible courses of action and link each one with possible outcomes. This will help identify the course of action that carries the most desirable result. A snap decision probably does not involve consideration of all options and possibilities and may result in regret. It may be beneficial to speak to a trusted peer or advisor, but this is not the initial course of action. Waiting and doing nothing is likely to result in increased stress related to the situation.
The nurse is reviewing the American Hospital Association's (AHA's) patient responsibilities with a 19-year-old patient at 34 weeks of gestation. As the nurse is speaking, the patient interrupts and says, "I get it. You're in charge, and I have to do what you tell me." Which response by the nurse is most appropriate? A. "Patient responsibilities are intended to help keep you and members of your healthcare team safe and comfortable." B. "Patient responsibilities are established to make sure that you know you can refuse care without suffering any consequences." C. "Patient responsibilities are designed to help you and your healthcare providers work together as a team." D. "Patient responsibilities are meant to help you understand that you are entitled to respectful, courteous care."
Answer: C Patient responsibilities emphasize healthcare as a partnership between the patient and caregivers and help patients more actively participate in their own healthcare. Patient responsibilities serve to protect the rights of all patients receiving care by emphasizing every patient's right to be safe and comfortable. Additionally, patient responsibilities include understanding that there are consequences to noncompliance with treatment plans. Respectful, courteous care is a patient right.
The nurse is caring for an older patient whose adult son is their healthcare proxy. The son is refusing to allow the mother to receive opioid medication for postoperative pain and to ambulate or engage in deep-breathing exercises because of pain. Which action by the nurse demonstrates ethical consideration for this patient? A. Keeping the son's wishes confidential by logging out of the medical record after documenting them B. Understanding state law that the patient's son can refuse treatment C. Requesting orders for the patient to receive non-narcotic and alternative treatments for pain D. Asking a pain management specialist to speak to the son
Answer: C Requesting non-narcotic and alternative treatments for pain control demonstrates ethical consideration for the patient's pain management and respects the son's decision to refuse opioid medication. Referring the patient to a pain management specialist exemplifies the ethical component of comfort. Understanding state law and keeping the patient's information confidential exemplifies the ethical concepts of cognition, communication, and legal issues.
A hospital that has a shortage of RNs but an increasing patient census is exploring ways to accommodate this increased patient volume without hiring additional RNs. The facility decides to increase the nurse/patient ratio and hire additional unlicensed assistive personnel (UAPs) to fill the gap. Which ethical dilemma does this solution present? A. This practice may discourage UAPs from furthering their careers because they already have steady employment. B. The hospital may not be able to attract qualified RNs if the nurse/patient ratio is increased. C. The decision could lead to a reduction in the quality of care provided. D. The hospital will be perceived as being cheap instead of cost-effective, resulting in bad publicity.
Answer: C Solving short staffing of RNs by using more unlicensed personnel could result in a decrease in the quality of care provided. Unlicensed personnel serve the important function of supporting and assisting nurses, but a decrease in the number of professional nurses and supplementation with unlicensed personnel will not provide the same level of care. Although the hospital may have difficulty recruiting or retaining RNs with this practice, this will likely lead to further staffing challenges rather than ethical concerns. Unlicensed personnel may or may not continue on the path of furthering their careers, but their decision will likely not be linked to staffing practices. The hospital may experience bad publicity as a result of staffing issues, but this is not the ethical dilemma associated with this practice.
The nurse is interviewing a patient who has a persistent cough. The patient reports doing online research and using essential oils to treat the cough. Which ethical dilemma does this pose for the nurse? A. Deciding whether to contact the manufacturer of the essential oils B. Deciding whether to document that the patient is using essential oils to treat the cough C. Deciding whether the patient should be told that the treatment is not effective D. Deciding whether to continue the interview, because the patient is already self-treating
Answer: C The emergence of smart technology has allowed patients to conduct online research about illnesses and their treatments. Some sources report information that might seem credible but is actually false. An ethical dilemma is created by this situation, because the nurse must decide whether the patient should be told that this choice of treatment is not effective. The interview should be completed; this is not an ethical decision. The use of essential oils should also be documented and shared with the healthcare provider, because the nurse is ethically obligated to report a complete medical history.
An older adult patient is increasingly unable to care for himself. The patient has had several falls and his children are worried about his ability to live alone safely. Which is the most frequently encountered patient rights issue related to older adult patients? A. Deciding whether or not to have a do-not-resuscitate (DNR) order B. Designating of a power of attorney for healthcare C. Deciding on long-term care in nursing homes or skilled nursing facilities D. Getting providers to listen and take their complaints seriously
Answer: C The most common patient rights issue for older adults is long-term care in a nursing home or skilled nursing facility. Long-term care facilities are required by federal law to protect the rights and promote the well-being of residents in their care. Designating someone to hold power of attorney and drawing up advance directive and DNR orders are also issues related to patient rights for the older patients but are not as commonly encountered as long-term care. Healthcare providers should take complaints seriously, regardless of the age of the patient.
The son of a patient who has end-stage liver cancer asks the nurse not to give his mother any pain medication, saying that it "makes her drowsy." Which action is the nurse's obligation as it relates to ethical care of the patient? A. Telling the son that this is not a viable course of action and notifying the healthcare provider B. Following the law by honoring the wishes of the son who is requesting that pain medication be withheld C. Arriving at the course of action that is in the best interest of the patient and preserves the integrity of all individuals involved D. Administering the pain medication without telling the son to protect the autonomy of the patient
Answer: C The nurse has an obligation to respect the autonomy and rights of the patient but is also obliged to include family in the care plan when applicable. The outcome may require a lot of discussion and clarification and a multidisciplinary approach to the patient's care. The nurse is not obligated to follow the wishes of the son without respect to the rights of the patient. Secretly administering the pain medication would violate the trust of the son. The nurse should include the healthcare provider but should not make a blanket statement to the son that this is not possible.
Which action can aid the nurse in making ethical decisions in patient care? A. Basing decisions on what most colleagues believe B. Reviewing and revising policies as needed C. Using evidence-based nursing protocols D. Taking the most conservative course of action
Answer: C Use of evidence-based nursing protocols can help drive ethical decision making because there is an established likelihood of a particular outcome. Policies should be reviewed regularly, but this is not linked to ethical practice. Basing decisions on a "majority rules" system is not ethical practice. Taking the most conservative action may be indicated in some situations but may not be the correct application of ethical practice.
The nurse is performing care interventions for patients who lack moral development or have been exposed to corrupt environments. Which is an important self-care consideration for the nurse? A. Refraining from speaking to these patient unless necessary because they pose a safety risk B. Taking the opportunity to discuss their own moral code with patients in an effort to foster moral development C. Ensuring personal safety by taking such measures as getting between a patient and the door D. Instructing these patients about how they must be compliant in all aspects of care because the care team has formed a plan that implements morals and ethics
Answer: C When caring for a patient with no moral development, the nurse should take precautions to ensure personal safety, such as not allowing the patient to get between the nurse and the door. The nurse may request a security escort for all patient contact as well. A nurse should never attempt to impart their own moral code on a patient, because this is a personal belief system. The patient still has rights, and the nurse should still interact with the patient. Instructing the patient to follow the prescribed plan of care because the healthcare providers know best is removing patient autonomy and is inappropriate.
The nurse is caring for a client who is awaiting the results of a magnetic resonance imaging (MRI) scan to determine the extent of a malignant brain tumor. The results are posted in the medical record and indicate that the prognosis is not good, but the healthcare provider has not seen the report yet. The client asks the nurse about the results. Which is the nurse's best response under the principle of veracity? A. "Your brain tumor has gotten worse and spread to other areas. Your condition is definitely worsening." B. "I don't know whether the results have been posted. The healthcare provider will need to give you that information." C. "The results have been posted on your chart, and your healthcare provider will come speak to you after reviewing them." D. "I am not allowed to tell you test results."
Answer: C Rationale: Applying the principle of veracity requires the nurse to be truthful, but it is not in the scope of practice for a nurse to disclose information about test results or diagnoses. Acknowledging that results are available and that the healthcare provider will discuss them with the client is truthful. Disclosing the diagnosis is not permitted under the scope of practice of nursing. Saying that the nurse is not allowed to report results may be a true statement, but it is not supportive or client centered. Stating that the results are unknown is not a true statement.
The nurse delivering a seminar about ethics and nursing asks the audience to describe an issue that could lead to ethical conflict in the workplace. Which response indicates an issue that may give rise to an ethical conflict? A. "Because of more stringent cost-containment methods, allocation of resources is becoming a less urgent ethical issue." B. "Personnel issues are not a valid source of ethical conflict because they're usually rooted in personality clashes." C. "Staffing shortages are a critical ethical concern because research shows a link between staffing and safe client care." D. "Focusing on palliative treatment and emphasizing the nurse's role leads to ethical conflicts in nursing."
Answer: C Rationale: Staffing shortages represent a critical concern; many studies link adequate staffing and safe client care. Personnel issues can give rise to ethical conflicts in the nursing workplace. Because of increasingly stringent cost-containment methods, resource limitations are especially urgent issues. Another source of ethical conflict is the traditional healthcare power structure, including the focus on providing curative rather than palliative treatment and emphasizing the healthcare provider's role.
The nurse is reading a news article in which the ethical dilemma posed by end-of-life suffering is discussed. The article describes how a healthcare provider delivered a requested lethal dose of pain medication to a client with a terminal illness. Which end-of-life issue does this article address? A. Do-not-resuscitate (DNR) order B. Assisted suicide C. Euthanasia D. Advance directives
Answer: C Rationale: The administration of a lethal medication to a client is euthanasia. A DNR order is an example of an advance directive, a document that lets caregivers know the desires of the client regarding care, especially end-of-life care. In assisted suicide, the client is provided a lethal dose of medication for self-administration.
An emergency department nurse is contacted by a friend whose father is a long-term care resident in a nursing facility that has had a fire. The friend describes the father and asks to be informed if he arrives in the emergency department. As those injured in the fire begin to arrive, the nurse spots a man matching the description given by the friend. Which action should the nurse take? A. Calling the friend and saying that the father has arrived B. Taking a picture of the man, posting it on social media, and tagging the friend C. Identifying the man and confirming his emergency contact D. Telling the friend that nothing can be done
Answer: C Rationale: The best action by the nurse is to confirm the identity of the client and the client's contact information to see whether the friend is the emergency contact. If there is no way to confirm that the friend is related or should be contacted, there is nothing the nurse can do. The nurse would not notify the friend without the client's consent. The nurse should never post information about clients to social media.
The nurse delegates vital signs to an unlicensed assistive personnel (UAP). The UAP reports the vital signs to the nurse, which indicate hypotension and bradycardia. The nurse then assesses the client. Which moral principle is exhibited by the nurse? A. Nonmaleficence B. Fidelity C. Accountability D. Beneficence
Answer: C Rationale: Under the principle of accountability, the nurse is responsible for the outcomes of care rendered and the care given by trainees and subordinates. Fidelity is faithfulness to an agreement. Beneficence is the act of doing well. Nonmaleficence is the avoidance of causing harm.
The nurse is working with a client with a progressive, debilitating muscle disease. The client is struggling with treatment and end-of-life decision making, so the nurse begins the process of clarifying values. Which is the first step in this process? A. Acting with a pattern B. Examining possible consequences C. Listing alternatives D. Choosing a course of action
Answer: C Rationale: Values clarification is a seven-step process that begins with listing the alternatives. The next steps are examining possible consequences of choices, freely choosing a course of action, feeling good about the choice, affirming the choice, acting on the choice, and acting with a pattern.
A 16-year-old girl reports being sexually active and taking birth control pills. The patient tells the nurse that her parents don't know this and would kick her out of the house if they did. Which action should the nurse take? A. Telling the patient that the parents wouldn't really kick them out B. Informing the parents because the patient is a minor C. Telling the patient not to worry, that this information will not be documented D. Respecting the right to confidentiality provided for adolescents
Answer: D Pediatric patient rights have a provision that is particularly applicable to adolescents. The rights note that because the patient is a minor, parents must be told about all aspects of treatment and care, with the provision that it is safe for the patient. It is also essential that nurses understand the state laws related to confidential care for adolescents and are prepared for the ethical dilemmas involved. The decision to inform the parents must be weighed against the possible detriment to the patient. The information must be documented and should be disclosed to other members of the healthcare team. The fears of the adolescent should also not be downplayed, because the nurse does not have firsthand knowledge of the family's dynamics.
The nurse is reviewing the Patient's Bill of Rights with colleagues. Which factor mentioned by a colleague requires further teaching? A. Information about how to file a complaint against a provider or organization B. Information about the confidentiality of patient information C. Information about the right of patients to choose their providers D. Information about damages awarded if a patient is harmed
Answer: D The Patient's Bill of Rights is intended to protect consumers. It provides information about a patient's right to be informed about care, right to choose a provider, right to privacy and confidentiality, and right to file a complaint. There is no provision for awarding damages in the event of harm.
The nurse is caring for a patient who has no brain activity and no hope of recovery. Three family members agree to withdraw care while one family member refuses this course of action stating, "I saw a woman on TV who was declared brain dead but who woke up a year later." Which indication of unclear values applies in this situation? A. Ignoring a healthcare professional's advice B. Numerous or repeated instances of the same behavior C. Inconsistent communication or behavior D. Confusion or uncertainty about which course of action to take
Answer: D The fact that the family members do not agree on a course of action indicates confusion resulting from unclear values. The family member who disagrees with the course of action may have an unclear understanding of the situation and may therefore require support and further discussion with providers. The situation is not an example of failure to follow the healthcare provider's advice or inconsistent communication. Nor is there any indication of numerous or repeated instances of the same behavior.
A highly skilled bariatric surgeon performs about one surgery per month at the facility, and the hospital is required to carry expensive insurance to cover bariatric procedures. The hospital decides to discontinue the service as a cost-saving measure. Which consequent-based theory is applied in this situation? A. Relationship-based theory B. Responsibility C. Principles-based theory D. Utilitarianism
Answer: D Utilitarianism is a form of consequence-based theory in which a moral act is chosen on the grounds that it will provide the most good and pose the least harm for the greatest number of people. A utilitarian approach is often used in making decisions about the funding and delivery of healthcare. Principles-based theory involve logical and formal processes and emphasize individual rights, duties, and obligations. Relationships-based theories stress the importance of the roles of courage, generosity, and commitment. These are framed in terms of justice.
The nurse in an inpatient hospice realizes that part of hospice care is aggressive pain management, including the administration of high doses of pain medications to patients. The nurse is not morally opposed to this practice, believing that it gives comfort in a patient's final days. Which process does the nurse apply to reach this decision? A. Social justice B. Continuing education C. Patient advocacy D. Values clarification
Answer: D Values clarification is a process of consciously identifying, examining, and developing individual values. Some of these developed values are incorporated into patient advocacy. Continuing education can help shape values, but this is not the individual application of them. Social justice refers to the upholding of justice on a community or social scale.
A nurse whose brother was killed by a drunken driver is assigned to admit a client who has been in a car crash. The client is in police custody after being arrested for driving drunk for the third time. Which action on the part of the nurse aligns with the professional code of ethics for nurses? A. The nurse provides minimal care to keep the client alive. B. The nurse delegates all care of the client to an assistant. C. The nurse refuses care of the client. D. The nurse cares for the client in the same manner as for other clients.
Answer: D Rationale: The professional ethics code for nursing care aligns with the equal effort of care delivery to all clients despite differences in moral agreement between the client and the nurse. Refusal of care, purposeful delegation for the avoidance of care, and poor effort in equal care delivery do not align with the professional code of ethics for nurses.
The nurse on an organ transplant unit is saddened by the death of a client and reflects on the many issues surrounding organ transplantation. Which issue is the nurse most likely to identify as the primary ethical concern in organ transplantation? A. The high risk of transplantation surgery B. The nursing shortage C. The cost of organ transplantation D. The lack of organs for those needing transplantation
Answer: D Rationale: These issues all influence the running of an organ transplantation program, but the primary ethical concern of organ transplantation is the lack of donor organs for those who need transplants, leading to difficulty in ethical decision making regarding who should receive these precious resources.
The grandmother of a child in need of medical treatment tells a nurse that the parents are withholding consent for necessary care and asks whether this is legal. Which is the nurse's best response? A. "If you kidnap the child to get treatment, we'll treat the child." B. "I cannot discuss issues about potential clients." C. "The parents ultimately make the decision." D. "Withholding treatment could be viewed as child abuse."
Answer: D Rationale: Withholding necessary treatment of a child if the case is not futile is child abuse under the Child Abuse and Treatment Act of 1984. The nurse would teach the concerned grandmother and connect her with the needed resources to ensure the proper care of the child. The nurse would not focus on the consent of the parents or potential care of the child or encourage the grandmother to kidnap the child.
