Ch. 5
A 20-year-old client with Down syndrome is diagnosed with an illness. Even though the client is able to live in an assisted environment and work part-time for a local bookstore, the parents of the client are adamant about not initiating a course of treatment whose side effects are unknown with Down syndrome clients. According to the nursing code of ethics, to whom is the nurse's first loyalty? 1. The client 2. The parent 3. The physician 4. The nurse
Correct Answer: 1 Rationale 1: The nurse's first loyalty is to the client. Conflicts among obligations to families, physicians, employing institutions, and clients may arise because of the nurse's unique position. It is not always easy to determine which action best serves the client's needs. Rationale 2: The nurse's first loyalty is to the client. Conflicts among obligations to families, physicians, employing institutions, and clients may arise because of the nurse's unique position. It is not always easy to determine which action best serves the client's needs. Rationale 3: The nurse's first loyalty is to the client. Conflicts among obligations to families, physicians, employing institutions, and clients may arise because of the nurse's unique position. It is not always easy to determine which action best serves the client's needs. Rationale 4: The nurse's first loyalty is to the client. Conflicts among obligations to families, physicians, employing institutions, and clients may arise because of the nurse's unique position. It is not always easy to determine which action best serves the client's needs.
The school of nursing professor is preparing a classroom activity to assist the students in acquiring professional values. Which actions should the professor select for this assignment? Standard Text: Select all that apply. 1. Discuss codes of ethics with the students. 2. Recommend that the students avoid ethical issues. 3. Encourage the students to discuss experiences. 4. Invite other professors to participate in a discussion. 5. Have the students interview each other about experiences.
Correct Answer: 1, 3, 4, 5 Rationale 1: Nurses' professional values are acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers. Rationale 2: Ethical issues cannot be avoided in nursing or health care. This is not a viable approach for the professor to use. Rationale 3: Nurses' professional values are acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers. Rationale 4: Nurses' professional values are acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers. Rationale 5: Nurses' professional values are acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers.
The nurse is addressing an ethical issue. In which order should the nurse implement the steps of this decision-making process? Standard Text: Click and drag the options below to move them up or down. Choice 1. Interviewing the client regarding details of the problem Choice 2. Discussing the various results of the identified possible actions to resolve the problem Choice 3. Determining what, if any, ethical issues exist Choice 4. Determining whether affected parties are in ethical conflict Choice 5. Assessing all involved parties concerning their ethical beliefs regarding the problem
Correct Answer: 1, 3, 5, 4, 2 Rationale 1: Gathering additional information to clarify the situation is the first step in this model. Rationale 2: Identifying the range of actions with anticipated outcomes is the final step in this process among the available options. Rationale 3: Identifying the ethical issues in the situation occurs immediately after the information concerning the problem is obtained. Rationale 4: Identifying value conflicts occurs after information has been gathered, after it is determined that an ethical problem exists, and after affected individuals are assessed for their ethical beliefs. Rationale 5: Identifying moral positions of key individuals involved occurs after information has been gathered and it is determined that an ethical problem exists.
Parents of a terminally ill child have decided to remove their child from life support, a decision that has met with little positive support. Which nursing action demonstrates autonomy regarding the parents' decision? 1. Showing respect for the family 2. Respecting the parents' decision 3. Referring the parents to social services 4. Asking to be assigned to a different client
Correct Answer: 2 Rationale 1: A nurse can show respect for the family without respecting the decision of the parents. Rationale 2: Autonomy is the right to self-determination, and professional practice reflects autonomy when the nurse respects patients' rights to make decisions about their health care. Rationale 3: Referring the parents to another entity points to feelings of unease about the parents' choice. Rationale 4: Asking to be assigned to another client does not honor the right of patients and families to make decisions about health care.
A nurse mistakenly gave a client who was NPO a morning breakfast tray. After realizing the mistake, the nurse notified the physician as well as the client; explained the consequences of this mistake, which included a delay in the client's scheduled procedure; and documented the situation in the client's medical record. What did this nurse demonstrate? 1. Altruism 2. Integrity 3. Social justice 4. Human dignity
Correct Answer: 2 Rationale 1: Altruism is a concern for the welfare and well-being of others. That is not the value described here. Rationale 2: Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. Rationale 3: Social justice is upholding moral, legal, and humanistic principles. That is not the value described here. Rationale 4: Human dignity is respect for the worth and uniqueness of individuals and populations. That is not the value described here.
A client has been complaining of pain, even though the nurse has given the client the maximum amount of medication as ordered by the physician. Which action demonstrates the nurse's respect for the client's autonomy? 1. Telling the client that he will have to "tough it out" 2. Calling the physician for further orders 3. Telling co-workers that this client has no pain tolerance 4. Believing the client is drug seeking
Correct Answer: 2 Rationale 1: This option does not exemplify the nurse's respect for or consideration of the client's situation. Rationale 2: Honoring the principle of autonomy means that the nurse respects the client's right to make decisions, treating others with consideration and not as impersonal sources of knowledge or training. Believing the client continues to have pain would be an example of treating with consideration. For whatever reason, this particular client is not responding to the medication ordered by the physician, and other medications or treatment should be initiated. Rationale 3: This option does not exemplify the nurse's respect for or consideration of the client's situation. Rationale 4: This option does not exemplify the nurse's respect for or consideration of the client's situation
The nurse manager determines that a staff nurse demonstrates understanding of the professional responsibility to advocate for a client's health, safety, and rights. What did the manager observe to come to this conclusion about the staff nurse? Standard Text: Select all that apply. 1. Reporting a medication error that he was responsible for making 2. Notifying the unit manager that a nurse is showing signs of being under the influence of alcohol 3. Being sure the computer screen is not visible to visitors when charting 4. Asking the client to explain in her own words the purpose of the research project she asked to act in as a participant 5. Calling the health care provider to clarify a confusing prescription for a client's pain
Correct Answer: 2, 3, 4, 5 Rationale 1: This is more reflective of the nurse's responsibility and accountability for personal nursing practice. Rationale 2: The nurse advocates for client health and safety when reporting the impaired nurse. Rationale 3: The nurse advocates for client rights when protecting confidentiality. Rationale 4: The nurse advocates for client health and safety when protecting the participants in a research project. Rationale 5: The nurse advocates for client health and safety when clarifying confusing orders or questionable medical practices.
A client with lung disease is strongly urged to stop smoking but likes to smoke and does not know what to do. In what order should the nurse take the following actions to help this client clarify values? Standard Text: Click and drag the options below to move them up or down. 1. Choose freely. 2. List alternatives. 3. Affirm the choice. 4. Act with a pattern. 5. Examine consequences of choices. 6. Examine feelings about the choice.
Correct Answer: 2, 5, 1, 6, 3, 4 Rationale 1: The nurse should ask if the client has a say in the decision in the third step of the process. Rationale 2: In the first step of the process, the nurse should help the client list alternatives so that the client is aware of all alternative actions. . Rationale 3: The nurse needs to ask how the client affirmed the choice by asking if the choice was discussed with others in the fifth step of the process. Rationale 4: The final step is to find out if the client has acted with a pattern or consistently performs an action in a certain way. Rationale 5: In the second step of the process, consequences of all choices need to be examined so that the client has thought about possible results of each action. Rationale 6: In the fourth step of the process, the nurse needs to examine the client's feelings about the choice. Some clients may not feel satisfied with their decision.
A client who has been blinded as result of an injury informs the rehabilitation staff of planning to return to her counseling practice and working full-time. The nurse should realize that this client is demonstrating which aspect of values clarification? 1. Choosing 2. Prizing 3. Acting 4. Clarifying
Correct Answer: 3 Rationale 1: Choosing is a cognitive action. Beliefs are chosen freely without outside pressure, from among alternatives, and after reflecting and considering consequences. That is not the aspect of values clarification described in the stem. Rationale 2: Prizing is an affective action where chosen beliefs are prized and cherished. That is not the aspect of values clarification described in the stem. Rationale 3: The "acting" component of values clarification is a behavioral action in which chosen beliefs are affirmed to others, incorporated into one's behavior, and repeated consistently in one's life. Stating the intention to return to prior employment on a full-time basis would be an affirmation of the client's plan. Rationale 4: Clarifying values is the process in which choosing, prizing, and acting are accomplished. That is not the aspect of values clarification described in the stem.
A client with terminal cancer is refusing food and fluids, and pushes the caregiver's hands away when attempts are made to feed the client or offer any kind of fluid. The family is considering placing a gastrostomy tube because they feel the client is "starving to death." What should the nurse do? 1. Honor the family's wishes and have them sign a consent form. 2. Talk to the physician so he or she can move forward with the family's wishes. 3. Honor the client's refusal and help the family come to terms with the situation. 4. Take the case to the hospital's ethics committee.
Correct Answer: 3 Rationale 1: Clients, not their families, should make decisions about their own health care and treatment. Rationale 2: The physician may or may not be involved, but not to disregard the client's refusal. Rationale 3: A nurse is morally obligated to withhold food and fluids if it is determined to be more harmful to administer them than to withhold them. The nurse must also honor competent patients' refusal of food and fluids. This position is supported by the ANA's Code of Ethics for Nurses, through the nurse's role as a client advocate and through the moral principle of autonomy. Clients, not their families, should make decisions about their own health care and treatment. In this case, the client has made a decision and it should be honored. Rationale 4: An ethics committee is usually considered when there is an ethical dilemma and more input is needed to make a decision. In this case, the client has made a decision.
The administration of a hospital, along with nursing services, is planning to incorporate a struggling private clinic into the infrastructure of the hospital. Although relocating the clinic may cause transportation difficulty for some clients, keeping the clinic running will allow current employees as well as clients the continued benefit of the clinic. Which moral framework did the hospital leadership use to make this decision? 1. Teleological theory 2. Deontological theory 3. Utilitarianism 4. Caring theory
Correct Answer: 3 Rationale 1: Teleological theories look at the outcomes of an action and judge it to be right or wrong. Rationale 2: Deontological theories, which are principles based, emphasize individual rights, duties, and obligations. In this situation, numerous people are involved with the clinic, not just one person. Rationale 3: Utilitarianism views a good act as one that brings the most good and the least harm for the greatest number of people. Continuing to provide a service, even though it has to be relocated, is better than discontinuing something that clients continue to use and employees depend on. Rationale 4: Caring theories stress courage, generosity, commitment, and the need to nurture and maintain relationships.
A student is attending a school with a high first-time pass rate on the NCLEX®. Which student statement articulates a belief that the nursing student has about faculty in the program? 1. Expect high academic standards from their students 2. Are concerned with job placement of their graduates 3. Are most concerned with the successful licensure of each student 4. Work hard to make sure students are successful
Correct Answer: 3 Rationale 1: The option expresses an attitude. Attitudes are mental positions or feelings that continue over time. This option describes how the student feels about the faculty. Rationale 2: The option expresses an attitude. Attitudes are mental positions or feelings that continue over time. This option describes how the student feels about the faculty. Rationale 3: Beliefs are interpretations or conclusions that people accept as true. They are based more on faith than fact and may or may not be true. Stating that faculty is more concerned with licensure would be a belief that the student has. It may or may not be true and it may be something that the student believes only for a short time—for example, until the student has had experiences with more of the faculty than just a few. Rationale 4: The option expresses an attitude. Attitudes are mental positions or feelings that continue over time. This option describes describe how the student feels about the faculty.
A decision has been made for an older client to receive aggressive cancer therapy despite knowing that the therapy will actually be more harmful than the disease and subject the client to harmful chemicals. With which ethical principle is this nurse caring for this client struggling? 1. Autonomy 2. Justice 3. Beneficence 4. Nonmaleficence
Correct Answer: 4 Rationale 1: Autonomy refers to the right to make one's own decisions. That is not what the nurse is having an ethical dilemma about. Rationale 2: Justice is often referred to as fairness. That is not what the nurse is having an ethical dilemma about. Rationale 3: Beneficence means "doing good." In this case the benefits are not known, making the harm more real. Although aggressive cancer therapy is difficult to endure and given the age of the client, this case suggests beneficence, but there is a more appropriate option available. Rationale 4: Nonmaleficence is the duty to "do no harm." Doing intentional harm is never acceptable in nursing. Placing a client at risk of harm is what is depicted in this scenario, and it occurs as a known consequence of a nursing intervention or some other type of treatment. It is unknown how much therapy will be of benefit to the client or whether it will actually do more harm.
A nurse manager has a staff nurse who observes certain religious holidays. The manager tries to make sure that these observances can be met if possible. Which value is the manager practicing? 1. Human dignity 2. Social justice 3. Autonomy 4. Altruism
Correct Answer: 4 Rationale 1: Human dignity is respect for the inherent worth and uniqueness of individuals and populations. That is not the value described here. Rationale 2: Social justice is upholding moral, legal, and humanistic principles. That is not the value described here. Rationale 3: Autonomy is the right to self-determination, and professional practice reflects autonomy when the nurse respects patients' rights to make decisions about their health care. That is not the value described here. Rationale 4: Altruism is a concern for the welfare and well-being of others. A professional behavior of this value is demonstrating understanding of the cultures, beliefs, and perspectives of others.
A student nurse accidentally left the call light outside the reach of an older client. Another nurse discovered the situation and was able to rectify the matter before something happened. The student apologizes and states the need to double check for call light placement before leaving a client's room. What behavior did the student demonstrate? 1. Justice 2. Fidelity 3. Responsibility 4. Accountability
Correct Answer: 4 Rationale 1: Justice is being fair. That it not the value exhibited by the student nurse. Rationale 2: Fidelity means to be faithful to agreements and promises. That it not the value exhibited by the student nurse. Rationale 3: Responsibility refers to the liability associated with the performance of the duties of a particular role. The student had the responsibility to provide safe care to the client (i.e., make sure the call light was within reach) but did not follow through with it. That it not the value exhibited by the student nurse. Rationale 4: Accountability means "answering to oneself and others for one's own actions." By admitting that double checking should be done, the student showed accountability.
A client with a sexually transmitted illness (STI) asks the nurse to not tell anyone about the diagnosis. According to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, what must the nurse do? 1. Honor the client's wishes. 2. Not disclose any information to anyone. 3. Respect the client's privacy and confidentiality. 4. Communicate only necessary information.
Correct Answer: 4 Rationale 1: Nurses should not make promises to keep necessary information private. Rationale 2: Nurses are entrusted with sensitive information that, at times, must be revealed to other health care personnel in order to provide appropriate health care. Rationale 3: Nurses are entrusted with sensitive information that, at times, must be revealed to other health care personnel in order to provide appropriate health care. Clients must be able to trust that their information is secure and will only be shared with appropriate entities. Rationale 4: HIPAA includes standards that protect the confidentiality, integrity, and availability of data as well as standards that define appropriate disclosures of identifiable health information and patient rights protection. Nurses are entrusted with sensitive information that, at times, must be revealed to other health care personnel in order to provide appropriate health care. In this case, the nurse may be required to report information to the state health department.
A nurse is working with a local agency to provide care to the inadequately insured by helping to staff an after-hours clinic. Which professional value is the nurse demonstrating? 1. Human dignity 2. Altruism 3. Social justice 4. Integrity
Correct Answer: 3 Rationale 1: Human dignity is respect for the worth and uniqueness of individuals and populations. That is not the value described here. Rationale 2: Altruism is concern for the welfare and well-being of others. That is not the value described here. Rationale 3: Social justice is upholding moral, legal, and humanistic principles. This value is demonstrated in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality health care. Rationale 4: Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. That is not the value described here.
The nurse is reviewing the ANA (American Nurses Association) Code of Ethics for Nurses. What should the nurse identify as a characteristic of this code? 1. It is a formal statement. 2. It contains the same standards as legal standards. 3. It is shared by group members. 4. It reflects legal judgments. 5. It serves as a standard for professional actions.
Correct Answer: 5 Rationale 1: A code of ethics is a formal statement of a group's ideals and values. It is a set of ethical principles that (a) is shared by members of the group, (b) reflects their moral (not legal) judgments over time, and (c) serves as a standard for their professional actions. Codes of ethics usually have higher requirements than legal standards, and they are never lower than the legal standards of the profession. Rationale 2: A code of ethics is a formal statement of a group's ideals and values. It is a set of ethical principles that (a) is shared by members of the group, (b) reflects their moral (not legal) judgments over time, and (c) serves as a standard for their professional actions. Codes of ethics usually have higher requirements than legal standards, and they are never lower than the legal standards of the profession. Rationale 3: A code of ethics is a formal statement of a group's ideals and values. It is a set of ethical principles that (a) is shared by members of the group, (b) reflects their moral (not legal) judgments over time, and (c) serves as a standard for their professional actions. Codes of ethics usually have higher requirements than legal standards, and they are never lower than the legal standards of the profession. Rationale 4: A code of ethics is a formal statement of a group's ideals and values. It is a set of ethical principles that (a) is shared by members of the group, (b) reflects their moral (not legal) judgments over time, and (c) serves as a standard for their professional actions. Codes of ethics usually have higher requirements than legal standards, and they are never lower than the legal standards of the profession. Rationale 5: A code of ethics is a formal statement of a group's ideals and values. It is a set of ethical principles that (a) is shared by members of the group, (b) reflects their moral (not legal) judgments over time, and (c) serves as a standard for their professional actions. Codes of ethics usually have higher requirements than legal standards, and they are never lower than the legal standards of the profession.
The nurse learns that a home care client is diluting prescribed nutritional supplements because of the cost. What should the nurse do to advocate for this client? 1. Help the client look for available community resources that may be of assistance. 2. Tell the client that she needs to take the prescribed amount. 3. Report the situation to the physician. 4. Weigh the client on a weekly basis to monitor weight gain or loss.
Correct Answer: 1 Rationale 1: Resource allocation and financial considerations are major issues in home health care. When clients are in their own home, they operate from their own values and client autonomy must be respected. Community resources may be of benefit for this client to be able to afford the proper supplement at the correct dose or to provide assistance in other financial areas so the client has the treatment needs met. Rationale 2: The client already knows she should take the prescribed amount. Rationale 3: Telling the physician will not help to solve the situation. Rationale 4: Weighing the client merely assesses the need, which has already been established.
A client has chosen to discontinue hemodialysis. His family is not supportive of his decision. Which statement should the nurse make that demonstrates the theory of principles-based reasoning? 1. "This client is of sound mind and is capable of making his own decisions regarding health care. It really is his decision to make." 2. "I need to try and help the family understand the client's decision so they can work through this situation together." 3. "This client's health is so deteriorated that the treatment is not saving his life. It is prolonging the ultimate outcome, which is his death." 4. "The client understands his decision and the advanced stage of his disease. If he quits treatment, he will die."
Correct Answer: 1 Rationale 1: Principles-based theories stress individual rights, such as autonomy. The client has the ability to make the decision and it is his right to autonomy to do that. Rationale 2: Caring theories, or relationship theories, stress courage, generosity, commitment, and the need to nurture and maintain relationships. Caring theories promote the common good or the welfare of the group. Trying to help the family understand the client's decision is an example of a caring-based theory in practice. Rationale 3: Consequence-based theories look at the outcomes of an action in judging whether that action is right or wrong. Rationale 4: Consequence theories are exemplified by the nurse looking at the outcomes of the client's decision.
The nurse needs to insert an intravenous access device into a toddler who is crying and scared. The parent asks if the procedure is painful. When practicing veracity, what should the nurse respond to the parent? 1. "I won't lie to you. It may be easier for you if you step out until we get the line in." 2. "We'll take every care not to hurt your child." 3. "It shouldn't be too bad and I'll be quick." 4. "We do this all the time, so don't worry."
Correct Answer: 1 Rationale 1: Veracity refers to telling the truth. Even though telling the truth may frighten the parent, starting an IV on a frightened, scared, ill child is a difficult task. Because of the child's developmental stage, any explanation given by the nurse won't be understood. Being honest with the parent will help the nurse gain trust and will outweigh any benefits that may be gained by downplaying the situation. Rationale 2: Saying that the nurse will everything possible not to hurt the child will not negate the fact that it will hurt. A needle going into a vein is not a comfortable procedure. Rationale 3: Saying that the nurse will perform the task quickly is not a sufficient answer to the parent. A needle going into a vein is not a comfortable procedure. The nurse really doesn't know how bad it will hurt the child. Rationale 4: Telling the parent not to worry is pointless.
The nurse is reviewing the preamble of the International Council of Nurses Code of Ethics. On which responsibilities should the nurse focus when reviewing this preamble? Standard Text: Select all that apply. 1. Promote health. 2. Restore health. 3. Inform the public about minimum standards of nursing conduct. 4. Provide self-regulation in the profession. 5. Prevent illness. 6. Alleviate suffering.
Correct Answer: 1, 2, 5, 6 Rationale 1: Promotion of health is one of the fundamental responsibilities of nurses according to the International Council of Nurses Code of Ethics. Rationale 2: Restoration of health is one of the fundamental responsibilities of nurses according to the International Council of Nurses Code of Ethics. Rationale 3: Informing the public about minimum standards of nursing conduct is not one of the fundamental responsibilities of nurses that is included in the preamble of the International Council of Nurses Code of Ethics. Rationale 4: Providing self-regulation in the profession is not one of the fundamental responsibilities of nurses that is included in the preamble of the International Council of Nurses Code of Ethics. Rationale 5: Preventing illness is one of the fundamental responsibilities of nurses according to the International Council of Nurses Code of Ethics. Rationale 6: The alleviation of suffering is one of the fundamental responsibilities of nurses according to the International Council of Nurses Code of Ethics.
A pregnant client says her main concern is that her baby will be born healthy, even though she admits to drinking alcohol on a regular basis. With what should the nurse realize this client is struggling? 1. Values transmission 2. Values clarification 3. Morals 4. Ethics
Correct Answer: 2 Rationale 1: Values transmission means that values are learned through observation and experience and are influenced by sociocultural environment and traditions. Rationale 2: Behavior that indicates unclear values includes ignoring a health professional's advice, such as using alcohol during pregnancy. Rationale 3: Morals refer to personal standards of what is right and wrong. Rationale 4: Ethics refers to the practices or beliefs of a certain group.
