Chapter 2: Ethics and Standards of Practice Issues

The labor and delivery nurse is providing care to a patient in active labor. The nurse notes electronic fetal monitoring (EFM) changes that suggest fetal distress and monitors the fetus for an additional 20 minutes before calling the health-care provider. The health-care provider determines that an emergency cesarean delivery is required. During transport, EFM is interrupted and not resumed due to expectations of an emergent procedure. A stillborn fetus is delivered. For which actions can the nurse be held legally responsible? Select all that apply

1. Lack of appropriate response to fetal compromise 2. Performance of a technical error related to monitoring 3. Delayed communication resulting in a delay of cesarean

Nurses' responsibilities for speaking up to advocate for the rights, health, and safety of patients are outlined in which of the following?

American Nurses Association Code of Ethics for Nurses

The nurse works in the labor and delivery department. Which action by the nurse indicates a breach in the nursing care principles outlined by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)?

Declines a patient assignment because of a history of illegal drug use

The nurse is providing care for a patient in labor. The unborn fetus was diagnosed with severe microcephaly at 20 weeks' gestation. The patient tells the nurse, "We want everything done to save our baby who has as much right to a good life as anyone else." Which ethical approach does this represent?

Egalitarianism

An experienced obstetrics (OB) nurse has accepted a position in labor and delivery of an inner-city hospital providing care for multicultural clients. Which action by the nurse is most helpful in preparation for this position?

Intensely studying qualitative research focused on practice enhancement

The nurse is experiencing an ethical dilemma when confronted with a situation in which either the mother or fetus is predicted to die. The nurse feels bound by the American Nurses Association (ANA) Code of Ethics to protect both patients. Which aspect of care during an ethical dilemma will guide the nurse?

Maternity nurses are bound to advocate first and foremost for the well-being of the mother.

The new grad nurse is employed in a neonatal intensive care unit (NICU). With each new admission, the neonate is classified in a specific category regarding care. The nurse is in the process of admitting a neonate at 22 weeks' gestation with multiple life-threatening conditions involving both cardiac and respiratory systems. In which category of care does the nurse expect the neonate to be placed?

The category where aggressive care is probably futile

The nurse works in the maternal-newborn unit dedicated to management of high-risk pregnancy and delivery. A patient has delivered two children who died from a genetic disorder. The current pregnancy tests positive for the same disorder. Which ethical decision-making model will the nurse use with this patient?

The model that focuses on quality of life

Which factors will facilitate the integration of evidence-based practice (EBP) in the maternal newborn clinical setting? Select all that apply

1. Frame clinical questions in the PICOT (patient, intervention, comparison, outcome and [sometimes] time) format 2. Cultivate a spirit of inquiry in the workplace. 3. Collect the best and most relevant evidence

Parents of a neonate are grieving over their child's life-threatening disabilities. The neonate's course of treatment has changed three times in the last 24 hours due to irrational parental decisions. Which interventions will the neonatal intensive care unit (NICU) nurse implement in order to fulfill nursing responsibility to both the parents and the neonate? Select all that apply

1. Inform the parents as to realistic expectations. 2. Use the neonate's status with parental counseling 3. Advocate for medical support of the neonate.

The nursing department of a large facility is interested in improving clinical care with the introduction of evidence-based practice (EBP). Which barriers to EBP does the nursing department expect within the facility? Select all that apply

1. Outdated facility politics and policies that do not embrace research-based change 2. Limited resources available to clinical care providers from nursing administration

The nurse is assisting a patient in the use of an ethical decision-making model related to quality of life. Which question is inappropriate when using this model?

Are arrangements made for prolonging life?

A nurse is suspended for refusal to participate in the performance of an elective termination of a pregnancy. Which specific group's standards does the nurse use for job reinstatement?

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)

The nurse is providing care for a patient close to delivery. The patient continuously asks the nurse for medication to "stop the pain." Which ethical principle does the nurse use when replying, "We need to protect the baby from being overmedicated. Let me help you with some breathing and relaxation techniques"?

Beneficence

Which of the following statements is true with regard to cultural competence and cultural humility?

Cultural humility includes ongoing self-reflection and education in which healthcare professionals seek to gain an awareness of their own assumptions and biases that contribute to health disparities.

The nurse in an obstetrics (OB) office is evaluating a patient who exhibits vaginal bleeding at 30 weeks' gestation. The patient is prescribed bedrest at home and instructed to avoid lifting. The patient states, "I cannot go to bed, I have an 18-month-old at home." On which topic of the Jonsen Model for ethical decision-making will the nurse focus?

Medical indications

The nurse on a maternity unit practices her faith as an Orthodox Jew whose rabbi teaches that pregnancy terminations are permitted only to save the life of the mother. Which situation becomes possible if the nurse puts aside personal values and assists with elective terminations?

Moral distress

A patient at 30 weeks' gestation with a first pregnancy arrives at the labor and delivery unit with contractions. After monitoring the patient, the nurse determines the woman is in active labor and calls the health-care provider (HCP), who prescribes a sleeping medication and sends the patient home. Which action does the nurse take?

Questions the HCP's prescribed treatment.

The nurse manager in the labor and delivery unit decides that all unit nurses are to take a course in electronic fetal monitoring (EFM) as recommended by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Which is the most important issue related to EFM the nurse manager is expecting to address?

Reduce failure to accurately assess maternal and fetal status

The nurse works in a postpartum maternal-newborn unit and notices a newborn who is exhibiting signs of distress. Through investigation, the nurse learns the newborn's mother has a history of abusing street drugs. Which facility system does the nurse report as being deficient?

Risk management

The nurse in an obstetrician's office is discussing a patient's request for legally terminating an unwanted pregnancy after the fetus tests positive for Down syndrome. The woman and her spouse have five children from ages 11 to 17 years, and the family lives in an isolated rural area. Which action does the nurse take?

Tell the physician of contextual factors identifying an ethical dilemma