Chapter 6, Values, Ethics, and Advocacy
A nurse provides client care within a philosophy of ethical decision making and professional expectations. What is the nurse using as a framework for practice? A) Code of Ethics B) Standards of Care C) Definition of Nursing D) Values Clarification
Ans: A Feedback: A professional code of ethics provides a framework for making ethical decisions and sets forth professional expectations. Codes of ethics inform both nurses and society of the primary goals and values of the profession.
A nursing instructor is teaching a class about ethical principles to a group of nursing students. The instructor determines that the teaching was successful when the students give which of the following as an example of nonmaleficence? A) Protecting clients from a chemically impaired practitioner B) Performing dressing changes to promote wound healing C) Providing emotional support to clients who are anxious D) Administering pain medications to a client in pain
Ans: A Feedback: Protecting clients from a chemically impaired practitioner is an appropriate example of nonmaleficence. Nonmaleficence means to avoid doing harm, to remove from harm, and to prevent harm. Performing dressing changes to promote wound healing, providing emotional support to clients who are anxious, and administering pain medications to a client in pain are examples of beneficence, which means doing or promoting good.
A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as? A) Nonmaleficence B) Justice C) Fidelity D) Autonomy
Ans: A Feedback: The principle-based approach to ethics combines elements of both utilitarian and deontologic theories and offers specific action guides for practice. The Beauchamp and Childress principle-based approach to bioethics (2001) identifies four key principles: autonomy (promote self-determination), nonmaleficence (avoid causing harm), beneficence (benefit the patient), and justice (act fairly).
A client with a diagnosis of colorectal cancer has been presented with her treatment options, but wishes to defer any decisions to her uncle, who acts in the role of a family patriarch within the client's culture. By which of the following is the client's right to self-determination best protected? A) Respecting the client's desire to have the uncle make choices on her behalf B) Revisiting the decision when the uncle is not present at the bedside C) Teaching the client about her right to autonomy D) Holding a family meeting and encouraging the client to speak on her own behalf
Ans: A Feedback: The right to self-determination (autonomy) means that it should never be forced on anyone. The client has the autonomous right to defer her decision-making to another individual if she freely chooses to do so.
When a nurse refuses to compromise a client's right to privacy, even when the nurse is threatened, the nurse is expressing an ethical framework termed what? A) Utilitarian B) Deontologic C) Justice D) Nonmaleficence
Ans: B Feedback: Deontologic frameworks emphasize roles or responsibilities that one is morally obligated to fulfill.
While at lunch, a nurse heard other nurses at a nearby table talking about a client they did not like. When they asked him what he thought, he politely refused to join in the conversation. What value was the nurse demonstrating? A) The importance of food in meeting a basic human need B) Basic respect for human dignity C) Men do not gossip with women D) A low value on collegiality and friendship
Ans: B Feedback: Nurses who feel uncomfortable gossiping with other nurses about patients realize that this behavior contradicts a basic respect for human dignity. This respect is a value that allows one to choose freely to believe in the worth and uniqueness of each individual.
What is the function of the American Nurses Association's Code of Ethics for Nurses? A) Serves to establish personal ethics for nurses B) Delineates nurses' conduct and responsibilities C) Serves as a guideline for all health care practice D) Plays an important role in legal proceedings
Ans: B Feedback: The ANA recently revised the Code of Ethics for Nurses that delineates the conduct and responsibilities expected of all nurses in their nursing practices.
An ethical conflict exists around a female client's expressed desire to have a neighbor make her treatment decisions. This neighbor is an individual who the client's children characterize as a predator. Place in the correct order the steps that the nurse should follow in resolving this ethical conflict. 1. Clearly identify the ethical problem 2. Apply ethical principles to the situation 3. Identify the different options 4. Gather relevant data about the situation 5. Make and evaluate a decision A) 1, 2, 3, 4, 5 B) 4, 1, 3, 2, 5 C) 2, 3, 4, 1, 5 D) 1, 4, 3, 2, 5
Ans: B Feedback: The nursing process of assessment, diagnosis, planning, implementation, and evaluation can be applied to appropriately respond to many ethical dilemmas.
A dying client tells the nurse that he doesn't want to see his family because he doesn't want to cause them more sadness. Which action by the nurse is most appropriate? A) Arrange a meeting between the family and the client. B) Help the patient clarify his values. C) Educate the patient on death and dying concepts. D) Allow the patient time for quiet reflection.
Ans: B Feedback: Values clarification is a method of self-discovery by which people identify their personal values and value rankings. The client's value of family may be obscured because of his overwhelming need to protect his family.
The nurse medicates her for pain. This is an example of which of the following ethical frameworks? A) Justice B) Fidelity C) Beneficence D) Nonmaleficence
Ans: C Feedback: Beneficence means doing or promoting good. The treatment of the client's pain is the nurse's act of doing good.
A client nearing the end of life requests that he be given no food or fluids. The physician orders the insertion of a nasogastric tube to feed the client. What situation does this create for the nurse providing care? A) Nurse must follow the physician's orders B) An inability to provide care for the patient C) An ethical dilemma about inconsistent courses of action D) A barrier to establishing an effective nurse-patient relationship
Ans: C Feedback: In an ethical dilemma, two or more clear moral principles apply but support mutually inconsistent courses of action. In this case, the nurse must decide what to do based on ethical decision making and take action that can be justified ethically based on that process.
A nurse has a duty of nonmaleficence. Which of the following would be considered a contradiction to that duty? A) Provide comfort measures for a terminally ill patient. B) Assist the patient with ADLs. C) Refuse to administer pain medication as ordered. D) Provide all information related to procedures.
Ans: C Feedback: The duty not to inflict harm, as well as prevent and remove harm, is termed nonmaleficence. Providing comfort measures for a terminally ill patient, assisting a patient with ADLs and providing information related to procedures would not be considered a contradiction to the nurse's duty of nonmaleficence.
A nurse in a women's health clinic values abstinence as the best method of birth control. However, she offers compassionate care to unmarried pregnant adolescents. What is the nurse demonstrating? A) modeling of value transmission B) conflict in values acceptance C) nonjudgmental "value neutral" care D) values conflict that may lead to stress
Ans: C Feedback: The nurse is demonstrating nonjudgmental "value neutral" care. This means she is respecting and accepting the individuality of patients, does not assume that her personal values are right, and does not judge the patients' values as right or wrong depending on their congruence with hers.
Which of the following modes of value transmission is most likely to lead to confusion and conflict? A) Modeling B) Moralizing C) Laissez-faire D) Responsible choice
Ans: C Feedback: Those who use the laissez-faire approach for value transmission leave children to explore values on their own (no one set of values is presented as best for all) and to develop a personal value system. This approach often involves little or no guidance and can lead to confusion and conflict.
A middle-aged man is having increasing difficulty breathing. He never exercises, eats fast food regularly, and smokes two packs of cigarettes a day. He tells the nurse practitioner that he wants to change the way he lives. What is one means of helping him change behaviors? A) Ethical change strategy B) Values neutrality choices C) Values transmission D) Values clarification
Ans: D Feedback: Values clarification is a process by which people come to understand their own values and value system. When nurses understand the values that motivate patients' decisions and behaviors, they can tap these values when teaching and counseling patients.
A male client age 56 years is experiencing withdrawal from alcohol and is placing himself at risk for falls by repeatedly attempting to scale his bedrails. Benzodiazepines have failed to alleviate his agitation and the nurse is considering obtaining an order for physical restraints to ensure his safety. The nurse should recognize that this measure may constitute what? A) Paternalism B) Deception C) Harm D) Advocacy
Ans: A Feedback: Paternalism involves the violation of a client's autonomy in order to maximize good or minimize harm, a situation that requires careful consideration in light of ethical principles. Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy is the protection and support of another's rights.
A client who is scheduled to have surgery for a hernia the next day is anxious about the whole procedure. The nurse assures the client that surgery for hernias is very common and that the prognosis is very good. What skills of the nurse are reflected here? A) Imaginal skills B) Interpersonal skills C) Instrumental skills D) Systems skill
Ans: B Feedback: The scenario reflects the nurse's interpersonal skills. It shows how a person relates with others. The nurse shows imaginal skills when he or she envisions a plan for adapting and personalizing client care. Instrumental skills are associated with basic physical and intellectual competencies. Systems skills are those that help the nurse see the whole picture and how various parts relate.
A nurse in a physician's office has noted on several occasions that one of the physicians frequently obtains controlleddrug prescription forms for prescription writing. The physician reports that his wife has chronic back pain and requires pain medication. One day the nurse enters the physician's office and sees him take a pill out of a bottle. The doctor mentions that he suffers from migraines and that his wife's pain medication alleviates the pain. What type of nursephysician ethical situation is illustrated in this scenario? A) Unprofessional, incompetent, unethical, or illegal physician practice B) Disagreements about the proposed medical regimen C) Conflicts regarding the scope of the nurse's role D) Claims of loyalty
Ans: A Feedback: The physician is demonstrating unprofessional, incompetent, unethical, or illegal physician practice.
A nurse working in a long-term care facility has an elderly male client who is very confused. What ethical dilemma is posed when using restraints in a long-term care setting? A) It limits personal safety. B) It increases confusion. C) It threatens autonomy. D) It prevents self-directed care.
Ans: C Feedback: Because there are safety risks involved when using restraints on elderly confused clients, this is a common ethical problem in long-term care settings, as well as other health care settings. Restraints limit the individual's autonomy because they are perceived as imprisonment. Restraints should not limit personal safety. Often, restraints increase confusion, and they prevent self-directed care.
A nurse has had, on several occasions, the opportunity to share personal prescriptions with family members when they were in need of pain medication or antibiotics. Which set of rules should govern this moral decision? A) Ethics B) Administrative law C) Common law D) Civil law
Ans: A Feedback: Although all of the options may affect your decision, moral decisions are guided by ethics, which are internal set of principles and values that guide the behavior of a person. Sharing medications prescribed to you with other people, including family members, would be considered unethical. It is important to distinguish ethics from law, religion, custom, and institutional practices. For example, the fact that an action is legal or customary does not in itself make the action ethically or morally right.
A nurse states to the client that she will keep her free of pain. However, her family wishes to try a treatment to prolong her life that may necessitate withholding pain medication. This factor will cause an ethical dilemma for the nurse in relation to which ethical principle? A) Fidelity B) Veracity C) Justice D) Autonomy
Ans: A Feedback: Fidelity means being faithful to one's commitments and promises.
A home health nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accord with which of the following, a principle of bioethics? A) Nonmaleficence B) Advocacy C) Morals D) Values
Ans: A Feedback: Nonmaleficence is a principle of bioethics and is defined as the obligation to prevent harm. Advocacy, morals, and values are not principles of bioethics.
A nurse is caring for a client who is a practicing Jehovah's Witness. The physician orders two units of packed cells based on his low hemoglobin and hematocrit levels. The nurse states to the surgeon that it is unethical to go against the patient's beliefs even though his blood counts are very low. What is the best description of the nurse's intentions? A) Acting in the patient's best interest B) Siding with the patient over the surgeon C) Observing institutional policies D) Being legally responsible
Ans: A Feedback: Nurses' ethical obligations include acting in the best interest of their clients, not only as individual practitioners, but also as members of the nursing profession, the health care team, and the community at large.
A group of nurse researchers has proposed a study to examine the efficacy of a new wound care product. Which of the following aspects of the methodology demonstrates that the nurses are attempting to maintain the ethical principle of nonmaleficence? A) The nurses are taking every reasonable measure to ensure that no participants experience impaired wound healing as a result of the study intervention. B) The nurses have organized the study in such a way that the foreseeable risks and benefits are distributed as fairly as possible. C) The nurses have given multiple opportunities for potential participants to ask questions, and have been following the informed consent process systematically. D) The nurses have completed a literature review that suggests the new treatment may result in decreased wound healing time.
Ans: A Feedback: The principle of nonmaleficence dictates that nurses avoid causing harm. In this study, this may appear in the form of taking measures to ensure that the intervention will not cause more harm than good. The principle of justice addresses the distribution of risks and benefits, and the informed consent process demonstrates that autonomy is being protected. Preliminary indications of the therapeutic value of the intervention show a respect for the principle of beneficence.
A student nurse is working in the library on her plan of care for a clinical assignment. The client's name is written at the top of her plan. What ethical responsibility is the student violating? A) Confidentiality B) Accountability C) Trust D) Informed consent
Ans: A Feedback: The student is violating confidentiality. Confidentiality is violated when patients are identified by name on written documents available to those who are not directly responsible for their care.
A mother always thanks clerks at the grocery store. Her daughter age 6 years echoes her thank you. The child is demonstrating what mode of value transmission? A) Modeling B) Moralizing C) Reward and punishment D) Responsible choice
Ans: A Feedback: Through modeling, children learn of high or low value by observing parents, peers, and significant others. Modeling can thus lead to socially acceptable or unacceptable behaviors. Children whose caregivers use the moralizing mode of value transmission are taught a complete value system by parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different values. Through rewarding and punishing, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Caregivers who follow the responsible-choice mode of value transmission encourage children to explore competing values and to weigh their consequences.
The children of a female client 78 years of age with a recent diagnosis of early-stage Alzheimer's disease are attempting to convince their mother to move into an assisted living facility, a move to which the client is vehemently opposed. Both the client and her children have expressed to the nurse how they are entrenched in their position. Which of the following statements expresses a utilitarian approach to this dilemma? A) The decision should be made in light of consequences. B) The client's autonomy and independence are the priority considerations. C) Benefits and burdens should be evenly distributed between the children and the client. D) The client has a right to self-determination.
Ans: A Feedback: Utilitarianism is the theory of ethics that weighs rightness and wrongness according to consequences and outcomes for all those who are affected. Utilitarianism prioritizes these consequences and outcomes over principles such as autonomy and justice; principles that underlie the other statements addressing the patient's right to self-determination; and fair distribution of benefits and burdens.
The client was diagnosed with diabetes three years ago, but has failed to integrate regular blood glucose monitoring or dietary modifications into his lifestyle. He has been admitted to the hospital for treatment of acute renal failure secondary to diabetic nephropathy, an event that has prompted the client to reassess his values. Which of the following actions most clearly demonstrates that this client is engaging in the step of prizing within his valuing process? A) The client expresses pride that he now has the knowledge and skills to take control of his diabetes management. B) The client states that he will now begin to check his blood glucose before each meal and at bedtime. C) The client is now able to explain how his choices have contributed to his renal failure. D) The client expresses remorse at how his failure to take make lifestyle changes has adversely affected his health.
Ans: A Feedback: Within the valuing process, expressions of pride and happiness are considered to be indications of prizing. Resolving to make changes is an aspect of choosing, while expressing insight about his role in his current diagnosis demonstrates that the client has the desire to re-examine his values.
Which of the following are examples of a nurse demonstrating the professional value of altruism? Select all that apply. A) The nurse arranges for an interpreter for a client whose primary language is Spanish. B) The nurse calls the physician of a client whose pain medication is not strong enough. C) The nurse provides information for a client so he is capable of participating in planning his care. D) The nurse reviews a client chart to determine who may be informed of the patient's condition. E) The nurse documents client care accurately and honestly and reviews the entry to ensure there are no errors.
Ans: A, B Feedback: The altruistic nurse demonstrates understanding of cultures, beliefs, and perspectives of others; advocates for clients; and takes risks on behalf of clients and colleagues. The professional practice reflects autonomy when the nurse respects clients' rights to make decisions about their health care. Human dignity is reflected when the nurse values and respects all clients and colleagues by preserving their confidentiality. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Social justice is upholding moral, legal, and humanistic principles. One way to do this is by encouraging legislation and policy consistent with the advancement of nursing care and health care.
A woman age 83 years who has suffered a cerebrovascular accident and is unable to swallow refuses the insertion of a feeding tube. This is an example of what ethical principle? A) Nonmaleficence B) Veracity C) Autonomy D) Justice
Ans: C Feedback: Autonomy essentially means independence and the ability to be self-directed.
A client, unsure of the need for surgery, asks the nurse, "What should I do?" What answer by the nurse is based on advocacy? A) "If I were you, I sure would not have this surgical procedure." B) "Gosh, I don't know what I would do if I were you." C) "Tell me more about what makes you think you don't want surgery." D) "Let me talk to your doctor and I will get back to you as soon as I can."
Ans: C Feedback: Nurses as advocates must realize that they do not make ethical decisions for their clients. Rather, they facilitate clients' decision-making by interpreting findings, informing cliients of various aspects to be considered, helping clients verbalize and organize their feelings, calling in others involved in the decision making, and helping clients assess all their options in relation to their beliefs.
A nurse is caring for a client who is a celebrity in the area. A person claiming he is a family member inquires about the medical details of the client. The nurse reveals the information but later comes to find out that the person was not a family member. The nurse has violated which of the following? A) Veracity B) Fidelity C) Confidentiality D) Autonomy
Ans: C Feedback: The nurse has violated the principle of confidentiality by revealing the client's personal medical information to a third person. Confidentiality is a professional duty and a legal obligation. What is documented in the client's record is accessible only to those providing care to that client. The nurse's action does not violate rules of veracity, fidelity, or autonomy. Fidelity means being faithful to one's commitments and promises. Veracity means telling the truth, which is essential to the integrity of the client-provider relationship. Autonomy involves a client making his or her own decisions.
A home care nurse visits a client who is confined to bed and is cared for by her daughter. The daughter is known to suffer from chemical dependence. The home is cluttered and unclean. During the assessment the nurse notes that the client is wet with urine and has dried feces on her buttocks, and demonstrates signs of dehydration. After caring for the client, the nurse contacts the physician and reports the incident to Adult Protective Services. This is an example of which ethical framework? A) Justice B) Autonomy C) Nonmaleficence D) Fidelity
Ans: C Feedback: The principle of nonmaleficence means to avoid doing harm, to remove harm, and to prevent harm. Autonomy means to respect the rights of clients or their surrogates to make healthcare decisions. Justice means to give each his or her due. Fidelity means to keep promises.
A nurse is concerned about the practice of routinely ordering a battery of laboratory tests for clients who are admitted to the hospital from a long-term care facility. An appropriate source in handling this ethical dilemma would be which of the following? A) The client's family B) The admitting physician C) The nurse in charge of the unit D) The institutional ethics committee
Ans: D Feedback: Many health care institutions have developed ethics committees whose functions include education, policymaking, case review, and consultation. These committees are multidisciplinary and provide a forum where divergent views can be discussed without fear of repercussion.
Two children need a kidney transplant. One is the child of a famous sports figure, whereas the other child comes from a low-income family. What ethically relevant consideration is important to the nurse as an advocate for these clients? A) Balance between benefits and harms in patient care B) Norms of family life C) Considerations of power D) Cost-effectiveness and allocation
Ans: D Feedback: The increasing awareness of how difficult it is to make valued and scarce health resources available to all in need has resulted in a new appreciation for the moral relevance of cost-effectiveness. Balance between benefits and harms in patient care relates to reasoning about the benefits or burdens of treatment and the related harms; in this scenario, both children's risk and benefits may be the same. Norms of family life relate to the ways a client's illness impacts family members and significant others; not enough information is provided to know how this ethical principle applies in this scenario. Considerations of power relates to abuse of power by clinicians; this scenario does not present information suggesting this is occurring.
