Ethical Aspects of Gerontological Nursing NCLEX Exam 3
A client has recently been told he has terminal cancer. As the nurse enters the room, he yells, "My eggs are cold, and I'm tired of having my sleep interrupted by noisy nurses!" The nurse may interpret the client's behavior as: A. An expression of the anger stage of dying B. An expression of disenfranchised grief C. The result of maturational loss D. The result of previous losses
A
Cultural awareness is an in-depth self-examination of one's: A. Background, recognizing biases and prejudices. B. Social, cultural, and biophysical factors C. Engagement in cross-cultural interactions
A
Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the: A. American Nurses Association's (ANA's) Code of Ethics B. Nurse Practice Act (NPA) written by state legislation C. Standards of care from experts in the practice field D. Good Samaritan laws for civil guidelines
A
The philosophy sometimes called the code of ethics of care suggests that ethical dilemmas can best be solved by attention to A. Relationships B. The client C. The code of ethics
A
When caring for a terminally ill client, it is important for the nurse maintain the client's dignity. This can be facilitated by: A. Spending time to let clients share their life experiences B. Decreasing emphasis on attending to the clients' appearance because it only increases their fatigue C. Making decisions for clients so they do not have to make them D. Placing the client in a private room to provide privacy at all times
A
Which of the following is not included in evaluating the degree of heritage consistency in a client? A. Gender B. Ethnicity C. Religion D. Culture
A
Nurses are bound by a variety of laws. Which of the following descriptions of types of law is correct? A. Statutory law is created by elected legislatures, such as the state legislature that defines the Nurse Practice Act (NPA). B. Regulatory law provides for prevention of harm to the public and punishment when those laws are broken. C. Common law protects the rights of the individual within society to fair and equal treatment. D. Criminal law creates boards that pass rules and regulations to control society.
A Statutory law is created by legislatures. These bodies enact statutes such as the NPA, which defines the role of the nurse and expectations of the nurse's performance of his or her duties and explains what is contraindicated as guidelines for the breach of those regulations. Regulatory law or administrative law is created by an administrative body such as the Board of Nursing, which passes rules and regulations. Common law is created by judicial decisions in court based on individual cases that are decided. Criminal law prevents harm to society and provides punishment for crimes
Obtaining informed consent is the responsibility of A. The physician B. The RN manager C. The nurse D. The CNA
A The physician is RESPONSIBLE for obtaining an informed consent. The nurse can witness that the signature was obtained by the patient.
When the nurse described the client as "that nasty old man in 354," the nurse is exhibiting which ethical dilemma? A. Gender bias and ageism B. HIPPA violation C. Beneficence D. Code of ethics violation
A. Stereotyping an "old man" as "nasty"is a gender bias and an ageism issue. The nurse is verbalizing a negative descriptor about the client.
A client's family member says to the nurse, "The doctor said he will provide palliative care. What does that mean?" The nurse's best response is: A. "Palliative care is given to those who have less than 6 months to live." B. "Palliative care aims to relieve or reduce the symptoms of a disease." C. "The goal of palliative care is to affect a cure of a serious illness or disease." D. "Palliative care means the client and family take a more passive role and the doctor focuses on the physiological needs of the client. The location of death will most likely occur in the hospital setting."
B
Cultural competence is the process of A. Learning about vast cultures B. Acquiring specific knowledge, skills, and attitudes C. Influencing treatment and care of clients D. Motivation and commitment to caring
B
The code of ethics for nurses is composed and published by A. The national league for Nursing B. American Nursing Association C. The American Medical Association D. National Institute of Health
B
What should the nurse do when planning nursing care for a client with a different cultural background? The nurse should: A. Allow the family to provide care during the hospital stay so no rituals or customs are broken B. Identify how these cultural variables affect the health problem C. Speak slowly and show pictures to make sure the client always understands
B
Loss is only experienced when there is an actual absence of something valued A. True B. False
B Loss may be maturational, situational, or both
The nurse practice acts are an example of civil law. A. True B. False
B False- they are Statutory law
Transcultural nursing implies? A. Working in another culture to practice nursing within their limitations B. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate C. Combining all cultural beliefs into a practice that is a nonthreatening approach to minimize cultural barriers for all clients' equality of care
B Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate
The nurse puts a restraint jacket on a client without the client's permission and without the physicians order. The nurse may be guilty of assault. A. True B. False
B. Battery is physical in nature. Assault is a threat.
A bioethical issue should be described as: A. The physician's making all decisions of client management without getting input from the client B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of a specific drug therapy. C. The withholding of food and treatment at the request of the client in a written advance directive given before a client acquired permanent brain damage from an accident. D. After the client gives permission, the physician's disclosing all information to the family for their support in the management of the client.
B. The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in the white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early in the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed.
Miss Magu, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value
C
The best explanation of what Title VI of the Civil Rights Act mandates is the freedom to: A. Pick any physician and insurance company despite one's income B. Receive free medical benefits as needed within the county of residence C. Have equal access to all health care regardless of race and religion
C
When helping a person through grief work, the nurse knows A. Coping mechanisms that were effective in the past are often disregarded in response to the pain of a loss B. A person's perception of a loss has little to do with the grieving process C. The sequencing of stages of grief may occur in order, they may be skipped, or they may reoccur. D. Most clients want to be left alone
C
The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? A. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state B. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. D. The client cannot make changes in the advance directive once the client is admitted into the hospital.
C A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.
The distribution of nurses to areas of "most need" in the time of a nursing shortage is an example of: A. Utilitarianism theory B. Deontological theory C. Justice D. Beneficence
C Justice is defined as the fairness of distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff.
A client who had a "Do Not Resuscitate" order passed away. After verifying there is no pulse or respiration's, the nurse should next: A. Have family members say goodbye to the deceased. B. Call the transplant team to retrieve vital organs. C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately. D. Call the funeral director to come and get the body
C The body of the deceased should be prepared before the family comes in to view and say their goodbyes. This includes removing all equipment, tubes, supplies, and dirty linens according to protocol, bathing the client, applying clean sheets, and removing trash from the room.
Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.
C Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.
Which factor is least significant during assessment when gathering information about cultural practices? A. Which factor is least significant during assessment when gathering information about cultural practices? B. Touch, eye contact C. Bio-cultural needs D. Pain perception, management expectations
C. Cultural practices do not influence bio-cultural needs because they are inborn risks that are related to a biological need and not a learned cultural belief or practice
A health care issue often becomes an ethical dilemma because A. A clients legal rights coexist with a health professionals obligation B. Decisions must be made quickly, often under stressful conditions C. Decisions must be made based on value systems D. The choices involved do not appear to be clearly right or wrong
D
A retired nurse stops to help in an emergency at the scene of an accident, if the injured party files suit and the, the nurse would probably be covered by A. Her homeowner's insurance B. Her automobile insurance C. National Care Act D. The Good Samaritan Law
D
Bereavement may be defined as A. The emotional response to loss B. The outward, social expression of loss C. Postponing the awareness of the reality of the loss D. The inner feeling and outward reactions of the survivor
D
The nurse is obligated to follow a physicians order unless: A. The order is a verbal order B. The order is illegible C. The order has not been transcribed D. The order is an error, violates hospital policy, or would be detrimental to the client.
D
What are the stages of dying according to Elizabeth Kubler-Ross? A. Numbing; yearning and searching; disorganization and despair; and reorganization. B. Accepting the reality of loss, working through the pain of grief, adjusting to the environment without the deceased, and emotionally relocating the deceased and moving on with life. C. Anticipatory grief, perceived loss, actual loss, and renewal. D. Denial, anger, bargaining, depression, and acceptance.
D
In the United States, access to health care usually depends on a client's ability to pay for health care, either through insurance or by paying cash. The client the nurse is caring for needs a liver transplant to survive. This client has been out of work for several months and does not have insurance or enough cash. A discussion about the ethics of this situation would involve predominately the principle of: A. Accountability, because you as the nurse are accountable for the well being of this client. B. Respect of autonomy, because this client's autonomy will be violated if he does not receive the liver transplant. C. Ethics of care, because the caring thing that a nurse could provide this patient is resources for a liver transplant. D. Justice, because the first and greatest question in this situation is how to determine the just distribution of resources.
D Justice refers to fairness. Health care providers agree to strive for justice in health care. The term often is used during discussions about resources. Decisions about who should receive available organs are always difficult.
Which statement would best explain the role of the nurse when planning care for a culturally diverse population? The nurse will plan care to: A. Include care that is culturally congruent with the staff from predetermined criteria B. Focus only on the needs of the client, ignoring the nurse's beliefs and practices C. Blend the values of the nurse that are for the good of the client and minimize the client's individual values and beliefs during care D. Provide care while aware of one's own bias, focusing on the client's individual needs rather than the staff's practices
D Without understanding one's own beliefs and values, a bias or preconceived belief by the nurse could create an unexpected conflict or an area of neglect in the plan of care for a client (who might be expecting something totally different from the care). During assessment values, beliefs, practices should be identified by the nurse and used as a guide to identify the choices by the nurse to meet specific needs/outcomes of that client. Therefore identification of values, beliefs, and practices allows for planning meaningful and beneficial care specific for this client.
Eligibility to receive low-income loans or reimbursement for expenses is provided to hospitals that follow safety provisions of service established by: A. Board of Nursing Examiners (BNE) B. Nurse Practice Act (NPA) C. American Nurses Association (ANA) D. Americans With Disabilities Act (ADA)
D If a hospital fails to follow ADA guidelines for meeting the special needs of persons with disabilities, the facility loses funding and become ineligible to receive low-income loans or reimbursement of expenses. ADA protects the civil rights of disabled people. Its provisions apply to both hospital clients and hospital staff.
Besides the Joint Commission on Accreditation of Healthcare Organizations (JACHO), which governing agency regulates hospitals to allow continued safe services to be provided, funding to be received from the government and penalties if guidelines are not followed? A. Board of Nursing Examiners (BNE) B. Nurse Practice Act (NPA) C. American Nurses Association (ANA) D. Americans With Disabilities Act (ADA)
D. If the hospital fails to follow ADA guidelines for meeting special needs, the facility loses funding and status for receiving low-income loans or reimbursement of expenses. ADA protects the civil rights of disabled people. It applies to both the hospital clients and hospital staff. Privacy issues for persons who are positive for human immunodeficiency virus (HIV) have been one issue in relationship to getting information when hospital staff have been exposed to unclean sticks. The ADA allows the infected client the right to choose whether or not to disclose that information.
When signing a form as a witness, your signature shows that the client: A. Is fully informed and is aware of all consequences B. Was awake and fully alert and not medicated with narcotics C. Was free to sign without pressure D. Understands the language of the form E. None of the above
E When a nurse witnesses an informed consent, he/she is only witnessing he/she saw it being done.
A nurses point of view is valuable in an ethical committee because it is recommended by the nurses code of ethics. A. True B. False
False
In a situation in which there is insufficient staff to implement competent care, a nurse should refuse the assignment. A. True B. False
False: Accept the assignment but make a protest in writing to the administration
As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the A. Nurse Practice Act (NPA). B. American Nursing Association (ANA) C. National Council for Lisensure Examinations D. State Board of Licensure
Nurse Practice Act (NPA)
Which statement about an institutional ethics committee is correct? A. The ethics committee is an additional resource for clients and health care professionals. B. The ethics committee relieves health care professionals from dealing with ethical issues. C. The ethics committee would be the first option in addressing an ethical dilemma. D. The ethics committee replaces decision making by the client and health care providers
The ethics committee is an additional resource for clients and health care professionals.
Disparities in health outcomes between the rich and the poor illustrate the influence of socioeconomic factors in morbidity and mortality. Social factors such as poverty and lack of universal medical insurance compromise the health status of the poor and unemployed True or False?
True
Ethnocentrism is the root of biases and prejudices. A. True B. False
True
Nurses who follow orders that are incomplete or incorrect are the leading cause of litigation in the hospital. A. True B. False
True The failure of the nurse to question the physician about an order creates an area of liability on the nurse's part because this is perceived as a medical action and not the role of the nurse to write orders.
The client's right to refuse treatment is an example of _________ laws.
civil
