TLB-Chapter 6: Values, Ethics, and Advocacy

A parent teaches a child not to drink and drive; however, the parent does drink and drive. This action results in: A. conflict with society. B. a failure to model one's own values. C. insecurity and a lack of safety. D. a disruption in consistency.

B a failure to model one's own values. RATIONALE Many role models fail to model their own values and, as a result, cause conflict with and confusion in those who look up to them, such as children (not society, in general). The primary result of this action, which is saying one thing and doing another, is not so much insecurity and a lack of safety or a disruption in consistency as it is a failure to reflect one's own values.

A nurse who is working in a hospital setting uses value clarification to help understand the values that motivate patient behavior. Which examples denote "prizing" in the process of values clarification? Select all that apply. A. A patient decides to quit smoking following a diagnosis of lung cancer. B. A patient shows off a new outfit that she is wearing after losing 20 pounds. C. A patient chooses to work fewer hours following a stress-related myocardial infarction. D. A patient incorporates a new low-cholesterol diet into his daily routine. E. A patient joins a gym and schedules classes throughout the year. F. A patient proudly displays his certificate for completing a marathon.

B. A patient shows off a new outfit that she is wearing after losing 20 pounds. F. A patient proudly displays his certificate for completing a marathon.

A client is scheduled to have an elective surgical procedure performed but cannot decide whether to go forward with the procedure or cancel it. The client asks the nurse to help make the decision because the client lacks knowledge about the procedure. Which action by the nurse is the best way for this nurse to advocate for the client? A. Call the surgeon, and have the surgeon explain the procedure again. B. Allow the client to verbalize feelings, and provide information to help the client assess options. C. Refer the client to the social worker for help assembling a team to help the client make the decision. D. Refuse to help the client, and state that the client alone must make the decision.

B. Allow the client to verbalize feelings, and provide information to help the client assess options. RATIONALE Nurses as advocates must realize that they do not make decisions for their clients, but they can facilitate decision making by allowing the client to verbalize feelings and by providing information to help the client assess options. This is not an appropriate time to call in the surgeon or the social worker. Refusing to help the client is not the best example of client advocacy performed by a nurse.

A nurse wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. The nurse believes his dying is being prolonged painfully. The patient's doctor threatens the nurse with firing if the nurse raises questions about the patient's care or calls the consult. What ethical conflict is this nurse experiencing? A. Ethical uncertainty B. Ethical distress C. Ethical dilemma D. Ethical residue

B. Ethical distress RATIONALE Ethical distress results from knowing the right thing to do but finding it almost impossible to execute because of institutional or other constraints (in this case, the nurse fears the loss of job). Ethical uncertainty results from feeling troubled by a situation but not knowing if it is an ethical problem. Ethical dilemmas occur when the principles of bioethics justify two or more conflicting courses of action. Ethical residue is what nurses experience when they seriously compromise themselves or allow themselves to be compromised.

A nurse caring for patients in an institutional setting expresses a commitment to social justice. What action best exemplifies this attribute? A. Providing honest information to patients and the public B. Promoting universal access to health care C. Planning care in partnership with patients D. Documenting care accurately and honestly

B. Promoting universal access to health care RATIONALE The American Association of Colleges of Nursing lists promoting universal access to health care as an example of social justice. Providing honest information and documenting care accurately and honestly are examples of integrity, and planning care in partnership with patients is an example of autonomy.

A nurse caring for patients in the intensive care unit develops values from experience to form a personal code of ethics. Which statements best describe this process? Select all that apply. A. People are born with values. B. Values act as standards to guide behavior. C. Values are ranked on a continuum of importance. D. Values influence beliefs about health and illness. E. Value systems are not related to personal codes of conduct. F. Nurses should not let their values influence patient care.

B. Values act as standards to guide behavior. C. Values are ranked on a continuum of importance. D. Values influence beliefs about health and illness.

A student nurse begins a clinical rotation in a long-term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements accurately describe this concept? Select all that apply. A. Advocacy is the protection and support of another's rights. B. Patient advocacy is primarily performed by nurses. C. Patients with special advocacy needs include the very young and the older adult, those who are seriously ill, and those with disabilities. D. Nurse advocates make good health care decisions for patients and residents. E. Nurse advocates do whatever patients and residents want. F. Effective advocacy may entail becoming politically active.

A, C, F RATIONALE Advocacy is the protection and support of another's rights. Among the patients with special advocacy needs are the very young and the older adult, those who are seriously ill, and those with disabilities; this is not a comprehensive list. Effective advocacy may entail becoming politically active. Patient advocacy is the responsibility of every member of the professional caregiving team—not just nurses. Nurse advocates do not make health care decisions for their patients and residents. Instead, they facilitate patient decision making. Advocacy does not entail supporting patients in all their preferences.

An older nurse asks a younger coworker why the new generation of nurses just aren't ethical anymore. Which reply reflects the BEST understanding of moral development? A. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." B. "I don't agree that nurses were more ethical in the past. It's a new age and the ethics are new!" C. "Ethics is genetically determined...it's like having blue or brown eyes. Maybe we're evolving out of the ethical sense your generation had." D. "I agree! It's impossible to be ethical when working in a practice setting like this!"

A. "Behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop an ethical code." RATIONALE The ability to be ethical, to make decisions, and to act in an ethically justified manner begins in childhood and develops gradually.

A parent of a 17-year-old high school student is allowing the child to decide which college the child will attend. When the child requests direction from the parent in making this decision, the parent responds by stating, "You will need to make this decision on your own." What type of value transmission is the parent displaying? A. Laissez-faire B. Modeling C. Moralizing D. Responsible choice

A. Laissez-faire RATIONALE This situation demonstrates laissez-faire value transmission, which is characterized by allowing the adolescent to explore values independently and the development of a personal value system. The laissez-faire approach involves little or no guidance and can lead to confusion and conflict. Through modeling, children learn that which is of high or low value by observing parents, peers, and significant others. The moralizing mode of value transmission teaches a complete value system and allows little opportunity for the weighing of different values. Responsible choice encourages children to explore competing values and to weigh their consequences while support and guidance are offered.

A nurse obtains an order for a bed alarm for a confused client. This is an example of which ethical principle? A. Paternalism B. Deception C. Confidentiality D. Conflict

A. Paternalism RATIONALE Making a decision for a client who is confused to prevent an injury is an example of paternalism. Deception occurs when the true nature or reason is concealed and the client is deprived of basic human rights. Confidentiality requires a health care provider to keep a client's personal health information private unless consent to release the information is provided by the client. Conflict is a disagreement or argument and does not represent the example in this question.

A hospice nurse is caring for a patient with end-stage cancer. What action demonstrates this nurse's commitment to the principle of autonomy? A. The nurse helps the patient prepare a durable power of attorney document. B. The nurse gives the patient undivided attention when listening to concerns. C. The nurse keeps a promise to provide a counselor for the patient. D. The nurse competently administers pain medication to the patient.

A. The nurse helps the patient prepare a durable power of attorney document. RATIONALE The principle of autonomy obligates nurses to provide the information and support patients and their surrogates need to make decisions that advance their interests. Acting with justice means giving each person his or her due, acting with fidelity involves keeping promises to patients, and acting with nonmaleficence means avoiding doing harm to patients.

A nurse shows client advocacy by: A. insisting that a medication be taken. B. offering a hospice consultation to a client who is terminally ill. C. sending a client home with D. verbal discharge instructions. D. refusing to allow a spouse to stay by the bedside.

B. offering a hospice consultation to a client who is terminally ill. RATIONALE The definition of advocacy is to ensure that the client's best interests are being met. A hospice consult is an appropriate example. Insisting that a client take a medication does not reflect advocacy for the client because it violates the client's autonomy. Sending a client home with verbal discharge instructions is normal and customary practice and does not ensure that the client's best interests are being met. Refusing to allow a spouse to stay by the client's bedside is not likely to be in the best interests of the client.

What would be an example of the nurse practicing fidelity? The nurse: A. regulates visitors. B. stays with a client during death as promised. C. withholds information as requested. D. provides continuity of care.

B. stays with a client during death as promised. RATIONALE Fidelity requires the nurse to keep promises made and to be faithful to one's commitments. Regulating visitors is a demonstration of the value of privacy. Withholding client's information as requested is an example of maintaining confidentiality. Providing continuity of care is an example of integrity and professionalism.

It is time for a nurse to renew licensure. The nurse says, "I need some really easy and quick continuing education hours. I don't understand why we have to do these every year." What is the nurse's coworker's best response? A. "There is lots of free continuing education online." B. "See if any of the classes we have to take at the hospital each year will count." C. "Life-long learning is part of the code for nurses." D. "It is hard to get enough hours since we work full time and have families."

C. "Life-long learning is part of the code for nurses." RATIONALE While all of these answers have some merit, the best is to remind the nurse that life-long learning is an expectation of nursing and is part of the American Nurses Association Code for Nurses.

A nurse reports to the charge nurse that a client medication due at 9 am was omitted. Which principle is the nurse demonstrating? A. Altruism B. Social justice C. Integrity D. Autonomy

C. Integrity RATIONALE The principle of integrity is based on the honesty of a nurse according to professional standards. In this instance, the nurse reported the occurrence of the missed medication to the charge nurse. The definition of altruism is concern for others; it can best be explained by a nurse concerned about how a client will care for self after discharge. Social justice is a concept of fair and just relations between the individual and society and is related to wealth and distribution of goods in a society. Autonomy is the right to self-determination or acting independently and making decisions.

Ethical distress is: A. being aware of the principles of right and wrong. B. supporting the rights of a client during hospitalization. C. knowing the correct action but being unable to perform it due to constraints. D. having trouble deciding which of two conflicting ethical principles to follow.

C. knowing the correct action but being unable to perform it due to constraints. RATIONALE Knowing the correct action but being unable to perform it due to constraints is the definition of moral or ethical distress. Being aware of knowing what is right and wrong is the first step of having an ethical conscience. Supporting a client during a hospitalization is an ethical principle of doing what is right (beneficence) and the focus of client-centered care. An ethical dilemma is a situation in which a person has difficulty deciding which of two or more conflicting ethical principles to follow.

Which example best describes feminist ethics? A. A combination of elements of utilitarian and deontologic theories that offer specific action guidelines for practice B. Attention directed to the specific situation of individual clients viewed within the context of their life narratives C. The formal study of ethical issues that arise in the practice of nursing D. An approach critiquing existing patterns of oppression and domination in society

D. An approach critiquing existing patterns of oppression and domination in society RATIONALE Feminist ethics offer an approach critiquing existing patterns of oppression and domination in society, especially as they affect women and the poor. The principle-based approach to ethics combines elements of utilitarian and deontologic theories and offers specific action guidelines for practice. The care-based approach directs attention to the specific situation of individual clients viewed within the context of their life narratives. The formal study of ethical issues that arise in the practice of nursing describes nursing ethics.

A nurse incorporates the "five values that epitomize the caring professional nurse" (identified by the American Association of Colleges of Nursing) into a home health care nursing practice. Which attribute is best described as acting in accordance with an appropriate code of ethics and accepted standards of practice? A. Altruism B. Autonomy C. Human dignity D. Integrity

D. Integrity RATIONALE The American Association of Colleges of Nursing defines integrity as acting in accordance with an appropriate code of ethics and accepted standards of practice. Altruism is a concern for the welfare and well-being of others. Autonomy is the right to self-determination, and human dignity is respect for the inherent worth and uniqueness of individuals and populations.

A pediatric nurse is assessing a 5-year-old boy who has dietary modifications related to his diabetes. His parents tell the nurse that they want him to value good nutritional habits, so they decide to deprive him of a favorite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission? A. Modeling B. Moralizing C. Laissez-faire D. Rewarding and punishing

D. Rewarding and punishing RATIONALE When rewarding and punishing are used to transmit values, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. Through modeling, children learn what is of high or low value by observing parents, peers, and significant others. 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. Those who use the laissez-faire approach to value transmission leave children to explore values on their own (no single set of values is presented as best for all) and to develop a personal value system.

A home health nurse performs a careful safety assessment of the home of a frail older adult to prevent harm to the patient. The nurse's action reflects which principle of bioethics? A. Autonomy B. Beneficence C. Justice D. Fidelity E. Nonmaleficence

E. Nonmaleficence RATIONALE Nonmaleficence is defined as the obligation to prevent harm. Autonomy is respect for another's right to make decisions, beneficence obligates us to benefit the patient, justice obligates us to act fairly, and fidelity obligates us to keep our promises.