Contemporary Medical Surgical Nursing 2nd Edition by Daniels, Rick – Test Bank

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Chapter 5–Legal and Ethical Aspects of Health Care

MULTIPLE CHOICE

1.The nurse is providing care for a client who is 18 years old. Which of the following ethical principles should be implemented for this client? 

ANS: 4

A person who is at least 18 years of age and can make reasoned choices has autonomy and is free to make decisions regarding his own health care. Liberty is a characteristic of autonomy. Justice is an ethical principle that supports all people seeking health care receiving the best treatment available with dignity and respect. Agency is another characteristic of autonomy that means the capacity for intentional action.

PTS: 1 DIF: Apply REF: Principles of Clinical Ethics

2.A client, being treated with chemotherapy and radiation for terminal cancer, decides to stop any further treatment and enter the hospice program. The nurse realizes this client’s decision is supported by the ethical principle of: 

ANS: 2

Nonmaleficence is the use of ability, judgment, or skill to help someone else without intent to cause injury or harm. In this case, nonmaleficence can support the option of not providing further aggressive or invasive treatment that could cause injury or harm. Autonomy is a self-rule that is free from interference by others and from limitations that prevent a meaningful choice. Beneficence means to be of benefit to others. Justice is a principle whereby all people who seek health care should receive the best possible treatment available with dignity and respect.

PTS: 1 DIF: Analyze REF: Principles of Clinical Ethics

3.The care a nurse provides to clients is considered as being a benefit to their health and recovery. The principle that supports the nurse’s behavior is considered: 

ANS: 3

Justice requires that all cases are treated in like fashion. Beneficence requires that actions are of benefit to others. Autonomy is self-rule that is free from controlling influence by others and from limitations such as inadequate understanding. Nonmaleficence means “do no harm.”

PTS: 1 DIF: Analyze REF: Principles of Clinical Ethics

4.A client recovering from surgery does not want to move out of bed because of pain. The nurse explains the long-term effects of staying in bed and the benefits of movement. The client agrees and is assisted out of bed. This is an example of:

ANS: 3

Beneficence requires that actions are of benefit to others even if the nurse must first cause harm (pain). Autonomy is self-rule that is free from controlling influence by others and from limitations such as inadequate understanding. Nonmaleficence means “do no harm.” Justice requires that cases are treated in like fashion.

PTS: 1 DIF: Analyze REF: Principles of Clinical Ethics

5.The nurse who bases client care actions on the principle of “greatest good” is implementing which ethical theory?

ANS: 3

Utilitarian theory (part of teleology theory) means that the action must be of benefit to the greatest number of people affected by the action. Teleology is the evaluation of final causes (outcomes). Deontology is about one’s moral duty and obligation and is most concerned not with the outcomes of an action but rather with the action. Justice is an ethical principle, not a theory.

PTS:1DIF:ApplyREF:Ethical Theories

6.The nurse is preparing a consent form for a client to sign before a procedure. Which of the following statements explains a characteristic of informed consent? 

ANS: 3

In an emergency situation in which life or limb is at risk, the process of informed consent is waived. Minors cannot give consent unless the client is an emancipated minor. The client must have autonomy, be of legal age, and have the cognitive ability to understand to give consent.

PTS:1DIF:AnalyzeREF:Informed Consent

7.When the nurse obtains a client’s signature for informed consent, the nurse’s responsibility is the verification that:

ANS: 3

The nurse verifies that the person named on the consent is the person to receive the procedure. The nurse ensures that the patient has the right to freely consent or refuse to consent based on the information given and her own personal values and wishes. Informed consent is not agreeing that the client understands everything about a procedure, that a family member witnesses the signature, nor the client has asked all questions about the procedure.

PTS:1DIF:ApplyREF:Informed Consent

8.The health care team is addressing an ethical issue regarding one client’s continuing care. The nurse wants to ensure that the principle of justice is taken into consideration. Which of the following ethical decision-making modules would support this principle?

ANS: 4

The contextual features ethical decision-making model supports the ethical principle of justice. Medical indications support the ethical principles of beneficence and nonmaleficence. Patient preferences support the ethical principle of autonomy. Quality of life supports the ethical principles of beneficence, nonmaleficence, and autonomy.

PTS: 1 DIF: Apply REF: Ethical Decision Making Models

9.The nurse, caring for an elderly client recovering from a fractured coccyx, wants to discuss palliative care. The client becomes alarmed and asks “is there something you aren’t telling me? Am I dying?” Which of the following should the nurse respond?

ANS: 2

Palliative care is a process that focuses on relieving pain, enhancing psychosocial supports, and allowing clients and families to achieve meaningful resolution to their lives together. This is what the nurse should respond to the client. The other responses are either inappropriate for the nurse to make or are incorrect.

PTS: 1 DIF: Apply REF: Hospice and Palliative Care

10.The nurse provides a terminally ill client with dose of a newly prescribed pain medication. Shortly afterwards, the client experiences respiratory arrest and dies. Which of the following describes this client scenario?

ANS: 4

Double effect occurs when the intended use of a palliative therapy has the unintended effect of hastening a client’s death. This is what occurred with the client and the pain medication. Euthanasia is the act of administering a lethal injection of medication with the intent to end another person’s life. Assisted suicide is similar to euthanasia in that a health care provider assists another person to end his life. Intended effect is an intervention that has the outcome that was expected to occur.

PTS: 1 DIF: Analyze REF: Concept of Double Effect

11.An elderly client with septic leg wounds develops multi-system organ failure. The physicians discuss treatment options with the family but explain that success to reverse the condition is minimal. The family has decided to stop all further treatment of the client. This scenario is an example of:

ANS: 1

Medical futility means that an identified therapy for a client has no medical benefit. Do-not-resuscitate means if a client stops breathing or the heart stops beating, resuscitation will not be provided. Active euthanasia is performing an action that ends a person’s life. Assisted suicide is an action by a health care provider that assists a client in ending his or her life.

PTS: 1 DIF: Analyze REF: Limitation of Treatment

12.A client is asked to participate in a research study. The client does not want to participate but does not want to seem unwilling to receive treatment for an illness. Which of the following should the nurse explain to this client?

ANS: 3

The nurse needs to support the client’s right to autonomy and explain that the client has the right to refuse participation in the research study. There is no guarantee that negative effects from the research study will not occur. The nurse should not persuade the client by stating that it is an honor to be asked to participate or that the physician wants the client to participate.

PTS:1DIF:ApplyREF:Research Ethics

13.The nurse caring for elderly clients begins to experience anger, guilt, and frustration over the prescribed medical treatments for the clients. The nurse is demonstrating which of the following? 

ANS: 1

Moral distress in nursing occurs when the nurse is aware of the right and moral action to take in client situations but is unable to carry out the action because of external constraints. This form of distress can lead to feelings of anger, guilt, and frustration. The nurse is not experiencing burnout though burnout could occur if moral distress continues. The nurse is not experiencing signs of a chronic or acute illness.

PTS:1DIF:AnalyzeREF:Moral Distress

MULTIPLE RESPONSE

1.The nurse is analyzing the main principles of clinical ethics prior to planning care for a client. Which of the following are considered the main principles of clinical ethics? (Select all that apply.)

ANS: 2, 4, 5, 6

The four main principles of clinical ethics are: 1) autonomy, 2) nonmaleficence, 3) beneficence, and 4) justice. Liberty is a component of autonomy. Malfeasance is wrong or illegal conduct.

PTS: 1 DIF: Analyze REF: Principles of Clinical Ethics

2.A client, hospitalized with an extensive cerebral vascular accident, is unable to make any treatment decisions. Which of the following documents addresses the client’s treatment choices? (Select all that apply.)

ANS: 1, 2, 4, 5

Advance directives allow a person to make specific decisions about their future health care treatments in advance. Forms of advance directives are the living will, durable power of attorney for health care, and written or verbal advance directive. The incident report is a document that records errors of omission or commission as well as any unusual occurrence. The medication administration record does not address clients’ treatment choices.

PTS:1DIF:ApplyREF:Advance Directives

3.The nurse is confronted with an ethical decision regarding a client’s continuing care. Which of the following approaches can be used to reach a decision for this client? (Select all that apply.)

ANS: 1, 2, 3, 5, 6

There are several approaches that can be used to help with ethical decision making. These approaches are medical indications, client preferences, quality of life, contextual features, and the integrated model. The client’s health insurance plan is not used to help with ethical decision making.

PTS: 1 DIF: Apply REF: Ethical Decision Making Models

4.An elderly terminally ill client is experiencing apnea periods and within an hour, dies. No efforts were provided to resuscitate this client. Which of the following would describe this client event?

ANS: 1, 4

Passive euthanasia means the omission of an action that could prevent death and allowing death to occur. An example of passive euthanasia is following a do-not-resuscitate order. Coma depasse is a term for irreversible coma. Brain death is used when a client is assessed as being dead by neurological criteria. Assisted suicide and active euthanasia are similar in that an action must be carried out by one person to help end the life of another person.

PTS: 1 DIF: Analyze REF: Euthanasia and Assisted Suicide

5.The nurse reviews the American Nurses Association’s Code of Ethics for Nurses. Which of the following is included in this code?

ANS: 1, 2, 3, 6

The American Nurses Association’s Code of Ethics for Nurses has nine statements that define and guide the moral sense of nursing. These statements include: 1) care is provided with compassion and respect; 2) primary commitment is to the client; 3) strive to protect the health, safety, and rights of the client; 4) and collaborate with other health care professionals. Delegation is to be conducted to provide optimum client care. The nurse owes the same duties to self as others.

PTS: 1 DIF: Analyze REF: Box 5-1 The ANA Code of Ethics for Nurses