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Potter: Basic Nursing, 7th Edition
Chapter 05: Ethics
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MULTIPLE CHOICE
1.A 73-year-old patient with hypertension is awaiting a triple cardiac bypass surgery. Robert is hard of hearing and did not understand what the surgeon told him regarding the surgery. His daughter is concerned that he does not understand the risks of the surgery. If not clarified, this would be a violation of what principle?
| A. | Autonomy |
| B. | Justice |
| C. | Fidelity |
| D. | Nonmaleficence |
ANS: A
Autonomy refers to a person’s independence. As a principle in bioethics, autonomy represents an agreement to respect a patient’s right to determine a course of action.
PTS: 1 DIF: Cognitive Level: Analysis REF: 63
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
2.A 45-year-old mother of two children has cirrhosis of the liver and is on a waiting list for a liver transplantation. She had to meet certain criteria to be eligible to receive a liver. She has been waiting for seven months for a donor liver and fears that she is running out of time. She understands that she is next on the list for a donor liver that matches. This is an example of which of the following principles?
| A. | Autonomy |
| B. | Justice |
| C. | Fidelity |
| D. | Nonmaleficence |
ANS: B
Justice refers to the principle of fairness. A nurse will often refer to this principle when discussing issues of health care resources. In the United States a national multidisciplinary committee strives for fairness by ranking recipients according to need, rather than resorting to selling organs for profit or distributing them by lottery.
PTS: 1 DIF: Cognitive Level: Analysis REF: 63
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
3.A registered nurse who works on an oncology unit discussed pain control options that the health care provider had ordered with a patient undergoing treatment for pancreatic cancer. The patient requested that they be given prn intravenous (IV) pain medication on a regular basis. The nurse agreed to provide the prn IV pain medication as requested. This is an example of which of the following principles?
| A. | Autonomy |
| B. | Justice |
| C. | Fidelity |
| D. | Nonmaleficence |
ANS: C
Fidelity refers to the agreement to keep promises. The principle of fidelity also promotes the obligation of a nurse to follow through with the care offered to patients.
PTS: 1 DIF: Cognitive Level: Analysis REF: 63
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
4.A registered nurse knows that an oncology patient undergoing a bone marrow transplant will spend weeks in isolation in the hospital. During that time the patient will be at an increased risk for infection and other complications. There is the possibility that the patient may not recover from the complications of the procedure. The nurse has a duty to ensure that the patient has been given information regarding the risks and potential benefits of the procedure. This is an example of which of the following principles?
| A. | Autonomy |
| B. | Justice |
| C. | Fidelity |
| D. | Nonmaleficence |
ANS: D
The principle of nonmaleficence promotes a continuing effort to consider the potential for harm even when it is necessary to promote health.
PTS: 1 DIF: Cognitive Level: Analysis REF: 63
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
5.A registered nurse is working on a pediatric oncology unit and caring for four children undergoing chemotherapy. Today she has a new nursing assistive personnel (NAP) assigned to assist her. Although she has never worked with this person, she understands that the NAP had to pass a basic competency examination before he was allowed to work on the unit with patients. She will delegate a portion of the fundamental nursing tasks to the NAP during the shift. This is an example of demonstrating which of the following?
| A. | Ethical dilemma |
| B. | Code of ethics |
| C. | Bioethics |
| D. | Feminist ethics |
ANS: B
The code of ethics reflects underlying principles that include responsibility, accountability, respect for confidentiality, competency, judgment, and advocacy.
PTS: 1 DIF: Cognitive Level: Analysis REF: 63
OBJ: Explain the importance of accountability and responsibility in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
6.The mother of a 45-year-old patient is a retired physician and requests to discuss her daughter’s plan of care with the nurse caring for the patient. What is the nurse’s best response to this request?
| A. | “I will need to ask permission from my supervisor before I can share that information.” |
| B. | “I cannot share that information with you. I would suggest you ask your daughter.” |
| C. | “I would suggest that you discuss that with your daughter’s physician.” |
| D. | “I will have to get your daughter’s permission before I can share that information.” |
ANS: D
The concept of confidentiality in health care has widespread acceptance in the United States. Federal legislation known as HIPAA (Health Insurance Portability and Accountability Act of 1996) requires that those with access to personal health information not disclose the information to a third party without patient consent.
PTS: 1 DIF: Cognitive Level: Application REF: 64
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
7.A RN has been a nurse for 35 years. During that time she has become very intolerant to patients who are smokers. This is a violation of __________ standards.
| A. | legal |
| B. | ethical |
| C. | clinical |
| D. | professional |
ANS: B
Ethics has a broader base of interest than legal issues and includes personal behavior and issues of character, such as kindness, tolerance, and generosity.
PTS: 1 DIF: Cognitive Level: Application REF: 62
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
8.A registered nurse has recently been reassigned to the gynecology unit at her hospital. She is a devout Catholic and is strongly against abortion. She contacts the nursing supervisor regarding her assignment because the unit cares for women who are undergoing abortions. With which of the following is she having a conflict?
| A. | Morals |
| B. | Values |
| C. | Beneficence |
| D. | Fidelity |
ANS: B
A value is a personal belief about the worth of an idea, a custom, or an object. The values a person holds reflect cultural and social influences. Systems of ethics usually grow from shared values that are negotiated and discussed over time by groups of people such as religious groups.
PTS: 1 DIF: Cognitive Level: Application REF: 62
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
9.A 9-year-old patient was severely burned and has been undergoing whirlpool treatments to debride her wounds. She is crying and does not want to go to the physical therapy department for the treatment. The registered nurse caring for the girl knows that, even though it is uncomfortable, she needs to have the therapy for the wounds to heal properly. The nurse is demonstrating which of the following principles?
| A. | Feminine ethics |
| B. | Bioethics |
| C. | Nonmaleficence |
| D. | Beneficence |
ANS: D
The principle of beneficence promotes taking positive, active steps to help others. It encourages a nurse to do good for the patient. Beneficence guides decisions in which the benefits of a treatment pose a risk to the patient’s well-being or dignity.
PTS: 1 DIF: Cognitive Level: Application REF: 63
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
10.Although a registered nurse has been working for several years as a staff nurse on an adult oncology unit, he recently transferred to a pediatric unit in the hospital. He will be in orientation for several days to learn about the different systems, and he will need to demonstrate proficiency in various pediatric areas such as medication administration. This is because he will need to demonstrate which of the following?
| A. | Competency |
| B. | Judgment |
| C. | Advocacy |
| D. | Utilitarianism |
ANS: A
Competence refers to specific knowledge and skills necessary to perform a task. In the practice of nursing, competence ensures the provision of safe nursing care. Regulations that guide the documentation of competence vary from state to state, but the agreement to practice with competence is a common denominator for all states and is in the nursing code of ethics.
PTS: 1 DIF: Cognitive Level: Application REF: 64
OBJ: Explain the importance of accountability and responsibility in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
11.A code of ethics provides the foundation for professional nursing. A nurse’s use of ethical responsibility can best be exemplified when the nurse:
| A. | delivers competent care. |
| B. | applies the nursing process. |
| C. | forms interpersonal relationships. |
| D. | evaluates new computerized technologies. |
ANS: A
A code of ethics is a set of ethical principles that members of a society accept because it sets the group’s expectations and standards of behaviors. The nursing process uses five steps that enable nurses to plan care.
PTS: 1 DIF: Cognitive Level: Application REF: 63-64
OBJ: Explain the importance of accountability and responsibility in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
12.A nurse decides to withhold a medication because it will further lower a patient’s respiratory rate. In this case, the nurse is practicing what principle?
| A. | Responsibility |
| B. | Accountability |
| C. | Competency |
| D. | Moral behavior |
ANS: B
Responsibility refers to the execution of duties associated with a nurse’s role. Competency refers to specific knowledge and skills needed to perform a task. Moral behavior refers to judgment about right and wrong behavior.
PTS: 1 DIF: Cognitive Level: Application REF: 64
OBJ: Explain the importance of accountability and responsibility in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
13.A patient is about to undergo a new, controversial bone marrow transplant procedure. The procedure may cause periods of pain and suffering. Although nurses agree to do no harm, this procedure may be necessary to promote health. This is an example of which of the following ethnical principles?
| A. | Autonomy |
| B. | Justice |
| C. | Fidelity |
| D. | Nonmaleficence |
ANS: D
Autonomy refers to a person’s independence. Justice refers to the principles of fairness.
Fidelity refers to the agreement to keep promises.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 63
OBJ: Describe ethical conflicts nurses experience in different clinical settings
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
14.A community health nurse states, “I wish we had just a portion of the dollars spent repairing atherosclerotic hearts to teach the community about cardiovascular risk factors.” This statement stems from what philosophy?
| A. | Deontology |
| B. | Feminist ethic |
| C. | Utilitarianism |
| D. | Ethics of care |
ANS: C
Deontology defines actions as right or wrong according to principles. The feminist ethic asks how ethical decisions will affect women. The ethics of care suggests that health care workers solve ethical dilemmas by the promotion of the fundamental act of caring.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 66
OBJ:Describe the role of ethics in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
15.A nurse decides to tell adult children that they need to decide how to advise their father about taking narcotics during the terminal phase of his illness. This critical processing step of an ethical dilemma:
| A. | articulates the problem. |
| B. | evaluates the action. |
| C. | negotiates the outcome. |
| D. | determines values surrounding the problem. |
ANS: C
Articulation occurs when a simple and clear statement of the problem occurs. Evaluation of the actions is the last step. Values clarification provides a foundation for clarity that will be necessary for resolution.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 65
OBJ:Describe the role of ethics in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
16.The code of ethics for nursing sets forth ideals of nursing conduct and provides a common foundation for nurses’ training, which was developed by what organization?
| A. | Board of Registered Nurses |
| B. | American Medical Association |
| C. | National League for Nursing |
| D. | American Nurses Association |
ANS: D
The Board of Registered Nursing regulates nursing programs. The American Medical Association deals with physicians. The National League of Nursing is an agency concerned with nursing education.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 64
OBJ:Describe the role of ethics in nursing practice
TOP:Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
SHORT ANSWER
1.Nursing staff members strive to advocate for their patients. When a nurse practices patient advocacy, he or she will ____________________.
ANS:
give patients the information they need to make decisions
Ethical decision making requires nurses to follow a set of ethical principles that guide professional practice and decision making. When nurses advocate for their patients, they strive to understand and clearly state a patient’s point of view to other health care providers.
PTS: 1 DIF: Cognitive Level: Application REF: 64-65
OBJ: Discuss patient advocacy TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1.A nurse is working with the parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. To help the parents resolve this conflict, the nurse will begin to analyze this ethical dilemma by doing which of the following? Select all that apply.
| A. | Identifying people who can solve this dilemma |
| B. | Gathering all relevant information surrounding this dilemma |
| C. | Clarifying the values related to the cause of this dilemma |
| D. | Consulting a professional ethicist regarding how to proceed with this dilemma |
| E. | Considering possible courses of action |
ANS: B, E
The nurse should gather all relevant information and consider possible courses of action. Seven steps are used when solving an ethical dilemma: (1) Asking “is it an ethical dilemma?”, (2) gathering all information, (3) examining and determining one’s own values and opinions about the issue, (4) articulating the problem, (5) considering possible courses of action, (6) negotiating an outcome, and (7) evaluating the action.
PTS: 1 DIF: Cognitive Level: Application REF: 67-68
OBJ:Explain a process for analyzing an ethical dilemma
TOP:Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
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