Chapter 44. Values & Ethics My Nursing Test Banks

Chapter 44. Values & Ethics

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A 77-year-old woman with an inoperable brain tumor has been hospitalized for the past 5 days. Her daughter comes to visit her. The patient has asked that her daughter not be told her diagnosis. After visiting with her mother, the daughter asks to speak to the nurse. She says, My mother claims she has pneumonia, but I know she is not telling me the truth. The daughter asks the nurse to tell her what is truly wrong with her mother. The nurse should tell her that:

1)

Her mother has an inoperable brain tumor, but does not wish anyone to know.

2)

She needs to speak to the physician in charge of her mothers care.

3)

Her mother has requested that her case not be discussed with anyone, not even family.

4)

Her mother is very sick with a serious case of pneumonia that could lead to death.

____ 2. Which of the following terms refers to the ethical questions that arise out of nursing practice?

1)

Nursing ethics

2)

Bioethics

3)

Ethical dilemma

4)

Moral distress

____ 3. A belief about the worth of something that serves as a principle or a standard that influences decision making is called which of the following?

1)

Morals

2)

Attitudes

3)

Beliefs

4)

Values

____ 4. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is conscious and competent and has decided that he wants to be removed from the ventilator. His family and the multidisciplinary team agree. The nurse believes the patient intends suicide, and would prefer he choose differently, but says nothing. The nurse remains at the bedside holding the patients hand. In this instance the nurse is displaying which of the following?

1)

Value set

2)

Value system

3)

Value neutrality

4)

Value awareness

____ 5. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is alert and oriented and, after giving it much thought, has decided that he wants to be removed from the ventilator. The nurse believes the patient intends suicide, but supports his final decision. When the ventilator is removed, the nurse remains with the patient to support him. The nurses action demonstrates respect for what moral principle?

1)

Nonmaleficence

2)

Autonomy

3)

Beneficence

4)

Fidelity

____ 6. Which of the following consequentialist theories takes the position that the value of an action is determined by its usefulness?

1)

Ethics of care

2)

Utilitarianism

3)

Deontology

4)

Categorical imperative

____ 7. The ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making is known as which of the following?

1)

Ethical agency

2)

Attitudes

3)

Belief

4)

Value neutrality

____ 8. Identify the third step in the MORAL decision-making model.

1)

Reassess the dilemma

2)

Resolve the dilemma

3)

Review the problem

4)

Recall the history of the problem

____ 9. A patient has asked the nurse to explain her laboratory results. The nurse informs the patient that he must first assist another patient to the bathroom and then he will explain the results. The nurse assists the other patient to the bathroom and then returns to explain the results to the patient. What moral principle has the nurse displayed?

1)

Nonmaleficence

2)

Autonomy

3)

Beneficence

4)

Fidelity

____ 10. The nurse is a member of the ethics committee. An alert, oriented, and competent 87-year-old man has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and requests the ethics committee to intervene on their behalf. The ethics committee would most likely use which model in this patients case?

1)

Social justice

2)

Patient benefit

3)

Autonomy

4)

DNAR determination

____ 11. A 60-year-old patient with a treatable form of breast cancer has decided not to pursue radiation or chemotherapy. The nurse believes that the patient should be treated. She coerces her into receiving treatment by continuing to remind the patient about her responsibilities for raising her children. What type of behavior has the nurse displayed?

1)

Nonmaleficence

2)

Autonomy

3)

Paternalism

4)

Beneficence

____ 12. Nursing codes are:

1)

Legally binding.

2)

Not legally binding.

3)

Legally binding in some circumstances.

4)

Not admissible in court.

____ 13. An alert, oriented, and competent frail older adult man has been told that he is dying, and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. After a great deal of discussion among the physician, nurse, and family, they are no closer to resolution of the conflict. The nurse asks the hospital chaplain to come and help the family and the team understand each others opposing views. Which step of the MORAL model does this illustrate?

1)

MMassage the dilemma

2)

OOutline the options

3)

RResolve the dilemma

4)

LLook back and evaluate

____ 14. An alert, oriented, and competent frail older adult man has been told that he is dying, and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. The healthcare team does not agree, and after several days the family takes the matter to court. The court sides with the family and orders the healthcare team to remove the DNAR order. This is an example of which of the following?

1)

An integrity-producing (good) compromise

2)

An ethically sound compromise

3)

Settlement of an issue by force

4)

An effort to keep peace on the unit

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Which of the following is an example of whistle-blowing? Choose all that apply.

1)

Reporting fraudulent billing practices

2)

Reporting patients health status against the patients wishes

3)

Reporting unsafe work practices

4)

Reporting a coworker for working under the influence of drugs

____ 2. The nurses obligations in ethical decisions include which of the following? Choose all that apply.

1)

Be a patient advocate.

2)

Involve institutional ethics committees.

3)

Improve ones own ethical decision making.

4)

Respect patient confidentiality.

Completion

Complete each statement.

1. ____________________ refers to private, personal, or group standards of right and wrong.

2. ____________________ refers to the application of ethical principles to healthcare.

3. ____________________ is the duty to do or promote good.

Chapter 44. Values & Ethics

Answer Section

MULTIPLE CHOICE

1. ANS: 3

The nurses first allegiance is to the patient and her desire for confidentiality. Telling the daughter to speak to the physician would place the physician in the same position as the nurse. Telling her that her mother has pneumonia would be a lie. The nurse, of course, should inform the physician of the patients wishes so that he will be prepared if the daughter questions him about her mothers health condition.

PTS: 1 DIF: Difficult REF: V1, p. 1088

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

2. ANS: 1

Nursing ethics refers to ethical questions that arise out of nursing practice. Bioethics is a broader field that refers to the application of ethics to healthcare. An ethical dilemma occurs when a choice must be made between two equally undesirable actions, and there is no clearly right or wrong option. Moral distress occurs when someone is unable to carry out his or her moral decision.

PTS: 1 DIF: Moderate REF: V1, p. 1084

KEY: Client need: SECE | Cognitive level: Recall

3. ANS: 4

A value is a belief you have about the worth of something that serves as a principle or a standard that influences decision making. Morals are private, personal, or group standards of right and wrong. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true.

PTS: 1 DIF: Difficult REF: V1, p. 1090 | V2, p. 1053

KEY: Cognitive level: Recall

4. ANS: 3

Value neutrality occurs when we put aside our own values regarding an issue in order to provide nonjudgmental care to clients. A value set is your list of values. A value system is your value set with the values ranked on a continuum from most important to least important.

PTS: 1 DIF: Moderate REF: V1, p. 1091

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

5. ANS: 2

Autonomy refers to a persons right to choose and his ability to act on that choice. In this case, the nurse respects the patients right to choose to die. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. Fidelity is the obligation to keep promises.

PTS: 1 DIF: Moderate REF: V1, p. 1095

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

6. ANS: 2

Utilitarianism is a consequentialist theory that takes the position that the value of an action is determined by its usefulness. An ethics of care is a nursing philosophy that directs attention to the specific situations of individual patients viewed within the context of their life narrative. Deontology considers an action to be right or wrong independent of its consequences. A categorical imperative is a principle, established by Immanuel Kant, that states that one should act only if the action is based on a principle that is universal.

PTS: 1 DIF: Moderate REF: V1, p. 1093

KEY: Client need: SECE | Cognitive level: Comprehension

7. ANS: 1

Ethical agency is the ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. Value neutrality is when we attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgmental when providing care to clients.

PTS: 1 DIF: Moderate REF: V1, p. 1086 | V2, p. 1053

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

8. ANS: 2

MORAL is an acronym for the following steps: M, Massage the dilemma; O, Outline the options; R, Resolve the dilemma; A, Act by applying the chosen option; L, Look back and evaluate.

PTS: 1 DIF: Easy REF: V1, p. 1104 | V2, p. 1048

KEY: Client need: SECE | Cognitive level: Recall

9. ANS: 4

Fidelity is the obligation to keep promises. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good.

PTS: 1 DIF: Moderate REF: V1, p. 1096

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

10. ANS: 3

The autonomy model is useful when the patient is competent to decide. This model emphasizes patient autonomy and choice as the highest values. The patient benefit model assists in decision making for the incompetent patient by using substituted judgment. The social justice model focuses more on broad social issues involving the entire institution rather than on a single patient issue. There is no DNAR determination model.

PTS: 1 DIF: Moderate REF: V1, p. 1106

KEY: Client need: SECE | Cognitive level: Synthesis

11. ANS: 3

Paternalistic behavior occurs when the nurse thinks she knows what is best for a competent patient and coerces the patient to act as she wishes rather than to act as the patient originally desired. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good.

PTS: 1 DIF: Moderate REF: V1, p. 1096

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

12. ANS: 2

Codes of ethics are open to public scrutiny. The ethical aspects of nursing work, just like the technical aspects, are subject to review by professional groups and licensure boards, which may use sanctions to punish code violations. However, nursing codes are not legally binding.

PTS: 1 DIF: Difficult REF: V1, p. 1098

KEY: Client need: SECE | Cognitive level: Recall

13. ANS: 2

In Massaging the dilemma, the team would have identified and defined the issues in the dilemma, and considered the values and options of all the major players. At the Outlining the options step, someone should delineate all of the options to all parties, including those that are less realistic and conflicting. In that step, someone often asks a member of the ethics committee or the hospital chaplain to help the parties understand the opposing viewpoints. Resolving the dilemma is the step in which all the options are reviewed and basic moral principles and frameworks are applied to arrive at a decision. Looking back to evaluate is done after a decision has been made and acted on. At that time, the entire process, including the consequences, are evaluated to determine how well they worked.

PTS: 1 DIF: Moderate REF: V1, p. 1104 | V2, p. 1048

KEY: Client need: SECE | Cognitive level: Application

14. ANS: 3

This is clearly an example of settling an issue by force, bringing in a more powerful entity (the court) to force the healthcare team to do what the family wants. It is not a compromiseof any sortbecause neither party backed away from its original position, and the action that was taken was not agreed on by both parties. This was not an effort to keep peace. The familys effort was to settle the disagreement in their favor. If the healthcare teams goal had been to keep peace on the unit, they would have acceded to the familys wishes without the need for court order.

PTS: 1 DIF: Difficult REF: V1, p. 1105

KEY: Client need: SECE | Cognitive level: Application

MULTIPLE RESPONSE

1. ANS: 1, 3, 4

Reporting a patients health status against the patients wishes is a breech of patient confidentiality. Whistle-blowing is identifying incompetent, unethical, or illegal situations or actions of others in the workplace and reporting to someone who may be in a position to rectify the situation. Fraudulent billing practices are illegal and unethical; unsafe work practices are unethical and illegal; and a coworker under the influence of drugs is a risk to patients, as well acting in an illegal and unethical manner.

PTS: 1 DIF: Moderate

REF: V1, pp. 1086-1087; requires critical thinking | V2, p. 1053; requires critical thinking

KEY: Client need: SECE | Cognitive level: Analysis

2. ANS: 1, 2, 3, 4

The nurses obligations in ethical decisions include being a patient advocate, using and participating in institutional ethics committees, and improving ethical decision making. Confidentiality is a basic patient right. The nurses role is to uphold that right.

PTS: 1 DIF: Moderate REF: V1, pp. 11051106

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

COMPLETION

1. ANS: Morals

PTS: 1 DIF: Easy REF: V1, p. 1084

KEY: Cognitive level: Comprehension

2. ANS: Bioethics

PTS: 1 DIF: Moderate REF: V1, p. 1084

KEY: Client need: SECE | Cognitive level: Comprehension

3. ANS: Beneficence

PTS: 1 DIF: Easy REF: V1, p. 1096

KEY: Client need: SECE | Cognitive level: Comprehension

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