Chapter 7- Ethical Issues in Critical Care Nursing My Nursing Test Banks

 

1.

The physician has just told a patient that he has stage 4 lung cancer and likely has only months to live. After the physician leaves, the patient, who is visibly shaken, asks the nurse, Couldnt the doctor be wrong? Is it really that bad? The nurse explains to him that, although there is no way to know for certain how the disease will progress, the stage of his lung cancer is the most serious. The nurse also indicates that the cancer has spread to other organs in his body, meaning that the odds of recovery are not good. The patient then asks that the nurse not tell his wife, who is in the waiting room, about the diagnosis just yet. Later the patients wife enters the room and, seeing that he is asleep, asks the nurse if there is any update on the patients condition. The nurse explains that the doctor talked to the patient earlier and that the patient can provide details once he wakes up. Which ethical principle or principles has the nurse exercised in this situation? Select all that apply.

A)

Justice

B)

Fidelity

C)

Veracity

D)

Nonmaleficence

2.

Before administering a new medication to a patient, the nurse explains to her the adverse effects she may experience as a result of the medication and asks whether the patient has any questions about the medication. When the patient indicates that she understands the risks involved, the nurse has her sign a document and proceeds with the treatment. The nurses action is an example of which of the following?

A)

Obtaining informed consent

B)

Ensuring confidentiality

C)

Observing the principle of nonmaleficence

D)

Acting with fairness

3.

A patient is at severe risk of forming life-threatening clots in his thoracic region following surgery. The physician has prescribed an anticoagulant medication. The patient has had a negative experience with anticoagulants in the past and refuses the medication. Which two ethical principles are in conflict with each other in this situation?

A)

Fidelity vs. justice

B)

Maleficence vs. beneficence

C)

Veracity vs. autonomy

D)

Beneficence vs. autonomy

4.

A patient in the ICU recently experienced a myocardial infarction that resulted in an aneurysm of the ventricular wall. The patients cardiovascular surgeon has determined that the aneurysm is irreparable. In this situation, an attempt to repair the rupture via laparoscopic surgery would be considered which of the following?

A)

Palliative

B)

Curative

C)

Medically futile

D)

Beneficent

5.

The family of a patient in a coma is struggling to decide whether to remove the patient from a ventilator. What would be the most appropriate intervention?

A)

Explain the statistical odds that the patient will regain consciousness.

B)

Facilitate a care conference with the family.

C)

Leave the family alone to make their decision.

D)

Distribute copies of the American Nurses Association Code of Ethics to the family.

6.

A patient complains of severe pain and requests an increase in dose of her pain medication. Her husband, however, does not want the patients pain medication increased, as he is worried about her becoming dependent on the medication. Which principle(s) from the ANA Code of Ethics would be most appropriate for the nurse to apply in this situation? Select all that apply.

A)

The nurses primary commitment is to the patient.

B)

The nurse collaborates with other health professionals and the public.

C)

The nurse owes the same duties to self as to others.

D)

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

7.

A nurse learns that a patient in the ICU who is scheduled to undergo a liver transplant has a history of alcoholism. Which principle or principles from the ANA Code of Ethics would be most appropriate for the nurse to apply while caring for this patient? Select all that apply.

A)

The nurse practices with compassion and respect unrestricted by considerations of the nature of the health problem.

B)

The nurses primary commitment is to the patient.

C)

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

D)

The nurse participates in establishing, maintaining, and improving health care environments.

8.

A nurse works in an ICU in which she routinely sees physicians neglecting the care of patients who do not have health insurance. She feels angry about the unfairness of this situation but also powerless to do anything because she fears the loss of her job. Which of the following best describes what the nurse is experiencing?

A)

Medical futility

B)

Nonmaleficence

C)

Moral distress

D)

Paternalism

9.

An elderly patient who is about to have open-heart surgery has verbally instructed the nurse that she does not want her life to be extended by a ventilator after the surgery. The patients advance directive, however, indicates that she would prefer to receive all life-support measures. The nurse suspects that the patient has dementia. Which of the following questions would be most appropriate for the nurse to ask in the assessment stage of ethical decision making?

A)

What are the ethical issues related to continuing or removing life-support measures for this patient?

B)

Who should be involved in making the decision regarding life-support measures for this patient?

C)

Is this patient mentally competent to make decisions about use of life support?

D)

What educational changes can be made in the ICU to resolve similar ethical challenges related to life support measures in the future?

10.

A patient who had provided an advance directive indicating that he should not be resuscitated was allowed to die when his heart stopped beating shortly after his admission to the ICU. The family of the patient has disputed the authenticity of the advance directive and filed a complaint with the hospital. Which intervention would be most appropriate to address this ethical dilemma?

A)

Ethics rounds involving the medical staff involved in the patients care

B)

Review by the hospitals institutional ethics committee

C)

An individual patient ethics conference with the family

D)

Review of the ANA Code of Ethics by the patients nurse

11.

The nurse has learned about the application of ethical principles in nursing. How does this knowledge facilitate the practice of nursing for the individual nurse?

A)

It is mandated by accreditation agencies.

B)

It is a component of bioethical theory.

C)

It assists in defining good nursing care.

D)

It assists in determining the legal basis of decisions.

12.

The family wishes to continue all aspects of care for a terminally and critically ill patient in the interests of justice and nonmaleficence. The health care team believes that further sophisticated and technical interventions are futile and that the focus of care should be shifted to provision of comfort, dignity, and palliative care. Neither the family nor the health care team is willing to compromise any portion of their stances. The patient is unresponsive. This situation is an example of what kind of problem?

A)

Ethical dilemma

B)

Recalcitrant family

C)

Biotechnology effects

D)

Paternalism

13.

The nurse consistently applies guidelines for safe administration of medications during patient care. This practice is an example of the application of what ethical principle?

A)

Justice

B)

Veracity

C)

Beneficence

D)

Paternalism

14.

In determining which patient is to be transferred from the CCU to make room for a new admission, the nurse considers the relative benefit of continued CCU care related to eventual outcomes for each patient and compares them. The nurse does not consider factors such as ethnicity or socioeconomic status. This situation is an example of application of which ethical principle?

A)

Paternalism

B)

Veracity

C)

Beneficence

D)

Justice

15.

The health care team is considering a change in the treatment plan for a critically ill patient. As this change is considered, the dangers and possible outcomes for continuing with the same plan of care as well as those for the proposed change are thoroughly discussed. The beliefs and values of the patient and family are included. What is this situation an example of?

A)

Inability to make independent decisions

B)

Positive leadership action by the nurse

C)

Application of informed consent

D)

Riskbenefit analysis

16.

A patient is admitted to the CCU with active advance directives that include refusal of enteral feeding by tubes. When the physician writes an order for the insertion of a feeding tube, the nurse refuses to comply. This refusal is an example of adherence to what ethical principle?

A)

Nursing Practice Act

B)

Patient Bill of Rights

C)

Patient autonomy

D)

Patient advocacy

17.

While caring for a critically ill patient, the nurse identifies an ethical dilemma and seeks the advice of the agencys Ethics Committee. This scenario is an example of what kind of nursing action?

A)

Inability to make independent decisions

B)

Behavior mandated by protocols

C)

Appropriate use of resources

D)

Fear of autonomous action

18.

The family of a critically ill patient has said that the patient would not have wanted prolonged life support. The patient has been ventilator-dependent for several weeks and is not expected to improve. The physician states that, as the expert in health care, he knows best, and the patient will remain on the ventilator. What behavior is the physician exercising?

A)

Routine medical care

B)

Respect for autonomy

C)

Expert paternalism

D)

Biomedical ethics

19.

In delivering patient care, the nurse bases a decision upon the ANA Code of Ethics for Nurses. This is an example of what?

A)

Inability to make independent decisions

B)

Behavior mandated by protocols

C)

Appropriate use of resources

D)

Fear of autonomous action

20.

While caring for a critically ill patient, the nurse observes the family discussing funeral arrangements across the bed of the patient, who is intubated and sedated but awake. The family signs Do Not Resuscitate (DNR) request paperwork and leaves. The patient manages to communicate to the nurse that he does not want to die. What is the most appropriate nursing action?

A)

Adhere to the wishes of the family, since the patient is probably incompetent.

B)

Call a multidisciplinary conference with the family to resolve this conflict.

C)

Destroy the Do Not Resuscitate paperwork, since the patient wants to live.

D)

Apply the ethical principles of nonmaleficence and paternalism to the situation.

21.

Before a surgical procedure, the patient signs a document called an informed consent. What ethical principle is central to the use of informed consent?

A)

Autonomy

B)

Fidelity

C)

Nonmaleficence

D)

Beneficence

Answer Key

1.

B, C

2.

A

3.

D

4.

C

5.

B

6.

A, D

7.

A, B, C

8.

C

9.

C

10.

B

11.

C

12.

A

13.

C

14.

D

15.

D

16.

D

17.

C

18.

C

19.

C

20.

B

21.

A

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