Chapter 8- Ethical Concerns in Nursing Practice My Nursing Test Banks

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Chapter: Chapter 8: Ethical Concerns in Nursing Practice

Multiple Choice

1. A mother and a daughter are taken to the emergency room for injuries suffered in a car accident. When the mother is taken to surgery, the nurse tells her that her daughter will be fine, even though she does not know the exact extent of the daughters injuries. This nurses actions may have been guided by which of the following ethical theories?

A) Social equity and justice

B) Natural law

C) Deontology

D) Utilitarianism

Ans: D

Client Needs: C

Cognitive Level: Evaluation

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 2

Page and Header: 297, Table 8.2

Feedback: A central premise of utilitarianism is that an act is right when it is useful in bringing about a desirable or good end. In this case, instilling hope in the mother may alleviate her stress before surgery. A deontological view would condemn the nurses actions, since deontology proposes that ethical decision-making is based on moral rules and unchanging principles (i.e. that lying is categorically wrong). Social equity and natural law are not reflected in the nurses decision to temporarily deceive the patient.

2. A client has advance directives for a DNR code (do not resuscitate). When the nurse is caring for this client, the clients wife asks him to do everything in your power to keep my husband alive. This nurse is most likely to experience which of the following moral challenges?

A) Values clarification

B) Ethical dilemma

C) Values conflict

D) Nonmaleficence

Ans: B

Client Needs: C

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 4

Page and Header: 289, Understanding the Concept of Ethics

Feedback: An ethical dilemma is any situation in which guiding moral principles cannot determine which course of action is right or wrong. In this case, there is a conflict between the clients wishes and that of his wife, a situation that causes duress for the nurse. Values clarification, values conflict, and nonmaleficence are not at the root of the situation the nurse faces.

3. Which of the following statements accurately reflects one of the primary provisions of the ANA Code for Nurses?

A) The administrators of the healthcare facility are responsible and accountable for individual nursing practice.

B) The physician determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care.

C) The nurses primary commitment is to the employing agency.

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

Ans: D

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 302, Display 8.1

Feedback: The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. The Code does not place primary ethical responsibility with administrators or physicians nor does it claim that the nurses main commitment is to the employer.

4. A nurse helps a client work through an ethical dilemma by using an ethical decision-making framework. Which of the following statements describes a component of this process?

A) The steps of this process are distinctly different from those of the nursing process.

B) Most ethical problems have one possible solution.

C) The nurse uses the framework of his or her own values to assist the clients to make a decision.

D) The facts of a situation make a difference in the options that are possible.

Ans: D

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 311, Gather Factual Data

Feedback: When attempting to make ethical decisions, it is important to have as much information about the unique situation as possible because the facts of the situation make a difference in what options are possible. The steps in ethical decision-making mimic those of the nursing process. The nurse should not impose his or her values on clients and most ethical problems have more than one potential solution.

5. Which of the following is an accurate guideline for reporting the chemical dependency of a colleague?

A) Confront the person you suspect, and offer assistance in obtaining treatment.

B) Be sure beyond any doubt that a problem exists.

C) Rely on an informed supervisor to assume responsibility for the problem.

D) Be aware that help and rehabilitation are only offered to the person need it following disciplinary proceedings.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 325, Reporting the Chemically Impaired Colleague

Feedback: Usually, once you have notified your supervisor, he or she will assume responsibility for the problem. When planning to report, you do not have to be sure beyond any doubt that a problem exists. Confrontation is often ill-advised and rehabilitation may accompany or precede discipline.

6. A nurse on a palliative care unit has attended an educational inservice on ethics. Which of the following statements most accurately describes the concept of ethics?

A) Ethics offers a process that can be used to guide behavior.

B) Ethics is the expression of social and culture values, priorities, and norms.

C) Ethics is the basis for evaluating personal character.

D) Ethics is the tangible application of religious and spiritual truths.

Ans: A

Client Needs: C

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 1

Page and Header: 289, Understanding the Concept of Ethics

Feedback: Ethics offers a formal process for answering the question about what one ought to do in a given situation. Ethics is not considered to be simply an expression of cultural or religious principles and it does not specify criteria for evaluating an individuals character.

7. Nursing involves close interaction between nurses and patients, a situation which can create the potential for boundary violations. Which of the following situations most clearly constitutes a boundaries violation?

A) A community health nurse continues weekly visits to a former client despite the fact that the client is no longer receiving care.

B) A nurse states that she is willing to advocate to the patients employer than the patient was genuinely ill and not feigning health complaints to gain time off work.

C) A nurse attends a family meeting at the hospital in which the patient and his family discuss the patients code status.

D) A nurse contacts a social worker without the patients knowledge because of admissions the patient has made about her substandard living conditions.

Ans: A

Client Needs: C

Cognitive Level: Evaluation

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 8

Page and Header: 326, Boundary Violations

Feedback: Continuing contact with a patient outside of the domain of care is a boundaries violation. Informing an employer that a patient was ill is not likely a boundaries violation, since the nurse is reporting facts with the patients permission. Nurses often participate in family meetings and referrals made without a patients knowledge are not a violation of boundaries.

8. A few weeks ago, a nurse worked a shift with a colleague during which three oxycodone tablets went missing from the narcotic cupboard. As well, the nurse has noted that the colleague has sometimes documented the administration of oxycodone to patients only to have the patients continue to complain of pain. The nurse suspects that the colleague is taking the oxycodone from the unit for personal use. How should the nurse best follow up these suspicions?

A) Organize coworkers and the colleagues family members to carry out an intervention

B) Contact representatives from the state board of nursing

C) Report these suspicions to the unit supervisor

D) Confront the colleague with these suspicions

Ans: C

Client Needs: C

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 325, Reporting the Chemically Impaired Colleague

Feedback: Reasonable suspicions of chemical abuse should be reported to a nurses immediate supervisor. Confrontation, either face-to-face or in a group setting, should normally be avoided. It would be premature to contact the state board of nursing.

9. Mr. Bains is a 70-year-old man who has been recently diagnosed with colon cancer. Mr. Bains is adamant that he does not want to undergo chemotherapy or radiotherapy, citing the unpleasant side effects and the absence of a guaranteed cure. His wife, however, is distraught that he would give up so quickly and begs the nurse to convince him to pursue treatment. Which of the following ethical principles would underlie the nurses decision to respect Mr. Bains informed choice?

A) Beneficence

B) Nonmaleficence

C) Fidelity

D) Autonomy

Ans: D

Client Needs: C

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 1

Page and Header: 291, Autonomy

Feedback: Autonomy involves the right of self-determination or choice, independence, and freedom. As such, an expression of autonomy would involve respecting the patients wishes even if they are unusual or opposed by family members. Beneficence and nonmaleficence denote doing good and avoiding harm. Fidelity refers to the obligation to be faithful to the agreements and commitments.

10. An obstetrical-gynecological nurse has moved to a new region and is seeking employment. The nurse opposes the ethics of elective abortion and refuses to participate in the procedures. However, the only hospital in the immediate area is the site of numerous elective abortions. How should the nurse account for this fact when seeking employment?

A) Ask the hospital administrators to exempt her from participating in any aspect of abortion.

B) Consider applying for a nursing position that will not involve abortion.

C) Begin working at the hospital and attempt to change the hospital politically.

D) Accept a position at the hospital and then make her position known to supervisors.

Ans: B

Client Needs: C

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 308, Seeking Employment

Feedback: Nurses have a responsibility to avoid situations that they know would be personally problematic for ethical reasons. It would be unreasonable to accept a position and expect special treatment. As well, it would be disingenuous for the nurse to accept a position without disclosing her stance or to accept a position with the intent of enacting a change.

11. A patient with a long-standing diagnosis of renal failure has declared her intention to stop hemodialysis. Because of the ethical ramifications of this, the care team has begun the process of making an ethical decision. This process should begin by

A) eliciting input from impartial individuals from outside the hospital setting.

B) explaining the major concepts of ethics to the patient and her family.

C) clearly identifying the essential elements of the ethical problem.

D) confirming the patients cultural and religious background.

Ans: C

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 311, Identify and Clarify the Ethical Problem

Feedback: A process for ethical decision-making begins with the clear identification of the situation at hand. This should precede the involvement of other individuals or an exploration of the patients culture and religion. It would not likely be helpful to explain ethical concepts to the patient.

12. The care providers and administrators of a hospital have struggled to find an appropriate response to a patient who has a long history of being admitted to hospital and then leaving against medical advice. Under the direction of the hospital ethics committee, a plan was created and implemented. What action should the care providers and the ethics committee take after the plan has been implemented?

A) Continue to implement the plan when necessary

B) Assess the outcomes of applying the plan

C) Seek input from the hospitals risk manager

D) Report to the state board of nursing about the manner in which the situation was handled

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 5

Page and Header: 312, Act and Assess

Feedback: Implementation of an ethical decision should always be followed by evaluation and appraisal of the course of action that was chosen. Involvement of the hospitals risk manager should take place during the planning phase. It would not normally be necessary to involve the state board of nursing in this decision-making process.

13. A nurse is working a shift with a colleague who has a nursing student participating in the care of the colleagues patients. The nurse notices that the colleague has spent much of the morning on the computer at the nurses station and is allowing the student to perform every aspect of the patients care. How should the nurse best respond to this colleague?

A) Speak directly to the colleague about these observations.

B) Ask the nursing student if she feels like the colleagues patients are receiving good care.

C) Report the colleague to the supervisor of the unit.

D) Create a written report recording the facts of the morning.

Ans: D

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 319, Addressing Substandard Care

Feedback: Lapses in the quality of care are best addressed by speaking directly and privately to the person involved. The individuals response to this discussion would determine whether involvement by supervisors is necessary. It would be inappropriate to involve the nursing student in this matter, given the power differential that exists between the nurse and the student.

14. Tom is a nurse who provides care on a busy medical unit. One of Toms colleagues has just confided in him that she erroneously gave her patient 16 mg of immediate-release hydromorphone instead of 16 mg of extended-release hydromorphone. She tells Tom that she does not want to report the incident and so she plans to simply monitor the patients level of consciousness and respiratory status closely for the next several hours. Which of the following statements best describes Toms required response to this situation?

A) Tom has a professional and legal responsibility to report this.

B) Tom should strongly encourage his colleague to document this error.

C) Tom is obliged to assist his colleague with follow-up assessments.

D) Tom has no legal obligation to respond, but he should take advantage of this teaching opportunity.

Ans: A

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 320, A Basic Pattern for Action

Feedback: Incidents that have the potential for patient harm create a legal and moral obligation for the nurse to report. Simply encouraging the colleague to document this matter or helping with assessments are insufficient responses.

15. After working for several months on a geriatric subacute medicine unit, a nurse has come to the conclusion that substandard care has become accepted as the norm by the majority of nurses as well as their immediate supervisors. The nurses attempts to discuss and address some significant and persistent lapses in care have been rebuffed by nurses and supervisors alike. What should the nurse do next?

A) Enlist the support of current and previous patients

B) Resign from the unit

C) Contact media outlets

D) Further discuss the benefits of practice improvements with the nurses

Ans: B

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 320, Alternative Approaches for Action

Feedback: A final alternative to a workplace problem may be to resign. It is normally inappropriate to involve patients. Further discussions with the nurses are unlikely to be beneficial, given the systemic nature of problems on this unit. Contacting the media is rare and appropriate response.

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