Chapter 9- Bioethical Issues in Healthcare My Nursing Test Banks

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Chapter: Chapter 9: Bioethical Issues in Healthcare

Multiple Choice

1. A doctor performs an abortion on a woman who is unable to carry a fetus to term because of a severe risk to her health. What is the term for this type of abortion?

A) Spontaneous abortion

B) Elective abortion

C) Therapeutic abortion

D) Legal abortion

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 2

Page and Header: 338, Abortion

Feedback: A therapeutic abortion is performed for medical reasons while elective abortion is undertaken for personal reasons. Both are legal under legally appropriate circumstances. A spontaneous abortion results from natural causes.

2. Which of the following statements accurately describes a characteristic of the stem cell?

A) Stem cells are not able to renew themselves.

B) Stem cells give way to specialized cells.

C) Stem cells are committed to conduct a specific function.

D) Pluripotent stem cells are derived from the patients own DNA.

Ans: B

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 11

Page and Header: 363, Stem Cell Research

Feedback: A stem cell is a special kind of cell that is able to renew itself and give rise to specialized cell types. These cells, unlike most other cells in the body, such as those of the heart or skin, are not committed to conduct a specific function. The cell remains uncommitted until it receives a signal to develop into a specialized cell. Pluripotent cells have the ability to differentiate into any type of cell found in the body; they are not directly derived from DNA.

3. A nurse is asked to obtain informed consent for a procedure to be performed on a patient who has not yet been told her cancer is terminal. Which of the following is an issue surrounding guidelines to the amount of information that should be given to this patient?

A) Under a paternalistic model of care, the locus of decision-making resides with the patients family, who are responsible for informing the patient.

B) Physicians basically agree on the amount and nature of the information that should be provided to the patient, but disagree on its delivery.

C) It is the responsibility of the nurse to inform the patient of matters that have not been discussed with the physician.

D) In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news.

Ans: D

Client Needs: C

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 364, Truth Telling and Healthcare Providers

Feedback: In some cultures, both physicians and families strongly believe that those who are ill should be protected from bad news. A paternalistic model of care denigrates the role of the patients family. The nurse is not always obliged to compensate for missing information and there is controversy surrounding the appropriate nature of information to provide to patients and/or families.

4. Which of the following guidelines supports current practice when using behavior control on a client?

A) Methods of influence that decrease a persons ability to think rationally should only be used when a client is not acting in his or her own best interest.

B) In many cases, the use of psychosurgery to effect a permanent change is recommended over drug therapy.

C) Methods of influence that keep relevant facts from a client should only be used with the consent of the clients significant others.

D) Methods that work through the cognitive and affective structure of a person are preferred treatment.

Ans: D

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 12

Page and Header: 366, Ethical Concerns and Behavior Control

Feedback: Although there are widely varying opinions regarding the appropriate application of behavior control in clients with mental illness, it is generally agreed that nonsurgical options are preferred over surgical interventions. Family consent does not necessarily warrant the withholding of information from clients. Interventions do not have the goal of reducing a persons ability to think rationally.

5. Which of the following best describes the term rationing of healthcare?

A) Providing healthcare only to those who can afford it.

B) Providing a planned approach to the use of limited resources.

C) Asking consumers to prioritize their use of healthcare resources.

D) Requiring consumers to carry private insurance to cover healthcare not covered by the public sector.

Ans: B

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 13

Page and Header: 367, Rationing of Healthcare

Feedback: Most consider rationing to be a planned, thoughtful approach to a limited supply. This does not involve mandatory insurance or restricting care to those who can afford it. Individual preferences should be considered, but the philosophy of rationing does not require consumers to prioritize their own use of resources.

6. During the various clinical placements that a nursing student has had during a baccalaureate program, the student has become increasingly aware of how significant bioethical issues are in the delivery of healthcare. Which of the following factors has contributed most significantly to the importance of bioethical issues in healthcare?

A) Increased health literacy among healthcare consumers

B) The development of new healthcare technologies

C) The politics of proposed universal healthcare in the United States

D) Increased incidence and prevalence of chronic health problems

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 332, Introduction

Feedback: Bioethical issues have always been present, but their importance has grown alongside changes in technology. The phenomena of increased health literacy, chronic diseases, and politics are not among the primary factors that have increased the visibility of bioethics.

7. The history of family planning in the United States has been characterized by controversies, many of which continue to the present day. Which of the following statements most accurately conveys an aspect of these controversies?

A) Protestant Christianity advocates a careful and deliberate control of the size of a population.

B) The Church of Jesus Christ of Latter Day Saints (Mormons) teach that only nonhormonal contraceptive methods may be used.

C) The Roman Catholic church states that the purpose of all sexual activity is the creation of new life.

D) Judaism teaches that family planning should be the exclusive domain of wives.

Ans: C

Client Needs: C

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 2

Page and Header: 335, Family Planning

Feedback: The Roman Catholic Church has strongly advocated that the natural purpose of sexual activity is to create new life and nothing should try to interfere with that potential. The members of the Church of Jesus Christ of Latter Day Saints (Mormons) do not differentiate between the hormonal and nonhormonal methods of contraception. Some conservative Protestant Christians and conservative Muslims also advocate allowing God to plan families and do not use birth control methods. Judaism does not explicitly teach about family planning.

8. In vitro fertilization (IVF) is an example of assisted reproductive technology (ART) that has become more common in recent decades. However, IVF is not without controversy. Which of the following aspects of IVF is most often contentious?

A) The number of fertilized ova normally exceeds the number of children that a woman desires.

B) The success or failure of IVF rests on the genetic characteristics of sperm that comes from a man unknown to the woman undergoing the procedure.

C) IVF is most common among women who have a history of elective abortion.

D) IVF is often undertaken without the consent of a womans partner.

Ans: A

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 3

Page and Header: 344, Assisted Reproductive Technology (ART)

Feedback: In IVF, several fertilized ova are usually returned to the uterus to ensure that at least one will survive. If more than one implants successfully, it is possible for the mother to have multiple births. The alternative to this potential is the abortion of one of more of the implanted ova, a practice that is controversial. IVF may or may not use sperm from an anonymous donor and is not normally performed without the awareness or consent of the womans partner. IVF is not normally necessitated by prior elective abortions.

9. The advent of technology has made it increasingly difficult to define the exact point at which death occurs. Which of the following is currently the most commonly-accepted criterion for death?

A) The cessation of blood circulation

B) The inability to perform respiration spontaneously

C) Persistent lack of interaction with outside stimuli

D) The cessation of brain activity

Ans: D

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 4

Page and Header: 350, Death Defined

Feedback: Brain activity, with few exceptions, is said to be nonexistent when flat electroencephalographic tracings are obtained over a given period, often 48 hours. After this point, the person may be considered dead, although machines may be supporting the vital functions of respiration and circulation. Many institutions now accept this definition of cerebral death and use it as a basis for turning off respirators and stopping other treatments. It is also used as a basis for determining death when there is a desire to recover organs from the patient.

10. After several rounds of unsuccessful in vitro fertilization (IVF), a couple has chosen to explore the use of a surrogate mother. In most states, this would involve

A) a civil court case in which a judge grants permission for the couple to proceed with surrogacy.

B) the use of a surrogate who is selected from a state-recognized list of approved surrogates.

C) the drafting of a detailed contract between the surrogate mother and the couple.

D) a covert and illegal arrangement between the couple and the potential surrogate mother.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 3

Page and Header: 347, Surrogate Mothers

Feedback: A formal, contractual relationship is usually established. The couple who wishes to have the child agrees to pay all expenses associated with the pregnancy, and to pay the surrogate mother an agreed sum for her time and involvement In a few states, however, such arrangements are illegal. A court case is not required and approval of a particular surrogate mother is not the jurisdiction of the state.

11. A nurse is aware that there are numerous bioethical issues involved in the practice or euthanasia. Which of the following events most clearly constitutes active euthanasia?

A) A woman chooses not to phone 911 when her elderly husband become unconscious in the home.

B) At his and his wifes request, a doctor provides a man with a fatal dose of phenytoin.

C) A nurse withholds cardiopulmonary resuscitation (CPR) from a patient in light of the patients DNR order.

D) A family decides against treating their mothers sepsis because of her low potential for recovery.

Ans: B

Client Needs: C

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 353, Positive Euthanasia

Feedback: Negative, or passive, euthanasia refers to a situation in which no extraordinary or heroic measures are undertaken to sustain life. This includes applying DNR orders, opting not to phone 911, or choosing to withhold treatment of an acute illness. Active euthanasia, however, occurs in a situation in which the physician prescribes, supplies, or administers an agent that results in death.

12. There are differing viewpoints surrounding the withholding and withdrawal of treatment. Which of the following situations constitutes the most acceptable application of the withholding and/or withdrawal of treatment?

A) A competent patient expresses a desire that hydration and nutrition be discontinued.

B) The potential benefits of a patients antibiotic therapy exceed the likely risks.

C) A patients family will be forced to pay out-of-pocket for the patients life support due to a lack of insurance coverage.

D) A patients children wish to discontinue the patients treatment because they have lost faith in the care team.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 6

Page and Header: 354, Table 9.2

Feedback: Most healthcare organizations and institutions agree that a competent patient has the right to withdraw or withhold treatment, especially when such treatment is unlikely to result in positive outcomes. When benefits exceed risks, treatment is normally undertaken. Financial concerns and interpersonal disputes should ideally not form the basis of such life-and-death decisions.

13. The practice or organ transplantation is associated with several important bioethical issues. The ethics of transplantation primarily surround the fact that

A) organ transplantation does not guarantee positive outcomes.

B) only a small number of the organs in the body are amenable to transplantation.

C) transplantation is a treatment of last resort.

D) the demand for organs greatly exceeds the available supply.

Ans: D

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 8

Page and Header: 357, Organ and Tissue Transplantation

Feedback: Ethical issues in organ transplantation most often surround the fact that there is a very finite supply of available organs and a larger number of potential recipients. As a result, difficult decisions must be made around the allocation of a valuable and scarce resource. The fact that transplantation is a measure of last resort is less salient. The facts that transplantation does not guarantee recovery and that only certain organs may be transplanted are not central to these difficult decisions.

14. The Human Genome Project (HGP) has been the subject of extensive attention, both in the healthcare community and in the public at large. Which of the following bioethical issues is most applicable to the HGP?

A) The HGP was conducted with little participation from developing countries.

B) The HGP did not result in the number or quality of medical applications that were originally hoped.

C) The HGP provides information that has the potential to influence the selection of behavioral attributes.

D) The HGP calls into question many of the practices that have been accepted in Western medicine.

Ans: C

Client Needs: C

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 9

Page and Header: 361, The Human Genome Project

Feedback: The ethical and bioethical concerns that can evolve from the HGP are many and varied. Among them are the issues of access to and use of new genetic information and technology to improve health, the research that would involve human participants, and the implications of the discovery of genetic contributions related to diseases, non-disease attributes, and various behavioral traits such as cognition, mental illness, diurnal rhythms, and aging for how we understand health and illness. The project did not discount common medical practices or fail to produce useful applications. The Western focus of the project was not widely criticized.

15. Gene therapy has been touted as one of the most promising therapies for healthcare in the 21st century. At present, gene therapy is primarily limited by

A) the dynamic nature of the human genome.

B) objections to gene therapy that are posed by religious groups.

C) the difficulty in producing safe, consistent therapeutic results.

D) the fact that only around a dozen known human diseases have a genetic basis.

Ans: C

Client Needs: C

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 10

Page and Header: 362, Gene Therapy

Feedback: Although gene therapy is a promising treatment option for a number of diseases (including inherited disorders, some types of cancer, and certain viral infections), the technique remains risky and is still under study to ensure its safety and effectiveness. The human genome is essentially consistent between individuals. Hundreds of diseases have a genetic basis and opposition from organized groups has not been the primary brake on the development of gene therapy.

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