Leadership Roles and Management Functions in Nursing: Theory and Application, Exams of Nursing

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Which statement by a nurse most clearly demonstrates an intuitionist framework for ethical decision making, duty based? A. "I've got to look at this situation on the basis of its unique characteristics, not by comparing it to other situations." B. "I'm trying to think of as many different options as I can rather than focusing on those that look most attractive." C. "I'll make the best decision if I choose the option that comes to mind first rather than overanalyzing the situation." D. "It's important that I consider the effect of my decision on the organization, not just the people who are directly involved." - correct answer ✅✅A. "I've got to look at this situation on the basis of its unique characteristics, not by comparing it to other situations." Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Consequently, there is a focus on the specific characteristics of a situation, not its commonalities with other situations. Thinking of as

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many options as possible is a good practice for ethical decision making, but it is not specifically aligned with an intuitionist framework. Similarly, considering the effects on the organization is not a particular characteristic of this framework. Intuition does not entail choosing the option that first comes to mind, without any further analysis or consideration Which statement best describes ethics? A. The conflict, power, and interdependency associated with the way we live B. How out lives and relationships are lead in day-to- day circumstances C. What our conduct and actions should be regarding what is right and good D. How people make decisions that they see as legally and morally appropriate - correct answer ✅✅C. What our conduct and actions should be regarding what is right and good Feedback: Ethics is the systematic study of what a person's conduct and actions should be

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with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are. It is not the study of what people actually do in their daily lives or how they live but rather what they should do. Ethics is related to legality and morality, but it is not synonymous with these concepts. A nurse is facing an ethical dilemma about whether to report a colleague's offensive comment, an action which is likely to jeopardize their relationship. What is a characteristic of this nurse's ethical dilemma? A. The dilemma can be solved by applying empirical data. B. The dilemma has no realistic solution. C. The situation involves two or more undesirable alternatives. D. The situation involves a breach of the law. - correct answer ✅✅C. The situation involves two or more undesirable alternatives.

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Feedback: Ethical dilemmas involve being forced to choose between two or more undesirable alternatives. Ethical dilemmas are often not amenable to being solved with empirical data; they involve values and beliefs, not only facts. Most ethical dilemmas do not involve a breach of the law; legal issues often have a more clear and unambiguous response. Even though ethical dilemmas are difficult to manage, this does not mean that there is no possibility of a realistic solution. The A nurse is applying the ethical principle of justice when providing care for clients. What action best exemplifies this principle? A. Prioritizing actions that will benefit the largest number of clients B. Meeting continuing education requirements for license renewal C. Respecting clients' rights to make decisions about their care

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D. Ensuring that time and resources are distributed equitably to clients - correct answer ✅✅D. Ensuring that time and resources are distributed equitably to clients Feedback: The principle of justice states that equals should be treated equally and that unequals should be treated according to their differences; this is the principle of equity. Justice is frequently applied when there are scarcities or competition for resources or benefits. Meeting requirements for licensure is a legal issue, not a principle of ethics. The principle of utility involves prioritizing actions that will benefit the largest number of clients. Respecting clients' rights to make decisions demonstrates autonomy. The only treatment alternative left for a client diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. Some individuals are arguing that the high cost of the procedure could be better spent providing well-baby screening for 2,000 residents in

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the service area. What ethical principle is most directly involved in this situation? A. Paternalism B. Utility C. Unethical conduct D. Maleficence - correct answer ✅✅B. Utility Feedback: The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficent (harmful) behavior. Paternalism would be characterized by decisions being made without the client having input A nurse is applying the MORAL decision-making model to a dilemma involving a colleague's possible dishonesty in documentation. What is the nurse's initial action? A. Think of as many alternatives as possible. B. Gather as much information about the situation as possible.

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C. Engage the colleague in the decision-making process. D. Perform a critical self-reflection of the nurse's own morals and values. - correct answer ✅✅B. Gather as much information about the situation as possible. Feedback: The first step of the MORAL decision- making model is to "massage the dilemma." This involves collecting data about the ethical problem and who should be involved in the decision-making process. However, this does not necessarily mean that the nurse must engage the colleague who is the object of the decision. Outlining options (alternatives) is the second step in the model. It is presumed that a nurse will engage in self-reflection when addressing dilemmas, but this is not an explicit component of the MORAL model A nurse has been asked to stay after a shift and work overtime because three nurses have called in sick. The nurse is reluctant to work the overtime because

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of a social commitment. Duty-based reasoning would dictate that the nurse: A. contact the three nurses to remind them of their obligations. B. base the decision on recent precedents in the health-care organization. C. work overtime because of the responsibility owed to clients. D. carefully weigh the effect of the decision on workplace relationships. - correct answer ✅✅C. work overtime because of the responsibility owed to clients. Feedback: Duty-based reasoning is an ethical framework stating that some decisions must be made because there is a duty to do something or to refrain from doing something. In this case, it could be construed that the nurse has a duty to care for clients that supersedes social activities. Duty-based reasoning would not prioritize the effect on relationships over the nurse's moral duty. Precedents would not necessarily indicate what the nurse's duty is. Duty-based reasoning

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emphasizes the nurse's own duty, not that of colleagues A nurse is integrating the Nursing code of ethics when making a decision about the best response to a challenging situation. What information will the nurse be able to obtain from this document? A. Guidelines that will help the nurse clarify his or her own values B. Legal guidelines to help the nurse make an ethical decision C. The principles that are most valued in nursing practice D. A model that will guide the nurse to make an ethical decision - correct answer ✅✅C. The principles that are most valued in nursing practice Feedback: A professional code of ethics is a set of principles, established by a profession, to guide the individual practitioner. It is not, however, a decision-making model or a tool for clarifying one's own values. Codes of ethics are not legally binding documents

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The nurse is faced with a situation that requires ethical decision making. What statement should guide the nurse's action? A. Only desirable alternatives should be identified when solving ethical dilemmas. B. Critical ethical decisions should be made quickly so the situation does not worsen. C. Outcomes are the main criterion for evaluating ethical decision making. D. Accepting some ambiguity and uncertainty is a part of ethical decision making. - correct answer ✅✅D. Accepting some ambiguity and uncertainty is a part of ethical decision making. Feedback: Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. Processes must be considered during ethical decision making, not only outcomes. The nurse should identify as many alternatives as

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possible during the early stages of decision making, not only desirable alternatives. Ethical decisions often require a careful and methodical approach rather than a quick decision The principle of autonomy would have the greatest bearing on what clinical situation? A. A client is unable to afford the treatment that carries the best chance for a cure. B. A client is discussing a do-not-resuscitate order with the care team. C. The nurse is caring for two clients in pain and must choose which to treat first. D. A nurse is considering whether to report a colleague's rough treatment of a client. - correct answer ✅✅B. A client is discussing a do-not- resuscitate order with the care team. Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for one's choice. Deciding on resuscitation options involves this

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principle because the client's preference is the final determinant on the matter. Situations involving scarce resources or time are more closely aligned with issues of justice. The nurse's ethical decision making around reporting bad practice align most closely with duty-based reasoning and beneficence for clients. The care team is working with a client who has mental illness and who has been deemed a threat to self and others. It may be justified to take away the client's right to: A. self-determination. B. beneficence. C. justice. D. confidentiality. - correct answer ✅✅A. self- determination. Feedback: When an individual's impaired decision making poses a threat to self or others, it may be in the interests of the client and other people to temporarily remove the client's right

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to self-determination. That is, to remove the client's right to reject treatment. This is ultimately an act of beneficence, even though the client may perceive otherwise. Justice is more closely aligned with the distribution of benefits between people. Confidentiality is maintained whether or not the client's right to self- determination remains in place The interdisciplinary team is considering whether to apply the principle of paternalism in the care of a client. What question should guide the team's decision? A. What interventions are in the client's best interest? B. Is the client competent to make decisions? C. What is the client's most likely prognosis? D. Does the client have strong social or family support? - correct answer ✅✅B. Is the client competent to make decisions? Feedback: Paternalism can be invoked when a client is unable to make sound decisions for

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himself or herself. Consequently, the client's ability to make decisions underlies the question of whether acting paternalistic is justified or not? The presence or absence of social and family support does not justify or rule out paternalism. Likewise, the particulars of the client's prognosis do not determine whether it is appropriate to be paternalistic. The client's competence decides whether the care team is justified in stepping in to act in the client's "best interest." The nurse has been navigating a difficult situation that involved an ethical dilemma. Which factors should be considered when assessing the quality of the nurse's ethical problem-solving process? Select all that apply. A. The number of alternatives that the nurse initially generated B. The process the nurse used for data gathering is not needed

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C. Precedents in the organization involving similar situations were compared to this one D. The outcomes of the process E. The process that was used to arrive at a decision - correct answer ✅✅A, D, E Feedback: Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving because many variables affect outcomes that have no reflection on whether the problem solving was appropriate. Quality, instead, should be evaluated both by the outcome and the process used to make the decision. Rigorous data gathering enhances the decision-making process, but this is not the criteria by which the overall process is gauged. Similarly, precedents can be used to inform decision making but do not constitute the basis for evaluating the overall process. Generating multiple alternatives aids the problem-solving process by identifying as many options as possible.

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The nurse has applied the MORAL decision-making model to a situation that involved an ethical dilemma. The nurse should complete the process by: A. leading the implementation plan. B. evaluating the effectiveness of the decision- making process. C. disseminating the results of the process to other nurses. D. reaffirming the nurse's relationships with stakeholders. - correct answer ✅✅B. evaluating the effectiveness of the decision-making process. Feedback: The final phase of the MORAL decision- making model involves "looking back." That is, evaluating the decision-making process. This model does not explicitly involve reaffirming relationships or disseminating the results, even though the model does not preclude these actions. Implementing the decision precedes the evaluation phase.

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Which statement is correct regarding the distinction between legal and ethical obligations in decision making? A. Ethical controls are much clearer and individualized. B. Legal controls are clearer and philosophically impartial. C. Ethical controls are clearer and philosophically impartial. D. Legal controls are much less clear and individualized. - correct answer ✅✅B. Legal controls are clearer and philosophically impartial. Feedback: In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized The nurse-manager has learned there is conflict between a nonresponsive client's family members about the best plan of care. The manager recognizes the complex ethics of this situation. What is the manager's best action? A. Make contact with the hospital's ethics committee.

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B. Refer the family to the hospital's spiritual care service. C. Base a decision on the most recent precedent in the organization. D. Ask an impartial staff member to mediate. - correct answer ✅✅A. Make contact with the hospital's ethics committee. Feedback: An ethics committee can bring needed experience, perspective, and insight to challenging ethical situations. Precedent cannot always be used as a guide because each situation is unique even if they appear superficially similar. Clients and families often benefit from spiritual care, but this does not help the manager make a good decision. Mediation can sometimes be beneficial, but this does not release the nurse-manager from addressing the situation as best as he or she can. In which situation would the nurse be justified in overriding a client's right to confidentiality?

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A. A client does not want her husband to know that she is a client on the unit. B. An older adult client discloses to the nurse that her son occasionally hits her. C. A teenage client asks the nurse not to tell her parents that she is pregnant. D. A client states that he does not want to know the results of his recent diagnostic test - correct answer ✅✅B. An older adult client discloses to the nurse that her son occasionally hits her. Feedback: Health-care managers are required by law to report certain cases, such as drug abuse in employees, elder abuse, and child abuse. This is considered a justifiable violation of confidentiality. The manager is obliged to respect client confidentiality around disclosing pregnancy, acknowledging a hospital admission, or not wanting to know diagnostic results The new nurse-manager has committed to modeling the leadership roles associated with applying ethics in the workplace. What is the manager's best action?

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A. Ensure nurses are responsible for scrutinizing each other's behavior to monitor for ethical violations. B. Demonstrate self-awareness about his or her own beliefs, morals, and values. C. Delegate ethical decision making to staff nurses whenever possible. D. Ensure that individual rights are always prioritized over collective rights. - correct answer ✅✅B. Demonstrate self-awareness about his or her own beliefs, morals, and values. Feedback: A core competency for ethical leadership is evaluating one's own values and beliefs. This form of self-reflection is foundational for providing ethical care and promoting in others. The balance between individual and collective rights is situation-specific; individual rights are not always priorities over group interests. The manager must show leadership in ethical decision making and cannot always delegate this important function to staff. Ethical nurses are observant for violations, but this should not result in an environment

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where each nurse is "scrutinizing" colleagues' practice Which nurse is experiencing moral distress? A. A heavy workload prevents a nurse from providing the care that each client requires. B. The children of a terminally ill client do not want the client's prognosis communicated to the client. C. A nurse knows that a colleague called in sick to work because the colleague had a social engagement. D. A nurse witnesses a colleague using a racial slur in a conversation with another nurse. - correct answer ✅✅A. A heavy workload prevents a nurse from providing the care that each client requires. Feedback: Each of the listed situations has an ethical element. However, moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. A nurse who lacks the time and energy to give

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clients what they need is likely to experience moral distress. Issues of respect, honesty, and confidentiality require ethical decision making, but they do not directly involve a disconnect between the desire and the ability to do the right thing The nurse is practicing in a challenging environment where ethical and moral issues must often be dealt with. Which statement describes how moral uncertainty occurs? A. An individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. B. An individual witnesses the immoral act of another but feels powerless to stop it. C. An individual is forced to choose between two or more undesirable alternatives. D. An individual knows the right thing to do, but organizational constraints make it difficult to take the right course of action. - correct answer ✅✅A. An individual is unsure which moral principles or values

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apply and may even include uncertainty as to what the moral problem is. Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Ethical dilemma is being forced to choose between two or more undesirable alternatives The nurse-manager is applying the MORAL decision- making model to a decision around a client's plan of care. The manager has engaged all the necessary stakeholders and collected as much data about the situation as possible. What should the manager do next? A. Identify as many alternatives as possible.

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B. Assess the client's values and beliefs. C. Arrange to meet with the institution's ethics board. D. Choose the option that best aligns with ethical principles. - correct answer ✅✅A. Identify as many alternatives as possible. Feedback: The initial step in the MORAL decision- making model involves collecting data and determining who should be involved in the decision-making process. After this, the nurse identifies alternatives and then chooses the best option. Engaging with an ethics committee should take place in the first step when the manager decides who to involve. Assessing the client's values should take place early in the decision-making process Which ethical principle is demonstrated when an adult child is legally given the right to make medical decisions for a cognitively impaired parent? A. Justice B. Fidelity C. Paternalism

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D. Beneficence - correct answer ✅✅C. Paternalism Feedback: Paternalism is when one individual assumes the right to make decisions for another. Justice requires that a person seek fairness, treat "equals" equally, and treat "unequals" according to their differences. Fidelity involves the need to keep promises. Beneficence involves actions that are taken in an effort to promote good A nurse has repeatedly witnessed a physician being dismissive of clients' reports of pain and anxiety. The nurse recognizes that the best action would be to address this behavior with the physician, but the nurse strongly suspects that these concerns would be dismissed. What phenomenon is this nurse experiencing? A. Ethical universalism B. Moral conflict C. Moral outrage D. Ethical relativism - correct answer ✅✅C. Moral outrage