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Chapter 19: Ethical Issues
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1. A nurse is educating an adult patient on patient rights, according to the American Hospital Association. The teaching has been effective when the adult states that the patient’s rights include:
a. “choice of diet to be eaten during hospitalization.”
b. “considerate and respectful care from all care providers.”
c. “medical care regardless of ability to pay.”
d. “information from nurses about diagnosis and prognosis.”
ANS: B
When you are a patient in the hospital, you have the right to receive considerate and respectful care. The American Hospital Association published a Patient’s Bill of Rights, which is now revised and called The Patient Care Partnership. This document reflects acknowledgment of patients’ rights to participate in their health care and was developed as a response to consumer criticism of paternalistic provider care. The statements detail the patient’s rights with corresponding provider responsibilities. This document reflects the increasing emphasis on patient autonomy in health care and defines the limits of provider influence and control. It does not contain information on diets, nursing diagnosis, or the ability to pay for medical care.
2. A nurse manager is teaching the purpose of the nurse’s Code of Ethics to a group of high school students. Which statement by one of the students indicates that the teaching has been effective? The purpose of the nurse’s Code of Ethics is
a. “to assist in clarifying the individual nurse’s personal values and goals.”
b. “to differentiate between moral and immoral acts.”
c. “to guide the behavior of the professional nurse.”
d. “to identify acts that are legal for the nurse to perform.”
ANS: C
The American Nurses Association (ANA) Code of Ethics (2001) is a statement to society that outlines the values, concerns, and goals of the profession. It should be compatible with the values and goals of each nurse. It does not outline moral or immoral acts or make statements regarding legal aspects of nursing.
3. Which statement best describes the Code of Ethics of the American Nurses Association?
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a. A moral statement of accountability for practicing nurses and for student nurses
b. A legal document describing the responsibilities of the nurse
c. A statement regarding nursing care that outlines principles for the hospital to use to evaluate quality of care
d. A document that is used as a guide for the nurse to consider in the decision-making process in legal situations
ANS: B
The Code of Ethics is a moral statement of accountability for practicing nurses and for student nurses. It is a statement to society that outlines the values, concerns, and goals of the profession, thereby addressing accountability. The code provides direction for ethical decisions and behavior by repeatedly emphasizing the obligations and responsibilities that the nurse–patient relationship entails. It lacks legal enforceability and is not a legal document like licensure laws
4. Which ethical principle is applied when the nurse acts to safeguard the patient and the public by reporting poor nursing practice?
a. Autonomy c. Justice
b. Fidelity d. Veracity
ANS: D
Veracity—the duty to tell the truth—is represented in this situation. Autonomy is the right of the patient to make an informed decision. Fidelity means to act in a way that is loyal, such as keeping information private and confidential. Justice requires the nurse to treat all patients fairly without regard to age, socioeconomic status, or other variables.
5. What ethical principle is implemented, or supported, when the nurse encourages a patient to be involved in planning and implementing self-care?
a. Autonomy c. Justice
b. Fidelity d. Veracity
ANS: A
A patient’s right to self-determination implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables. This principle involves the allocation of scarce and expensive health care resources. Fidelity
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6. The ethical principle of autonomy is not applicable in which patient situation?
a. The patient does not speak or understand the English language.
b. The patient is unaware of who or where he or she is.
c. The patient has been in a long-term care facility for 10 years.
d. The patient has values that conflict with the caregiver’s values.
ANS: B
This principle assumes rational thinking on the part of the individual, and being unaware of who and where the patient is, is not indicative of the ethical principle of autonomy. Autonomy is a patient’s right to self-determination implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. In the other situations, the patient has rational thinking even though he or she may not understand or speak English because an interpreter could assist.
7. A nurse is educating a nurse aide on patient confidentiality. The nurse believes the teaching to be effective when the nurse aide states that confidentiality will be maintained by a nurse who believes in and values the ethical principle of
a. veracity. c. justice.
b. autonomy. d. fidelity.
ANS: D
Fidelity involves keeping information confidential and maintaining privacy and trust. Veracity means to tell the truth. Autonomy involves the patient making an informed decision and implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Justice is the duty to treat all patients fairly without regard to age, socioeconomic status, or other variables.
8. A patient who has a terminal illness wants to be able to take a prescription medication to end life when suffering becomes unbearable. The patient asks the nurse for advice. Operating from a deontological point of reference, what action does the nurse take?
a. Advises the patient about local providers willing to participate
b. Assesses the patient for more information about the situation
c. Determines what kind of insurance the patient has before acting
d. Tells the patient that they cannot participate in this action
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ANS: D
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b. Advocacy d. Autonomy
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ANS: D
Autonomy implies the freedom to make choices and decisions about one’s own care without interference even if those decisions are not in agreement with those of the health care team. Veracity is the duty to tell the truth. Beneficence is the duty to actively do good for patients. Speaking out on behalf of the patient is an essential part of the advocacy role of the nurse.
12. A nurse is educating themself on the ANA Code of Ethics. Which action by the nurse would be unethical, according to the ANA Code of Ethics?
a. Joining unions or bargaining units
b. Engaging in lobbying related to health care issues
c. Reporting an incompetent or impaired colleague
d. Refusing to care for a patient who is diagnosed as HIV positive
ANS: D
ANA Code 1: The nurse provides services with respect for human dignity and the uniqueness of the patient unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problem. Nurses have the right to engage in collective bargaining and lobbying for health care issues. Nurses have a legal responsibility based on the Nurse Practice Act in their states to report an incompetent of impaired colleague.
13. Which action by the nurse shows an understanding of the ethical principle of autonomy?
a. Allowing a patient the right to make decisions regarding his health care even if the nurse does not agree with his decisions.
b. Making decisions for the patient regarding his care
c. Disregarding the patient’s decisions because they are not “normal” according to society
d. Consulting the attending physician to make decisions for the patient
ANS: A
The nurse shows understanding of the ethical principle of autonomy by allowing patients the right to make their own health care decisions even if the nurse does not agree with their decisions. It is not up to the nurse or the attending physician to make health care decisions for patients.
14. The nurse is educating a coworker on the ethical principle of beneficence. The nurse judges the teaching to be effective when her coworker states:
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b. “Beneficence is the duty to actively do good for patients.”
c. “Beneficence is the duty to do no harm.”
d. “Beneficence involves treating all patients equally.”
ANS: B
Beneficence is the ethical principle of actively doing good for patients. Allowing patients to make their own health care decisions is autonomy. Doing no harm to the patient is nonmaleficence. Justice involves treating all patients equally.
15. What action can the nurse take to uphold the ethical principle of fidelity?
a. Report unscrupulous billing practices.
b. Disclose the results of an HIV test to a patient’s family.
c. Make health care decisions for a patient.
d. Accept an assignment that is unsafe.
ANS: A
The nurse can uphold the ethical principle of fidelity by reporting unscrupulous billing practices. Disclosing the results of an HIV test to a patient’s family would violate fidelity. Making health care decisions would violate autonomy. Accepting an assignment that is unsafe violates nonmaleficence.
16. A nurse is caring for a patient who has just been diagnosed with cancer. The patient’s family has requested that the patient not be told at this time because it would be devastating. The patient asks the nurse if the diagnosis is cancer. If the nurse were to uphold the ethical principle of veracity, what would the response be?
a. “No, you do not have cancer.”
b. “The physician is unsure of your diagnosis at this time.”
c. “Yes, that is the diagnosis. Let me call the doctor so that we can have a discussion.”
d. “Yes, but your family told me that I could not talk to you about the diagnosis.”
ANS: C
If the nurse were to uphold the ethical principle of veracity, the nurse would inform the patient of the diagnosis and involve the physician in the discussion. The nurse should not lie to the patient or withhold information at the family’s request; the patient has a right to know information regarding his or her
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health care.
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ANS: A
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b. Call the attending physician and request a meeting so that there can be open communication
When identifying the ethical issues of the situation, the nurse should encourage the patient to share his wishes with his family. It is not the position of the nurse to try to change the patient’s mind or force him to remain a “full code.” The nurse should respect the patient’s wishes and document them accordingly.
20. A patient with cancer has decided to end treatment and is discussing end-of-life care with family. The nurse notices that the attending physician has just ordered another dose of chemotherapy. What would be the best action for the nurse to take as an advocate for the patient?
a. Send the order to pharmacy so that the chemotherapy can be prepared.
between the physician, patient and family.
c. Tell the patient that because the chemotherapy has been ordered, it must be given.
d. Request a meeting with the attending physician, patient, and family so the attending physician can convince the patient to receive the chemotherapy.
ANS: B
As an advocate for the patient, the nurse should advocate for the patient with the attending physician and family by facilitating communication. It would be best for all parties to be in a room together so that a discussion can take place. It would not be appropriate to send the order to pharmacy, try to convince the patient to receive chemotherapy, or to tell the patient that the drug must be given because it was already ordered.
21. A young woman has come to the hospital requesting medication to induce an abortion. The nurse assigned finds it too hard to provide care to this patient because it violates the nurse’s ethical principles. Which action would be the best for the nurse to take?
a. Continue to provide care for the patient but refuse to administer the medication.
b. Administer the medication because the doctor ordered it.
c. Find another nurse to provide care for the patient.
d. Try to talk the patient out of taking the medication.
ANS: C
To ensure care for the patient without violating the nurse’s ethical principles, the nurse should find another nurse to care for the patient. Because the patient has rights, it would be inappropriate to try to talk the patient out of receiving the medication or to deny the patient’s access to the medication.
22. A nurse is caring for a young patient recovering from a traumatic car accident. The patient has lost
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will not accept the blood. The nurse knows the patient will likely not survive if they do not receive the blood. What action should the nurse take?
a. Administer the blood anyway; the patient will die without it.
b. Try to talk the family into signing the consent for the blood.
c. Call the physician and report the patient’s decision.
d. Stop all care for the patient to respect their wishes.
ANS: C
The nurse should immediately call the physician to report the patient’s decision. The nurse should not administer the blood against the patient’s wishes or try to talk the family into signing the consent. The nurse should continue all care for the patient except administration of the blood.
23. The nurse has an adequate understanding of ethical issues regarding transplantation when stating which of the following?
a. “There are few Americans on the transplantation list.”
b. “Everyone on the transplantation list receives the organ they need.”
c. “There is an overabundance of organ donors.”
d. “The majority of individuals on the transplantation list will die because of the shortage of organs.”
ANS: D
There are almost 110,000 Americans on the transplantation list, and the majority of them will die without a transplant because of the shortage of available organs.
24. A nurse manager is educating a group of staff nurses about genetics and genomics. The nurse manager judges that the teaching has been effective when one of the staff nurses states:
a. “Health outcomes and treatment of disease processes have not increased with the study of genetics and genomics.”
b. “Only researchers benefit from the study of genetics and genomics.”
c. “This area of study has nothing to do with nurses.”
d. “Genetics and genomes have increased the ability of health care professionals to assist patients in improving health outcomes.”
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ANS: D
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There are three elements that must be present for a malpractice claim: (1) You must have a duty—there must be a professional nurse–patient relationship. (2) You must have breached a duty that was
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foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient injury or damages. The other options do not indicate the nurse’s understanding of malpractice.
2. In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, QID. The patient has a long history of gastrointestinal bleeding. What is the best nursing action?
a. Give the medication.
b. Withhold the medication and chart why it was not given.
c. Call the physician and question the order in light of the patient’s history.
d. Ask if the patient is allergic to aspirin.
ANS: C
The nurse should call the physician and question the medication order for aspirin based on the patient’s history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient’s allergies. The nurse would withhold the medication until the physician is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding.
3. The nurse enters a patient’s room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated they could not leave the hospital until the bill was paid. What is the best nursing action?
a. Comfort the patient and continue the preparations for discharge.
b. Call the social worker for a financial evaluation.
c. Call the family to arrange for the payment.
d. Cancel the discharge plans and notify the physician of the situation.
ANS: A
The best action is to comfort the patient and continue the discharge preparations. If the patient’s claim is accurate, this could be false imprisonment (wrongfully making someone believe that they cannot leave a place). The nurse’s best action is to comfort the patient and continue the discharge preparations. However, this should also be reported to the supervisor. Calling the social worker or the contacting the family is not appropriate.
4. What is a correct statement regarding a nurse who acts beyond the scope of practice?
a. Demonstrates what a good nurse he or she can be
