Chapter-6 Values Ethics and Advocacy
Questions, Assignment, Discusion Topics Answers and Case Study.
1. A nurse in a physician's office has noted on several occasions that one of the physicians frequently
obtains forms for writing prescriptions for controlled substances. The physician reports that the
physician's spouse has chronic back pain and requires pain medication. One day the nurse enters the
physician's office and sees the physician take a pill out of a bottle. The physician mentions having
migraines and that the spouse's pain medication alleviates the pain. What type of nurse–physician ethical
situation is illustrated in this scenario?
A. Unprofessional, incompetent, unethical, or illegal physician practice
B. Disagreements about the proposed medical regimen
C. Conflicts regarding the scope of the nurse's role
D. Claims of loyalty
Answer: A
Rationale: The physician is demonstrating unprofessional, incompetent, unethical, or illegal physician
practice. Claims of loyalty and conflicts regarding the nurse's role are not included in this situation. There
is no disagreement with the medical regimen as the physician is not supporting the spouse in obtaining
prescriptions from a different provider.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 134
2. A client diagnosed with diabetes 3 years ago has failed to integrate regular blood glucose monitoring or
dietary modifications into the client's lifestyle. The client has been admitted to the hospital for treatment
of acute renal failure secondary to diabetic nephropathy, an event that has prompted the client to reassess
personal values. Which action most clearly demonstrates that this client is engaging in the step of prizing
within the valuing process?
A. The client expresses pride over now having the knowledge and skills to take control of diabetes
management.
B. The client states an intention to check the blood glucose level before each meal and at bedtime.
C. The client is now able to explain how the client's choices have contributed to renal failure.
D. The client expresses remorse at how a failure to make lifestyle changes has adversely affected the
client's health.
Answer: A
Rationale: Within the valuing process, expressions of pride and happiness are considered to be indications
of prizing. Resolving to make changes such as checking the blood glucose level is an aspect of choosing.
Expressing insight about the client's role in contributing to the current diagnosis (such as explaining how
food choices have contributed to renal failure) and remorse for the failure to make lifestyle changes
demonstrate that the client is desiring to re-examine personal values.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
,Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process
Reference: p. 120
3. A group of nurse researchers has proposed a study to examine the efficacy of a new wound care
product. Which aspect of the methodology demonstrates that the nurses are attempting to maintain the
ethical principle of nonmaleficence?
A. The nurses are taking every reasonable measure to ensure that no participants experience impaired
wound healing as a result of the study intervention.
B. The nurses have organized the study in such a way that the foreseeable risks and benefits are
distributed as fairly as possible.
C. The nurses have given multiple opportunities for potential participants to ask questions, and have been
following the informed consent process systematically.
D. The nurses have completed a literature review that suggests the new treatment may result in decreased
wound healing time.
Answer: A
Rationale: The principle of nonmaleficence dictates that nurses avoid causing harm. In a research study,
this may appear in the form of taking measures to ensure that the intervention will not cause more harm
than good. The principle of justice addresses the distribution of risks and benefits. The informed consent
process demonstrates that autonomy is being protected. Preliminary indications of the therapeutic value of
the intervention show a respect for the principle of beneficence.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 123
4. A client with a diagnosis of colorectal cancer has been presented with the treatment options, but wishes
to defer any decisions to an uncle, who acts in the role of a family patriarch within the client's culture.
The client's right to self-determination is best protected by:
A. respecting the desire to have the uncle make choices on the client's behalf.
B. revisiting the decision when the uncle is not present at the bedside.
C. educating the client about the right to autonomy.
D. holding a family meeting and encouraging the client to speak on the client's own behalf.
Answer: A
Rationale: The right to self-determination (autonomy) means that actions should never be forced on
anyone. The client has the autonomous right to defer decision-making to another individual if the client
freely chooses to do so. Revisiting the issue with the client, educating on the right to autonomy, or having
a family meeting is disrespectful to the client and the client's wishes.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Caring
Reference: p. 137
,5. A client age 56 years is experiencing withdrawal from alcohol and is placing themselves at risk for falls
by repeatedly attempting to scale the bedrails. Benzodiazepines have failed to alleviate the client's
agitation and the nurse is considering obtaining an order for physical restraints to ensure client safety. The
nurse should recognize that this measure may constitute:
A. paternalism.
B. deception.
C. harm.
D. advocacy.
Answer: A
Rationale: Paternalism involves the violation of a client's autonomy in order to maximize good or
minimize harm (injury), a situation that requires careful consideration in light of ethical principles.
Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy
is the protection and support of another's rights.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process
Reference: p. 132
6. A parent always thanks clerks at the grocery store. The parent's child, age 6 years, echoes the thank
you. The child is demonstrating what mode of value transmission?
A. modeling
B. moralizing
C. reward and punishment
D. responsible choice
Answer: A
Rationale: Through modeling, children learn of high or low value by observing parents, peers, and
significant others. Modeling can thus lead to socially acceptable or unacceptable behaviors. Children
whose caregivers use the moralizing mode of value transmission are taught a complete value system by
parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different
values. Through rewarding and punishing, children are rewarded for demonstrating values held by parents
and punished for demonstrating unacceptable values. Caregivers who follow the responsible-choice mode
of value transmission encourage children to explore competing values and to weigh their consequences.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 119
7. Which mode of value transmission is most likely to lead to confusion and conflict?
A. Modeling
B. Moralizing
C. Laissez-faire
D. Responsible choice
, Answer: C
Rationale: Those who use the laissez-faire approach for value transmission leave children to explore
values on their own (no one set of values is presented as best for all) and to develop a personal value
system. This approach often involves little or no guidance and can lead to confusion and conflict. In
modeling, the client learns new skills by imitating another person, such as a parent or therapist, who
performs the behavior to be acquired. Children learn from parents and peers by modeling. Moralizing is to
reflect on or express opinions about something in terms of right and wrong, especially in a self-righteous
or tiresome way. By moralizing, parents can teach a child the right way to act. Responsible choice is an
approach in which parents teach their children to weigh the costs and benefits of various options when
choosing, so as to make a responsible choice.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Remember
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 119
8. While at lunch, a nurse sitting alone heard other nurses at a nearby table talking about a client they did
not like. When the group asked the solo nurse for their thought, the solo nurse politely refused to join in
the conversation. What value was the solo nurse demonstrating?
A. the importance of food in meeting a basic human need
B. basic respect for human dignity
C. that gossip with the group of peers has a role in society
D. a low value on collegiality and friendship
Answer: B
Rationale: Nurses who feel uncomfortable gossiping with other nurses about clients realize that gossiping
contradicts a basic respect for human dignity. This respect is a value that allows one to choose freely to
believe in the worth and uniqueness of each individual.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Caring
Reference: p. 119
9. A client who is having increasing difficulty breathing reports never exercising, eating fast food
regularly, and smoking two packs of cigarettes a day. The client tells the nurse practitioner that the client
wants to make lifestyle changes. Which would be the most appropriate means of helping the client
change behaviors?
A. Ethical change strategy
B. Values neutrality choices
C. Values transmission
D. Values clarification
Answer: D
Rationale: Values clarification is a process by which people come to understand their own values and
value system. When nurses understand the values that motivate clients' decisions and behaviors, they can
Questions, Assignment, Discusion Topics Answers and Case Study.
1. A nurse in a physician's office has noted on several occasions that one of the physicians frequently
obtains forms for writing prescriptions for controlled substances. The physician reports that the
physician's spouse has chronic back pain and requires pain medication. One day the nurse enters the
physician's office and sees the physician take a pill out of a bottle. The physician mentions having
migraines and that the spouse's pain medication alleviates the pain. What type of nurse–physician ethical
situation is illustrated in this scenario?
A. Unprofessional, incompetent, unethical, or illegal physician practice
B. Disagreements about the proposed medical regimen
C. Conflicts regarding the scope of the nurse's role
D. Claims of loyalty
Answer: A
Rationale: The physician is demonstrating unprofessional, incompetent, unethical, or illegal physician
practice. Claims of loyalty and conflicts regarding the nurse's role are not included in this situation. There
is no disagreement with the medical regimen as the physician is not supporting the spouse in obtaining
prescriptions from a different provider.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 134
2. A client diagnosed with diabetes 3 years ago has failed to integrate regular blood glucose monitoring or
dietary modifications into the client's lifestyle. The client has been admitted to the hospital for treatment
of acute renal failure secondary to diabetic nephropathy, an event that has prompted the client to reassess
personal values. Which action most clearly demonstrates that this client is engaging in the step of prizing
within the valuing process?
A. The client expresses pride over now having the knowledge and skills to take control of diabetes
management.
B. The client states an intention to check the blood glucose level before each meal and at bedtime.
C. The client is now able to explain how the client's choices have contributed to renal failure.
D. The client expresses remorse at how a failure to make lifestyle changes has adversely affected the
client's health.
Answer: A
Rationale: Within the valuing process, expressions of pride and happiness are considered to be indications
of prizing. Resolving to make changes such as checking the blood glucose level is an aspect of choosing.
Expressing insight about the client's role in contributing to the current diagnosis (such as explaining how
food choices have contributed to renal failure) and remorse for the failure to make lifestyle changes
demonstrate that the client is desiring to re-examine personal values.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
,Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process
Reference: p. 120
3. A group of nurse researchers has proposed a study to examine the efficacy of a new wound care
product. Which aspect of the methodology demonstrates that the nurses are attempting to maintain the
ethical principle of nonmaleficence?
A. The nurses are taking every reasonable measure to ensure that no participants experience impaired
wound healing as a result of the study intervention.
B. The nurses have organized the study in such a way that the foreseeable risks and benefits are
distributed as fairly as possible.
C. The nurses have given multiple opportunities for potential participants to ask questions, and have been
following the informed consent process systematically.
D. The nurses have completed a literature review that suggests the new treatment may result in decreased
wound healing time.
Answer: A
Rationale: The principle of nonmaleficence dictates that nurses avoid causing harm. In a research study,
this may appear in the form of taking measures to ensure that the intervention will not cause more harm
than good. The principle of justice addresses the distribution of risks and benefits. The informed consent
process demonstrates that autonomy is being protected. Preliminary indications of the therapeutic value of
the intervention show a respect for the principle of beneficence.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 123
4. A client with a diagnosis of colorectal cancer has been presented with the treatment options, but wishes
to defer any decisions to an uncle, who acts in the role of a family patriarch within the client's culture.
The client's right to self-determination is best protected by:
A. respecting the desire to have the uncle make choices on the client's behalf.
B. revisiting the decision when the uncle is not present at the bedside.
C. educating the client about the right to autonomy.
D. holding a family meeting and encouraging the client to speak on the client's own behalf.
Answer: A
Rationale: The right to self-determination (autonomy) means that actions should never be forced on
anyone. The client has the autonomous right to defer decision-making to another individual if the client
freely chooses to do so. Revisiting the issue with the client, educating on the right to autonomy, or having
a family meeting is disrespectful to the client and the client's wishes.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Caring
Reference: p. 137
,5. A client age 56 years is experiencing withdrawal from alcohol and is placing themselves at risk for falls
by repeatedly attempting to scale the bedrails. Benzodiazepines have failed to alleviate the client's
agitation and the nurse is considering obtaining an order for physical restraints to ensure client safety. The
nurse should recognize that this measure may constitute:
A. paternalism.
B. deception.
C. harm.
D. advocacy.
Answer: A
Rationale: Paternalism involves the violation of a client's autonomy in order to maximize good or
minimize harm (injury), a situation that requires careful consideration in light of ethical principles.
Deception is unlikely to occur and the risk for harm is likely decreased by the use of restraints. Advocacy
is the protection and support of another's rights.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process
Reference: p. 132
6. A parent always thanks clerks at the grocery store. The parent's child, age 6 years, echoes the thank
you. The child is demonstrating what mode of value transmission?
A. modeling
B. moralizing
C. reward and punishment
D. responsible choice
Answer: A
Rationale: Through modeling, children learn of high or low value by observing parents, peers, and
significant others. Modeling can thus lead to socially acceptable or unacceptable behaviors. Children
whose caregivers use the moralizing mode of value transmission are taught a complete value system by
parents or an institution (e.g., church or school) that allows little opportunity for them to weigh different
values. Through rewarding and punishing, children are rewarded for demonstrating values held by parents
and punished for demonstrating unacceptable values. Caregivers who follow the responsible-choice mode
of value transmission encourage children to explore competing values and to weigh their consequences.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Apply
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 119
7. Which mode of value transmission is most likely to lead to confusion and conflict?
A. Modeling
B. Moralizing
C. Laissez-faire
D. Responsible choice
, Answer: C
Rationale: Those who use the laissez-faire approach for value transmission leave children to explore
values on their own (no one set of values is presented as best for all) and to develop a personal value
system. This approach often involves little or no guidance and can lead to confusion and conflict. In
modeling, the client learns new skills by imitating another person, such as a parent or therapist, who
performs the behavior to be acquired. Children learn from parents and peers by modeling. Moralizing is to
reflect on or express opinions about something in terms of right and wrong, especially in a self-righteous
or tiresome way. By moralizing, parents can teach a child the right way to act. Responsible choice is an
approach in which parents teach their children to weigh the costs and benefits of various options when
choosing, so as to make a responsible choice.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Remember
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Nursing Process
Reference: p. 119
8. While at lunch, a nurse sitting alone heard other nurses at a nearby table talking about a client they did
not like. When the group asked the solo nurse for their thought, the solo nurse politely refused to join in
the conversation. What value was the solo nurse demonstrating?
A. the importance of food in meeting a basic human need
B. basic respect for human dignity
C. that gossip with the group of peers has a role in society
D. a low value on collegiality and friendship
Answer: B
Rationale: Nurses who feel uncomfortable gossiping with other nurses about clients realize that gossiping
contradicts a basic respect for human dignity. This respect is a value that allows one to choose freely to
believe in the worth and uniqueness of each individual.
Question format: Multiple Choice
Chapter 6: Values, Ethics, and Advocacy
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Management of Care
Integrated Process: Caring
Reference: p. 119
9. A client who is having increasing difficulty breathing reports never exercising, eating fast food
regularly, and smoking two packs of cigarettes a day. The client tells the nurse practitioner that the client
wants to make lifestyle changes. Which would be the most appropriate means of helping the client
change behaviors?
A. Ethical change strategy
B. Values neutrality choices
C. Values transmission
D. Values clarification
Answer: D
Rationale: Values clarification is a process by which people come to understand their own values and
value system. When nurses understand the values that motivate clients' decisions and behaviors, they can
