Nursing Ethics TEST BANK Questions and Answers

A 77-year-old woman with an inoperable brain tumor has been hospitalized for the past 5 days. Her daughter comes to visit her. The patient has asked that her daughter not be told her diagnosis. After visiting with her mother, the daughter asks to speak to the nurse. She says, My mother claims she has pneumonia, but I know she is not telling me the truth. The daughter asks the nurse to tell her what is truly wrong with her mother. The nurse should tell her that: 1) Her mother has an inoperable brain tumor, but does not wish anyone to know. 2) She needs to speak to the physician in charge of her mothers care. 3) Her mother has requested that her case not be discussed with anyone, not even family. 4) Her mother is very sick with a serious case of pneumonia that could lead to death. - 3) Her mother has requested that her case not be discussed with anyone, not even family. The nurses first allegiance is to the patient and her desire for confidentiality. Telling the daughter to speak to the physician would place the physician in the same position as the nurse. Telling her that her mother has pneumonia would be a lie. The nurse, of course, should inform the physician of the patients wishes so that he will be prepared if the daughter questions him about her mothers health condition. Which of the following terms refers to the ethical questions that arise out of nursing practice? 1) Nursing ethics 2) Bioethics 3) Ethical dilemma 4) Moral distress - 1) Nursing ethics Nursing ethics refers to ethical questions that arise out of nursing practice. Bioethics is a broader field that refers to the application of ethics to healthcare. An ethical dilemma occurs when a choice must be made between two equally undesirable actions, and there is no clearly right or wrong option. Moral distress occurs when someone is unable to carry out his or her moral decision. A belief about the worth of something that serves as a principle or a standard that influences decision making is called which of the following? 1) Morals 2) Attitudes 3) Beliefs 4) Values - 4) Values A value is a belief you have about the worth of something that serves as a principle or a standard that influences decision making. Morals are private, personal, or group standards of right and wrong. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is conscious and competent and has decided that he wants to be removed from the ventilator. His family and the multidisciplinary team agree. The nurse believes the patient intends suicide and would prefer he choose differently but says nothing. The nurse remains at the bedside holding the patients hand. In this instance the nurse is displaying which of the following? 1) Value set 2) Value system 3) Value neutrality 4) Value awareness - 3) Value neutrality Value neutrality occurs when we put aside our own values regarding an issue in order to provide nonjudgmental care to clients. A value set is your list of values. A value system is your value set with the values ranked on a continuum from most important to least important. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is alert and oriented and, after giving it much thought, has decided that he wants to be removed from the ventilator. The nurse believes the patient intends suicide but supports his final decision. When the ventilator is removed, the nurse remains with the patient to support him. The nurses action demonstrates respect for what moral principle? 1) Nonmaleficence 2) Autonomy 3) Beneficence 4) Fidelity - 2) Autonomy Autonomy refers to a persons right to choose and his ability to act on that choice. In this case, the nurse respects the patients right to choose to die. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. Fidelity is the obligation to keep promises. Which of the following consequentialist theories takes the position that the value of an action is determined by its usefulness? 1) Ethics of care 2) Utilitarianism 3) Deontology 4) Categorical imperative - 2) Utilitarianism Utilitarianism is a consequentialist theory that takes the position that the value of an action is determined by its usefulness. An ethics of care is a nursing philosophy that directs attention to the specific situations of individual patients viewed within the context of their life narrative. Deontology considers an action to be right or wrong independent of its consequences. A categorical imperative is a principle, established by Immanuel Kant, that states that one should act only if the action is based on a principle that is universal. The ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making is known as which of the following? 1) Ethical agency 2) Attitudes 3) Belief 4) Value neutrality - 1) Ethical agency Ethical agency is the ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. Value neutrality is when we attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgmental when providing care to clients. Identify the third step in the MORAL decision-making model. 1) Reassess the dilemma 2) Resolve the dilemma 3) Review the problem 4) Recall the history of the problem - 2) Resolve the dilemma MORAL is an acronym - M, Massage the dilemma; O, Outline the options; R, Resolve the dilemma; A, Act by applying the chosen option; L, Look back and evaluate. A patient has asked the nurse to explain her laboratory results. The nurse informs the patient that he must first assist another patient to the bathroom and then he will explain the results. The nurse assists the other patient to the bathroom and then returns to explain the results to the patient. What moral principle has the nurse displayed? 1) Nonmaleficence 2) Autonomy 3) Beneficence 4) Fidelity - 4) Fidelity Fidelity is the obligation to keep promises. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. The nurse is a member of the ethics committee. An alert, oriented, and competent 87-year-old man has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and requests the ethics committee to intervene on their behalf. The ethics committee would most likely use which model in this patients case? 1) Social justice 2) Patient benefit 3) Autonomy 4) DNAR determination - 3) Autonomy The autonomy model is useful when the patient is competent to decide. This model emphasizes patient autonomy and choice as the highest values. The patient benefit model assists in decision making for the incompetent patient by using substituted judgment. The social justice model focuses more on broad social issues involving the entire institution rather than on a single patient issue. There is no DNAR determination model. A 60-year-old patient with a treatable form of breast cancer has decided not to pursue radiation or chemotherapy. The nurse believes that the patient should be treated. She coerces her into receiving treatment by continuing to remind the patient about her responsibilities for raising her children. What type of behavior has the nurse displayed? 1) Nonmaleficence 2) Autonomy 3) Paternalism 4) Beneficence - 3) Paternalism Paternalistic behavior occurs when the nurse thinks she knows what is best for a competent patient and coerces the patient to act as she wishes rather than to act as the patient originally desired. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. Nursing codes are: 1) Legally binding. 2) Not legally binding. 3) Legally binding in some circumstances. 4) Not admissible in court. - 2) Not legally binding. Codes of ethics are open to public scrutiny. The ethical aspects of nursing work, just like the technical aspects, are subject to review by professional groups and licensure boards, which may use sanctions to punish code violations. However, nursing codes are not legally binding. An alert, oriented, and competent frail older adult man has been told that he is dying and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. After a great deal of discussion among the physician, nurse, and family, they are no closer to resolution of the conflict. The nurse asks the hospital chaplain to come and help the family and the team understand each others opposing views. Which step of the MORAL model does this illustrate? 1) Massage the dilemma 2) OOutline the options 3) Resolve the dilemma 4) Look back and evaluate - 2) OOutline the options This illustrates the Outlining-options step. In Massaging the dilemma, the team would already have identified and defined the issues in the dilemma, and considered the values and options of all the major players. At the Outlining the options step, someone should delineate all of the options to all parties, including those that are less realistic and conflicting. In that step, someone often asks a member of the ethics committee or the hospital chaplain to help the parties understand the opposing viewpoints. Resolving the dilemma is the step in which all the options are reviewed