Deck 3 Module 44 Flashcards
The nurse is caring for a client in the intensive care unit (ICU) who was in a motor vehicle crash. The healthcare provider asks the nurse to extubate the client because there is no communication between the brain and body due to a cervical fracture. The family agrees with the decision of the healthcare provider, but the nurse is uncomfortable pulling the tube. Which is the reason the nurse is experiencing difficulty with this task? A) An ethical conflict B) Personal values C) Legal issues D) Cultural values
B) Personal values
Rationale:
The nurse is distressed because of personal values, which are in conflict with causing the client’s death. The decision is within ethical principles. Cultural values are not in evidence in this instance. Extubating this client would not be a legal decision.
A nurse is caring for an older adult client with terminal cancer. The client's family wants to continue treatment, but the client would like to discontinue treatment and go home. The nurse agrees to be present while the client tells the family. Which principle is the nurse supporting? A) Beneficence for the client B) Autonomy for the client C) Nonmaleficence for the client D) Justice for the client
B) Autonomy for the client
Rationale:
Autonomy refers to the right to make one’s own decisions. The nurse is supporting this principle by supporting the client in his decision. Nonmaleficence is the duty to “do no harm.” Justice is often referred to as fairness. Beneficence means “doing good.”
Which statement accurately describes the purpose of the American Nurse’s Association’s Code of Ethics for Nurses?
A) It serves as a statement of nurses’ personal values and standards.
B) It serves as the profession’s nonnegotiable ethical standard.
C) It serves as an announcement of nurses’ commitment to the profession.
D) It serves as a standard protocol for performing nursing procedures.
B) It serves as the profession’s nonnegotiable ethical standard.
Rationale:
The ANA Code of Ethics for Nurses serves as a statement of nurses’ ethical obligations and duties (not their personal values and standards), as the profession’s nonnegotiable ethical standard, and as the nursing profession’s statement of commitment to society (not the nurse’s commitment to the profession). Nurses should refer to the ANA Code of Ethics for Nurses to direct how they perform their duties in daily practice, but it does not provide standard protocols for performing nursing procedures.
A nurse is volunteering time in a local free clinic that provides care to the underinsured population. By volunteering time to work in the clinic, this nurse is demonstrating which professional value? A) Human dignity B) Social justice C) Integrity D) Autonomy
B) Social justice
Rationale:
Social justice is upholding fairness on a social scale. This value is demonstrated in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality healthcare. Human dignity is respect for the worth and uniqueness of individuals and populations. Autonomy is respecting the client’s right to make decisions about their healthcare. Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice.
A nurse educator is talking to a student about how to deal with an ethical dilemma in practice. Which does the nurse educator explain to the student as important regarding actions during an ethical dilemma?
A) Examining all conflicts in the situation
B) Investigating all aspects of the situation
C) Relying on nursing judgment
D) Making a decision based on the policy of the agency
B) Investigating all aspects of the situation
Rationale:
To avoid making a premature decision, the nurse plans to investigate all aspects of the dilemma before deciding. Overconfidence can lead to poor decision making. Reading the agency policy regarding the matter addresses only one aspect of the situation. Examining the conflicts surrounding the issue is only one aspect of the situation to consider.
The nurse is caring for a client on a medical-surgical unit. The client tells the nurse that the healthcare provider has refused to treat the client further if the client continues to be noncompliant with the healthcare provider’s recommendations. Which is the priority nursing action in this situation?
A) Take the issue to the hospital ethics committee.
B) Advise the client to sue the healthcare provider.
C) Have the client contact a consumer agency.
D) Notify the healthcare provider of the client’s complaints.
A) Take the issue to the hospital ethics committee.
Rationale:
Acting as a client advocate and protecting the client’s rights, the nurse should enlist the help of the hospital ethics committee. The nurse never advises a client to sue but assists the client to find help resolving the issue. A consumer agency is not appropriate because this is an ethical matter. The nurse should act on behalf of the client, and the best way to do that is by taking the issue to the hospital ethics committee, not to the healthcare provider.
The nurse is caring for a 22-year-old client with Down syndrome. Because the client has an intellectual disability, he is under the legal care of his parents. The client needs medical treatment for aspiration pneumonia, but the parents are declining care because they have heard that aspiration pneumonia is often fatal in clients with chronic health conditions. In addition to ethics and advocacy, what other nursing concept must the nurse factor into care decisions made in this case? A) Informatics B) Development C) Mood and Affect D) Spirituality
B) Development
Rationale:
Down syndrome causes intellectual disability, so the client’s developmental stage needs to be taken into consideration when providing care, especially related to client teaching and advocating for the client whose rights appear to be in jeopardy. Informatics, mood and affect, and spirituality do not appear to play a role in this case.
The nurse administers morphine to a client after surgery to help manage pain even though morphine has a risk of creating dependence and addiction. What ethical principle does the nurse apply in this situation when planning care? A) Veracity B) Justice C) Autonomy D) Beneficence
D) Beneficence
Rationale:
Beneficence requires that the actions one takes should promote good. This includes giving treatments that have some risks when the nurse and others involved in client care have determined that the benefits outweigh the risks. Autonomy is the right to self-determination. Justice means treating all clients fairly. Veracity is the principle of always telling the truth.
Every year, the nurse attends a nursing conference and takes several continuing education courses to help maintain licensure. Which section of the ICN Code of Ethics does this uphold? A) Nurses and people B) Nurses and practice C) Nurses and the profession D) Nurses and co-workers
B) Nurses and practice
Rationale:
The nurses and practice section of the ICN Code of Ethics states that nurses carry the professional responsibility and accountability for nursing practice and for maintaining competence by continual learning. The other sections of the ICN Code of Ethics do not address continuing education for nurses.
A client, learning that her baby has died in utero, is planning to carry the baby until natural delivery because abortion is against her religion. Which is the client demonstrating based on this data? A) Fear of retribution B) Morals C) A healthy decision D) Sound judgment
B) Morals
Rationale:
Religion and morals can at times be interrelated within healthcare. The client wants to maintain the baby until natural delivery occurs because having an abortion would be against her religion. The client is demonstrating her morals. The client may or may not be demonstrating sound judgment or a healthy decision. The nurse has no way of knowing if the client is in fear of retribution.
Which situation indicates a conflict in morality?
A) The nurse provides a terminally ill client a meal that includes foods that should be avoided but were requested.
B) The nurse provides the mother of a dying neonate a cup of coffee in the intensive care unit.
C) The nurse provides over-the-counter pain relievers to the daughter of a client because of a headache.
D) The nurse purchases the daily newspaper for a client who does not have any money but will when his wife comes to visit.
A) The nurse provides a terminally ill client a meal that includes foods that should be avoided but were requested.
Rationale:
Morality refers to issues that are either right or wrong. In the situations provided, the nurse who provides a terminally ill client a meal with food that he should avoid but requested would demonstrate a conflict with morality. The nurse is going against the “right” decision, which would be to not provide the client with the foods; however, the client is terminally ill and is requesting foods that he enjoys. The other situations would not involve the same question of morality.
The family of a terminally ill client requests that the client not be informed of the diagnosis. Which moral principle does the request violate? A) Justice B) Veracity C) Beneficence D) Nonmaleficence
B) Veracity
Rationale:
Veracity is the duty to tell the truth. The family of a terminally ill client is requesting that the diagnosis be withheld from the client, which would violate the principle of veracity. Beneficence is the duty to “do good.” Nonmaleficence is the duty to do no harm. Justice refers to fairness.
A client who was raped tells the nurse that she is planning to have an abortion because she cannot raise a child who was conceived this way; however, abortion is against her religion. Which action by the nurse is the most appropriate?
A) Remind the client that abortion is killing and that’s why it is against her religion
B) Ask the client what she needs to support her decision.
C) Provide information on giving up children for adoption.
D) Suggest she talk with her clergy.
B) Ask the client what she needs to support her decision.
Rationale:
The client’s decision is to have an abortion even though it is against her religion. The best thing for the nurse to do is to ask the client what she needs to support her decision. The nurse should not provide information about adoption because the client is not planning on carrying the child to term. The nurse should not suggest she talk with clergy because the client did not ask to do so. The nurse should not remind the client that abortion is killing because this would not support the client’s resolution of her moral dilemma.
A nursing instructor is discussing moral principles with a group of students. Which comment made by a student nurse indicates the need for further instruction?
A) “A client choosing not to have a needed blood transfusion is an example of autonomy.”
B) “An example of veracity would be if a client asks her nurse if she is going to die and the nurse feels obligated to explain to the client that she is dying.”
C) “If a client asks the nurse to please come right back, and the nurse tells the client he will be back in just a couple of minutes, then that would be an example of fidelity.”
D) “A home health nurse carefully planning his or her day to assure each client gets an adequate amount of time is an example of beneficence.”
D) “A home health nurse carefully planning his or her day to assure each client gets an adequate amount of time is an example of beneficence.”
Rationale:
Justice is often referred to as fairness, which would be demonstrated by the nurse assuring that each client gets an adequate amount of time with the nurse. Beneficence refers to the fact that nurses are obligated to do good. Autonomy refers to the right to make one’s own decisions. Veracity refers to telling the truth. Fidelity means to be faithful to agreements and promises.
The nurse is admitting a client to the medical unit who was brought to the emergency department by a neighbor. The client states, "I ran out of my medication last week. I don't have any family or close friends to help me." Upon assessment, the nurse notes the following findings: oxygen saturation of 93% on room air, breath sounds reveal crackles bilateral bases, P 110 bpm, R 22 breaths per min, BP 110/60 mmHg. Which is the priority psychosocial nursing diagnosis for this client? A) Social Isolation B) Impaired Gas Exchange C) Noncompliance D) Interrupted Family Process
A) Social Isolation
Rationale:
Social isolation led to the client’s current medical manifestations. The priority nursing diagnosis based on the data is Social Isolation. Noncompliance and Interrupted Family Processes are not supported by the scenario presented. Impaired Gas Exchange is not a psychosocial nursing diagnosis; it is a physiologic nursing diagnosis.
The nurse is caring for a client who has chosen to discontinue hemodialysis. The client’s family, however, is not supportive of the decision. The nurse who uses the theory of principles-based reasoning would make which statement regarding the current situation?
A) “The client understands the decision and the advanced stage of the disease. If the client quits treatment, the client will die.”
B) “I need to try to help the family understand the client’s decision so they can work through this situation together.”
C) “This client is of sound mind and is capable of making independent decisions regarding healthcare. It really is the client’s decision to make.”
D) “This client’s health is so deteriorated that the treatment is not saving the client’s life. It is prolonging the ultimate outcome, which is death.”
C) “This client is of sound mind and is capable of making independent decisions regarding healthcare. It really is the client’s decision to make.”
Rationale:
Principles-based theories stress individual rights, such as autonomy. The client has the ability to make the decision, and it is his right to autonomy to do that. Trying to help the family understand the client’s decision is an example of a caring-based theory in practice. Caring theories, or relationship theories, stress courage, generosity, commitment, and the need to nurture and maintain relationships. Caring theories promote the common good or the welfare of the group. Considering the client’s condition and the outcome of treatment is an example of consequence-based reasoning, in which the nurse looks at the outcomes of the client’s decision. The client’s understanding of his decision and its consequences does not address the client’s right to make a decision autonomously.
The nurse on a committee to determine the funding that each part of the hospital receives would be most concerned with which moral theory? A) Consequence-based theory B) Principles-based theory C) Relationship-based theory D) Legal-based theory
A) Consequence-based theory
Rationale:
Consequence-based theories tend to view a moral act as one that brings about the most good and the least harm to the greatest number of people. This moral theory would be a driving force when allocating funding in a hospital. Principles-based theory determines morality based on an impartial, objective principle and is more concerned with the individual than the group. Relationship-based theories judge actions according to a perspective of caring and responsibility, which is less likely to be needed when determining funding. Legal-based theory is not a moral theory.
A hospice nurse is working closely with a client who, on several occasions, has asked about guidance and support in ending life. The nurse recognizes which in regard to making ethical and moral decisions in this circumstance?
A) Euthanasia has legal implications along with moral and ethical ones.
B) Passive euthanasia is an easy decision to arrive at.
C) Active euthanasia is supported in the Code for Nurses.
D) Assisted suicide is illegal in all states.
A) Euthanasia has legal implications along with moral and ethical ones.
Rationale:
Determining whether an action is legal is only one aspect of deciding whether it is ethical. Legality and morality are not one and the same. The nurse must know and follow the legal statutes of the profession and boundaries within the state before making any decision. Passive euthanasia involves the withdrawal of extraordinary means of life support and is never an easy decision. Active euthanasia and assisted suicide are in violation of the Code for Nurses, according to the position statement by the ANA (2013). Some states and countries have laws permitting assisted suicide for clients who are severely ill, are near death, and wish to commit suicide.
The nurse is talking with a parent who decides to decline treatment for a 3-year-old client whose cancer has metastasized. There is a conflict between the parents and the rest of the family regarding the withdrawal of care from the child. Which should the nurse consider when determining the appropriate action for this client? A) The beliefs of the child B) The values of the parents C) The age of the child D) The values of the rest of the family
B) The values of the parents
Rationale:
When confronted with a conflict regarding care, one of the first actions by the nurse is to consider the values and beliefs of the parents who are making the decision. The age of the child is not a relevant factor in the decision making if the child is under 18 years. The child is too young to have values and beliefs. The nurse is respectful with the rest of the family but should consider the parents’ decision only.
A client comes to the clinic and is found to have a sexually transmitted infection (STI). The client states to the nurse, “Promise you won’t tell anyone about my condition.” According to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which action must the nurse take?
A) Honor the client’s wishes.
B) Respect the client’s privacy and confidentiality.
C) Communicate only necessary information.
D) Not disclose any information to anyone.
C) Communicate only necessary information.
Rationale:
HIPAA includes standards that protect the confidentiality, integrity, and availability of data as well as standards that define appropriate disclosures of identifiable health information and client rights protection. Nurses are entrusted with sensitive information, which at times must be revealed to other healthcare personnel in order to provide appropriate healthcare. In this case, the nurse may be required to report information to the state health department. Clients must be able to trust that their information is secure and will only be shared with appropriate entities. Nurses should not make promises to keep necessary information private.
When faced with ethical dilemmas, which are some of the elements of risk management that can assist nurses in decision making? Select all that apply. A) Education B) Peer support and consultation C) Resource accumulation D) Righteousness E) Financial support
A) Education
B) Peer support and consultation
C) Resource accumulation
Rationale:
In addition to the ANA code of conduct in ethical situations, education and didactic training represent another source for developing primary risk-management skills. A practitioner’s professional network, consisting of peers, supervisors, and colleagues, can be a significant resource for primary prevention of ethical challenges. Resource accumulation involves acquiring the requisite resources and skills prior to the occurrence of a dilemma. Righteousness and financial support are not elements of risk management.
Staff at the hospital have decided to strike in order to try to improve working conditions. Which are some of the ethical issues that a nurse working in the hospital will have to consider when deciding whether or not to honor the picket line? Select all that apply.
A) The need to support coworkers in their efforts to improve working conditions
B) The need to ensure that clients receive care and are not abandoned
C) The desire to take some time off
D) Loyalty to the nurse’s employer
E) The need for higher pay
A) The need to support coworkers in their efforts to improve working conditions
B) The need to ensure that clients receive care and are not abandoned
D) Loyalty to the nurse’s employer
Rationale:
Strikers may be concerned about client care as it is related to adequate staffing. Strikes may adversely affect client care and outcomes. Nurses may feel allegiance to a hospital where they have worked for years. The desire to take time off and the need for higher pay are not ethical issues.
A pregnant client with a history of drug use refuses testing for human immunodeficiency virus (HIV), despite the recommendation of her nurse-midwife. Which actions by the nurse are appropriate in this situation? Select all that apply.
A) Refuse to treat the client.
B) Do the testing anyway.
C) Re-emphasize the importance of HIV testing.
D) Offer counseling.
E) Throughout the pregnancy, encourage the client to reconsider the decision not to be tested.
C) Re-emphasize the importance of HIV testing.
D) Offer counseling.
E) Throughout the pregnancy, encourage the client to reconsider the decision not to be tested.
Rationale:
Refusing HIV testing is legal and is not mandatory for obtaining care. However, if the mother-to-be is HIV-positive, the test will help her protect her health and the health of her child by obtaining appropriate treatment. The nurse should emphasize the importance of HIV testing and encourage her to receive the test. Offering counseling would also be appropriate. Refusing to treat the client is against the ANA position statement on risk and responsibility in nursing. Doing the test anyway goes against the client’s right to autonomy.
A hospice nurse is working with a client who has ovarian cancer. The client is concerned that her two daughters are at an increased risk for cancer and asks for the nurse’s help. Which actions by the nurse are appropriate? Select all that apply.
A) Provide the family with information on hereditary cancer risks.
B) Assure the client that ovarian cancer is not hereditary.
C) Offer to refer the daughters to a genetic counselor.
D) Arrange for the client to have genetic testing.
E) Tell the client that her additional worrying is too stressful.
B) Assure the client that ovarian cancer is not hereditary.
C) Offer to refer the daughters to a genetic counselor.
D) Arrange for the client to have genetic testing.
Rationale:
A nurse’s role as educator is crucial to ethical practice. Inaccurate reassurance or avoidance does not respect client rights. Providing appropriate alternatives and options for the client and the family are correct responses to the client’s concerns.
