Exam 1

Question 1

Moral thought

Answer 1

Related to the thoughtful examination of right and wrong, good and bad.
• Begins as individuals’ or groups’ desire to meet the needs of others.
• Empathy is a motive for moral reasoning and action.

Question 2

Who was Ascelpieons?

Answer 2

• Asclepius was the mythical god of medicine and healing. His followers established temples of healing or asclepieions

Question 3

Hippocrates: Father of Western Medicine

Answer 3

• Revolutionized healing arts in Greece, established medicine as a profession, believed the care of the sick included observation, symptoms, rational conclusions, and a predictable prognosis.
• Proposed the role of healing was to reinstate the healthy balance of four bodily humors.
• The Hippocratic oath is attributed to him.

Question 4

Nusing in the middle ages

Answer 4

• Based on imitating Jesus, who spent his life ministering to those in need.
• Service was viewed as a means of securing salvation.
• Religious orders were the way respectable women and men could serve as nurses.

Question 5

The Renaissance

Answer 5

• Birth of scientific revolution and a new era in the healing arts.
• Philosophical humanism emerged with humans rather than God as the focus.
• Empiric phenomena and subjective reasoning became the focus of knowledge.
Brought relief from witch hunts but didn’t really change the lives of women

Question 6

Florence nightingale

Answer 6

• Florence Nightingale worked to free nursing from the bonds of the church.
• Became a model for all nurses.
• Addressed moral and social issues.
• Was a nurse, statistician, sanitarian, social reformer, and a scholar.

Question 7

Moral theory

Answer 7

• Provides a framework for cohesive and consistent ethical reasoning and decision making.
• The best moral theories are part of larger integrated philosophies.
• Two moral theories having the greatest influence on contemporary bioethics and nursing: utilitarianism and deontology.

Question 8

Morals and ethics

Answer 8

• Moral philosophy is the philosophical discussion of what is considered good or bad, right or wrong, in terms of moral issues.
• Moral issues are those which are essential, basic, or important and deal with important moral issues.
Ethics is a formal process making logical and consistent decisions, based upon moral philosophy

Question 9

Naturalism

Answer 9

• Regards ethics as dependent upon nature and psychology.
– Proposes that nearly all people have a tendency to make similar ethical decisions despite differences in culture.
– Sympathy is a motivating factor in moral decision making.

Question 10

Utilitarianism

Answer 10

• Sometimes called consequentialism, holds that an action is judged as good or bad in relation to the consequence, outcome, or end result that is derived from it.
• Holds that no action is in itself either good or bad.
• Mill believed it to be in the spirit of the golden rule, “Do unto others as you would have them do unto you.”

Question 11

Types of Utilitarianism

Answer 11

Act-utilitarianism: people choose actions that will, in a given circumstance, increase the overall good.
Allows for different, sometimes opposing, action in different situations.
Rule-utilitarianism: people choose rules in all situations that increase the overall good.
Rules that maximize happiness and reduce unhappiness.
Rules are easy to learn and should be strictly followed.

Question 12

Deontology

Answer 12

Deontology is based upon the idea that rightness or wrongness of an act depends upon the nature of the act, rather than its consequences.
Ethical rules are universal, and humans can derive certain consistent principles to guide action.
Moral rules are absolute and apply to all people.

Question 13

Kantianism

Answer 13

Kantianism is a particular deontological theory developed by Immanuel Kant.
The categorical imperative assumes that if an action is morally right, it is reasonable to imagine it as a strict universal law.
The practical imperative requires that one treat others always as an end and never as a means only.

Question 14

Discernment

Answer 14

A sensitive insight involving acute judgment and understanding, and eventuating in decisive action
Allows us to see appropriate actions in a given situation and requires sensitivity and attention attuned to the demands of a particular context

Question 15

Paternalism

Answer 15

Paternalism: places power in the hands of the person who is making the decision for the patient. Implies that the decision maker knows what is best.

Question 16

Non-maleficience

Answer 16

Requires one to refrain from causing harm, including:
Deliberate harm
Risk of harm
Harm that occurs during the performance of beneficial acts

Question 17

Material rules of distributive justice

Answer 17

Systematic means of deciding such as:
Give to each person equally
Give to those who need it most
Give to those who deserve it most
Give to those who can pay for it
Give to those who arrive first

Question 18

Fidelity

Answer 18

Definition: faithfulness and promise keeping
Nurses must faithfully
Uphold the profession’s code of ethics
Practice within established scope of practice
Practice competently
Keep promises to patients

Question 19

Moral values

Answer 19

Individual cognitive evaluation of right and wrong, good and bad, is reflective of moral thought.
Preferences or dispositions reflective of right or wrong, should or should not, in human behavior are considered moral values.

Question 20

Overt Values

Answer 20

Values of individual institutions and organized health care systems that are explicitly communicated through philosophy and policy statements

Question 21

Covert Values

Answer 21

Values that may be implicit in expectations that are not in writing.
Many times, these covert values are only identified through participation in or controversies within the setting.

Question 22

Moral distress

Answer 22

Reaction to a situation in which there are moral problems that seem to have clear solutions, yet we are unable to follow our moral beliefs because of external restraints.

Question 23

Methods of fixing beliefs

Answer 23

Peirce proposed four basic methods of fixing belief:
Tenacity—obstinately adhering to beliefs already held
Authority—doctrines forced on people by repeating them
A priori—seeing other perspectives, willful adherence to beliefs forced by authority is given up
Reasoning—based on discovering what is real: it seeks truth

Question 24

Piagets stage of cognitive development

Answer 24

Address how the mind works, the development of intellectual capacities
Four stages:
Sensorimotor (birth to 24 months)
Preoperational (ages 2–7 years) includes preconceptual and intuitive stages
Concrete operations (ages 7–11 years)
Formal operations (ages 11–15 years)

Question 25

Kohlbergs method

Answer 25

Often referred to as an ethic of justice

Suggests that choices are based on objective rules and principles and are made from a stance of separateness

Question 26

Kohlberg level 1

Answer 26

Preconventional level—egocentric focus—includes two stages
Stage 1—punishment and obedience(obey rules = avoid punishment)
Stage 2—individual instrumental purpose and exchange (conformity to rules = person’s best interest/reward)

Question 27

Kohlberg level 2

Answer 27

Conventional level—social conformity—includes two stages:
Stage 3—mutual interpersonal expectations, relationships, and conformity (concern about others)
Stage 4—social system and conscience maintenance (conform to laws out of duty and respect)—guilt is more a motivator than fear of punishment

Question 28

Kohlberg level 3

Answer 28

Postconventional and principled level—universal moral principles as its focus—includes two stages:
Stage 5—prior rights and social contract or utility (equality, liberty, justice)
Stage 6—universal ethical principles (internalized rules and conscience)

Question 29

Gilligans model

Answer 29

Often referred to as the ethic of care.
The moral imperative is grounded in relationship and mutual responsibility.
Choices are contextually bound, requiring strategies that maintain connections and a striving to hurt no one.

Question 30

Gilligans model of moral development

Answer 30

Progression of moral thinking through three phases and two transitions—each reflecting greater depth of understanding and reevaluation of relationships
Phase 1—concern for survival
Phase 2—focusing on goodness
Phase 3—imperative of care

Question 31

Fowlerd stages of faith

Answer 31

Stage 1: Intuitive Projective
Stage 2: Mythic-Literal
Stage 3: Synthetic-Conventional
Stage 4: Individuative-Reflective
Stage 5: Conjunctive
Stage 6: Universalizing Faith

Question 32

Nursing as a profession

Answer 32

Seen as a profession prior to 1915.
Abraham Flexner and the Bixlers concluded nursing was not a profession.
Nurses evaluated their role resulting in:
Moving nursing education into the university setting
Political involvement
Increased autonomy for nursing
Extension of practice boundaries
Establishing codes of ethics

Question 33

Types of moral problems

Answer 33

Moral uncertainty
Moral dilemma
Moral distress
Moral outrage
Moral reckoning

Question 34

Moral uncertaintiy

Answer 34

Occurs when one senses that there is a moral problem, but
Is not sure of the morally correct action,
Is unsure which moral principles or values apply, or
Cannot define the moral problem

Question 35

Dilemma

Answer 35

A dilemma is a problem
That requires a choice between two equally unfavorable and mutually exclusive options
That seems to defy a satisfactory solution
It is necessary to differentiate between moral and practical dilemmas

Question 36

Moral dilemma presentation

Answer 36

Two ways moral dilemmas may present:
Evidence indicates that an act is morally right, and other evidence indicates that the act is morally wrong, but no evidence is conclusive.
One moral rule supports one course of action and another moral rule supports another course of action, yet the two actions are mutually exclusive.

Question 37

Moral distress

Answer 37

… arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.” (Jameton, 1984, p. 6)
“… nurses participate in the action that they have judged to be morally wrong.”

Question 38

Moral distress cont..

Answer 38

More likely to occur in highly stressful situations or when dealing with more vulnerable patients. Factors:
Ethical and working climate in the facility
Relationships—especially with physicians and role expectations
Stressors resulting from nursing shortage
Results in psychosocial, physical, and emotional consequences for nurses
When it occurs it is unfavorable for nurses and patients and can have a long-term impact

Question 39

Moral outrage

Answer 39

occurs when someone else performs an act the nurse believes to be immoral
Nurses
Do not participate in the act
Do not believe they are responsible for wrong
Believe they are powerless to prevent the act

Question 40

Moral reckoning

Answer 40

Encompasses moral distress, moral outrage, and more
May last a lifetime
Is a three-stage process
Stage of ease 
Stage of resolution 
Stage of reflection

Question 41

Intervening factor examples

Answer 41

uncertainty: refers to the lack of predictability because of insufficient evidence
*ex: an adult Jehovah’s witness sustains life-threatening injuries. She refuses any blood or blood products but agrees to surgery. During surgery she begins to bleed profusely. Her husband who is not Jehovah’s Witness demands the physicians to administer blood transfusions. The physicians and nurses respect the patient’s autonomous decision, however, they are tempted to order the transfusion
context includes a person’s unique life circumstances
is often the intervening factor that points toward one choice rather than another
multiple stakeholders: are persons with an interest in a given situation
this is also an example of power imbalance
*ex: Elderly woman who lived at home with her daughter suffers a stroke and is unable to communicate. After hearing the news, her eldest son who rarely talks with his mom arrives and starts arguing about what he believes should be done. Since the elderly woman has no POA, the son, being the eldest, believes he should be making all the decisions. The staff are unsure on who should be making the decisions
extraneous variables: are variables outside of the direct patient care setting
Decision makers must consider extraneous variables such as institutional policy, professional standards, third-party payers, and public policy when making ethical decisions

Question 42

What moral problem is the following an example of?
Several physicians are requesting that nurses have sedated patients sign the consent form for surgery. The physician’s decision to do this is based upon the high volume of patients on the busiest unit. The nurses know this is a breach of the patient’s right to informed consent, yet they feel powerless to make the necessary changes.

A. Moral Outrage
B. Moral Distress
C. Moral reckoning
D. It is not a moral problem

Answer 42

Moral distress

Question 43

The charge nurse on the surgical floor is working when the nursing supervisor comes to the floor to use the telephone to call the hospital administrator. The charge nurse overhears the supervisor describing a situation in which a physician endangered a patient when he insisted on performing a surgical procedure in the hospital room. The surgeon was in a hurry and felt the patient would be safe, even though there were violations of patient privacy, informed consent, and safety.  The charge nurse is uninvolved in the situation but recognizes a grave moral problem.
What is this an example of?
A. Moral Outrage
B. Moral Reckoning
C. Moral Distress
D. Moral Dilemma

Answer 43

Moral outrage

Question 44

What is the order of the three-stage process of Moral Reckoning?

A. Situational Binds, Stage of Ease, Stage of Resolution
B. Stage of Conflict, Stage of Ease, Stage of Resolution
C. Stage of Ease, Situational Binds, Stage of Resolution
D. Stage of Ease, Stage of Conflict, Stage of Resolution

Answer 44

Answer: C. Stage of Ease, Situational Binds, Stage of Resolution

Question 45

When making ethical decisions, context is often the intervening factor that points toward one choice rather than another?

Answer 45

Answer: True

Question 46

Four basic functions of the law

Answer 46

1. Defines relationships among members of society, and declares which actions are and are not permitted
2. Describes what constraints may be applied to maintain rules and by whom they may be applied
3. Furnishes solutions to problems
4. Redefines relationships between people and groups when circumstances of life change

Question 47

Constitutional law

Answer 47

A formal set of rules and principles that describe the powers of a government and the rights of the people
Bill of Rights and the U.S. constitution guarantee each citizen the rights of equal protection, due process, freedom of speech, and freedom of religion. These rights are consistent with the ethical principles of autonomy, confidentiality, respect for persons, and veracity that we use in our nursing practice.
The constitution supersedes all other law.

Question 48

Statutory/legislative law

Answer 48

Are formal laws that are written and enacted by federal, state, or local legislatures
Examples include changes in Medicare and Medicaid laws, health care reform legislation.

Question 49

Administrative law

Answer 49

National, state, and local governments set up agencies to do the work of the government- these agencies regulate activities such as education, public health, social welfare programs, and the professions.
Consists of legal powers granted to administrative agencies by legislatures and the rules that the agencies make to carry out their powers
Example: State Boards of Nursing- goal is the protect the public

Question 50

Common law

Answer 50

Is the basis of the judicial system
Also known as case law
Decisions based on earlier court rulings in similar cases (precedents)
Self-correcting because higher courts revisit unfair laws upon appeal
Over time precedents take on the force of law.

Question 51

Two types of law

Answer 51

1. Public law

2. Private Law

Question 52

Public law

Answer 52

Defines a person’s rights and obligations in relation to government, and describes the divisions of government and their powers
One branch is criminal law, which deals with crime
Each state has its own set of criminal laws ranging from public drunkenness to murder
Nurses can be accused of criminal offenses  directly injuring patient, falsifying narcotic records, failure to renew license, fraudulent billing
Felonies
Misdemeanor

Question 53

Private law

Answer 53

Also called civil law, which determines a person’s legal rights and obligations in many activities that involve other people (borrowing/ ending money, buying a home, signing a job contract).
When private laws are violated, plaintiff (person harmed) brings lawsuit against the defendant (violator). You cannot be sent to jail for violating private laws, courts grant monetary awards to the plaintiffs.
The branches of private law that most apply to nursing practice are tort law and contract law
Penalties associated with violation of private laws are monetary
Malpractice lawsuits are examples

Question 54

Tort

Answer 54

A tort is a wrong or injury that a person suffers because of someone else’s action, either intentional or unintentional.
I.e. invasion of privacy, damage personal property/ business/ reputation.
Purpose of a tort law is to make the person whole again and restore their previous financial position (through monetary awards to plaintiff) not to punish the defendant.
Intentional tort: a willful or intentional act that violates another person’s rights or property
Unintentional tort: an act or omission that causes unintended injury or harm to another person I.e. accident
Negligence
Malpractice

Question 55

six components of malpractice

Answer 55

. Duty owed to the patient “duty of care”

2. Breach of standard or care/ failure to carry out a duty
3. Foreseeability
4. Causality
5. Injury
6. Damages

Question 56

Intentional tort

Answer 56

A tort must include three elements to be considered intentional:

1. The defendant must intend to bring about the consequences of the act.
2. The act must substantially cause the consequences.
3. There is no legal requirement that the act causes damages or injury—proof of intention is sufficient.

Question 57

Examples of intentional torts

Answer 57

Fraud= deliberate deception for the purpose of securing an unfair gain, usually prosecuted as a crime I.e. falsification of patient records to cover up error
Right to privacy= the right to be left alone or to be free from unwanted publicity.
Invasion of privacy
Assault=intentional attempt or threat to touch a person without consent that results in fear of immediately harmful/ offensive contact.
Battery= unlawful, harmful touching of another. Actually carrying out the threatened physical harm I.e. surgery without informed consent
Necessity and Consent are two defenses that nurses can use when accused of battery. Necessity is the touching of a person without consent in an emergency to provide direct medical aid to protect self or others from a violent person. Consent is the approval/ verbal or written.

Question 58

Liability Insurance

Answer 58

Risk management strategy to protect assets/ income/ gives you a peace of mind
Nurses are increasingly vulnerable to claims of malpractice
Regardless of the nurses’ level of expertise, patients can be injured
Professional liability insurance offers protection against various injuries that are not directly related to malpractice.

Two basic types of coverage:
Occurrence-based policy: broad coverage, cover the nurse for claims arising from incidents that occur during the period of time that the policy is in effect and protects the nurse against lawsuits filed after the policy has expired.
* Preferable for most nurses.
2. Claims-based policy: provides coverage only in instances which both the injury and the claim are made during the time in which the policy is in effect.

Question 59

Types of insurance

Answer 59

Individual coverage: purchased by individual and offers the policy-holder 24 hour protection against liability claims for actions that fall within the scope of professional nursing practice, either paid or volunteer services.

Group coverage: purchased by professionals who have the same job description and covers only those activities performed during office hours
least expensive

Employer-sponsored coverage: purchased by employing agency for the purpose of protecting business concerns.
most limited type of insurance, if nurse found negligent he/she may be required to repay employer a portion of the loss

Question 60

Nurses are bound by a variety of laws. Which of the following descriptions of types of law is correct?

A. Statutory law is created by elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA).
B. Regulatory law provides for prevention of harm to the public and punishment when those laws are broken.
C. Common law protects the rights of the individual within society to fain and equal treatment.
D. Criminal law creates boards that pass rules and regulations to control society.

Answer 60

A
Rationale: Statutory law is created by legislature. It creates statues such as the NPA, which defines the role of the nurse and expectations of the performance of one’s duties and explains what is contraindicated as guidelines for breech of those regulations.

Question 61

The nurse should understand law primarily because the nurse:

A. Wants to avoid lawsuits
B. Can be an advocate for clients
C. Is mandated to review law to keep licensure
D. Can protect the hospital from minor lawsuits

Answer 61

ANSWER B
Rationale: As an advocate for the client, the nurse must make sure that “safe, effective care” is given as directed by the Nurse Practice Act (NPA). The client is the primary recipient of care and is the most important in health care relationships. Self, hospital, and physicians are secondary to the outcomes with clients.

Question 62

When a client is confused, left alone with the side rails down, and the bed in a high position, the client falls and breaks a hip. What law has been broken?

A. Assault
B. Battery
C. Negligence
D. Civil tort

Answer 62

ANSWER C
Rationale: Knowing what to do to prevent injury is a part of the standards of care for nurses to follow. Safety guidelines dictate raising the side rails, staying with the client, lowering the bed, and observing the client until the environment is safe. As a nurse, these activities are known as basic safety measures that prevent injuries, and to not perform them is not acting in a safe manner. Negligence is conduct that falls below the standard of care that protects others against unreasonable risk of harm.

Question 63

The best way for nurses to avoid being liable for negligence might be to do all of the following except:

A. Following standards of care
B. Giving safe competent care with a caring manner
C. Documenting assessments, interventions, and evaluations
D. Ignoring co-workers bad behavior as long as you do not do the same.

Answer 63

ANSWER D
Rationale: This is the exception or action that would involve liability for negligence on your part. You are by law and guidelines of the NPA to report any unsafe or unethical professional behaviors that are observed. Ignoring bad behavior does not relieve you of your duty. In court, if you are aware of another’s deeds that have created harm, you become an accomplice to the crime and can be punished, in addition to the perpetrator.

Question 64

A nurse evaluates a client’s understanding of informed consent in preparation for a brain tumor removal via craniotomy. The client states, “This surgery is low risk for me.” The nurse should:

A. Agree, and continue the evaluation.
B. Provide written materials on discharge information.
C. Agree with the client, but advise the family of the risks out of the client’s hearing.
D. Consult the surgeon for further communication with the client.

Answer 64

ANSWER D
Rationale: This client does not seem to understand the risks of a craniotomy and should re-discuss the procedure with the surgeon. Written materials about discharge will not reeducate this client at this time. The client and his family (if he desires) should be made aware of the risks since he is appears alert and oriented and able to give informed consent.

Question 65

Provision 1

Answer 65

The nurse, in all professional relationships, practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
• Treat every individual as an individual
• Respecting them as unique allowing them to make choices in healthcare not stereotyping or labeling

Question 66

Provision 2

Answer 66

The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
• Nurse primary commitment is to the patient
• Every patient is unique
• Nurses must examine the conflicts arising between values
• Concentrated effort of individuals and group to attain a shared goal
• Nurses act in professional roles, not blurring the lines

Question 67

Provision 3

Answer 67

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient
• Promote for, advocate, and protect patient health, safety, and rights
o Privacy
o Confidentiality
o Protection of participants in research
o Standards and review mechanisms (allowing those with the competency to participate in the health practice with the patient)
o Addressing impaired practice

Question 68

Provision 4

Answer 68

The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.
• The nurse is responsible and accountable for providing individual nursing care, as well as properly judging delegation to safely provide appropriate patient care

Question 69

Provision 5

Answer 69

The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth
• Nurse has an obligation to maintain own identity
• Take care of self and others
• Preserve integrity and safety
• Maintain competence and continue to learn

Question 70

Provision 6

Answer 70

The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action
• The nurse is responsible for contributing to a moral environment that encourages respectful interactions with colleagues, support of peers, and identification of issues that need to be addressed
• EX: nurse disagreeing with physician order. Nurse uses courage to question orders. Uses knowledge to recognize issue

Question 71

Provision 7

Answer 71

The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development
• Active involvement – leadership opportunities, committees
• Knowing own scope of practice
• Continuing educational opportunities – clinical ladder

Question 72

Provision 8

Answer 72

the nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs
• Collaborates with other healthcare professionals and the public in promoting national and international efforts to meet health needs.
• Should show human dignity and respect for other’s cultural values
• EX: public health nurse in the community

Question 73

Provision 9

Answer 73

The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
• Communicates values of nursing profession to other nurses, healthcare professions, and society
• Collaboration with other nurses to maintain professional standards and quality of care
• Bring about social change related to healthcare
• Encourages nurses to adhere to values of the profession

Question 74

Acts protecting against discrimination

Answer 74

Acts protecting against discrimination:
The Bill of Rights of the U.S. Constitution
The Civil Rights Act of 1964
The Americans with Disabilities Act of 1990
The Civil Rights Act of 1991

Question 75

Racial discrimination

Answer 75

The Civil Rights Act of 1964
Discriminatory outcomes:
Disparate treatment
Disparate impact
Sources of racial discrimination:
Stereotyping
Lack of recruitment and retention of minorities
Is an ethical issue

Question 76

Disabilities discrimination

Answer 76

The Americans with Disabilities Act of 1990
ADA does not require employers to hire individuals with a disability
Demands employers base their employment decisions only by qualifications and ability to perform safe work
Employees with disability can request physical accommodations at the workplace that do not cause undue hardship

Question 77

Sexual harassment

Answer 77

The Civil Rights Act of 1991
Two categories of sexual harassment:
Quid pro quo
Four requirements to prove
Hostile work environment 
Two requirements to prove
Does not need to be filed by the victim who is directly harassed

Question 78

True or false

Professional relationship problems are often more troubling than problems directly involving patients and can affect well-being directly and indirectly?

Answer 78

True