Chapter 07: Nursing Values and Ethics

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Chapter 07: Nursing Values and Ethics

Potter et al: Canadian Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

• Four patients in labour all request epidural analgesia to manage their pain at the same time.

Which ethical principle is compromised when only one nurse anaesthetist is on call?

• Justice.
• Nonmaleficence.
• Beneficence.
• Fidelity.

ANS: A

Justice refers to fairness and is used frequently in discussion regarding access to health care resources. In this situation, the distribution of resources—in this case, pain management—cannot be justly apportioned. Nonmaleficence means “do no harm,” beneficence means “to do good,” and fidelity means “to be true to” or “to be honest.” Each of these principles is partially alluded to in the question; however, justice is the principle most compromised because not all labouring patients have equal access to pain management owing to lack of personnel resources.

DIF: Understand REF: 91| 92

OBJ: Explain the relationship between ethics and professional nursing practice.

TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment

• The patient tells the nurse that she is afraid to speak up regarding her desire to end care for

fear of upsetting her husband and children. Which principle in the nursing code of ethics ensures that the nurse will promote the patient’s cause?

• Responsibility.
• Advocacy.
• Confidentiality.
• Accountability.

ANS: B

Nurses advocate for patients by supporting the patient’s cause. A nurse’s ability to advocate adequately for a patient is based on the unique relationship that develops between nurse and patient and on the opportunity to better understand the patient’s point of view. Responsibility refers to respecting one’s professional obligations and following through on promises.Confidentiality refers to privacy issues, and accountability refers to owning one’s actions.

DIF: Understand REF: 89| 90

OBJ: Explain the relationship between ethics and professional nursing practice.

TOP: Diagnosis MSC: NCLEX: Safe and Effective Care Environment

• The patient’s son requests to view the documentation in his mother’s medical record. What is

the nurse’s best response to this request?

• “I’ll be happy to get that for you.”
• “You will have to talk to the physician about that.”
• “You will need your mother’s permission.”
• “You are not allowed to see it.”

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ANS: C

Nurses should protect a patient's right to privacy and confidentiality by helping the patient access his or her health records (subject to legal requirements), intervening if other members of the health care team fail to respect the patient's privacy, and following policies that protect the patient's privacy. Private health information cannot be shared without the patient’s specific permission. The other three responses either are outright false or reflect poor communication techniques.

DIF: Apply REF: 90

OBJ: Explain the relationship between ethics and professional nursing practice.

TOP: Evaluate MSC: NCLEX: Safe and Effective Care Environment

• When individuals work together to solve ethical dilemmas, they must examine their own

values. This step is crucial to ensure what?

• The group identifies the one correct solution.
• Fact is separated from opinion.
• Judgemental attitudes are not provoked.
• Different perspectives are respected.

ANS: D

Values are personal beliefs that influence opinions; to be able to negotiate differences in opinions, the nurse must first be clear about personal values, which will influence behaviours, decisions, and actions. Ethical dilemmas are a problem in that no single correct solution exists.

DIF: Remember REF: 88 OBJ: Discuss how values influence patient care.TOP: Evaluate MSC: NCLEX: Safe and Effective Care Environment

• Ethical dilemmas are common occurrences in the care of patients. The nurse understands that

dilemmas are a result of which of the following?

• Presence of conflicting values.
• Hierarchical systems.
• Judgemental perceptions of patients.
• Poor communication with the patient.

ANS: A

The primary underlying reason that ethical dilemmas occur is that there are no clear-cut, universally accepted solutions to a problem when participating individuals do not share the same values. Poor communication and the hierarchical systems that exist in health care, such as reporting structures within the hospital or the historically unequal relationship between physicians and nurses, may complicate dilemmas. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgemental attitudes.

DIF: Understand REF: 88 OBJ: Discuss the role of values in the study of ethics.TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• The nurse questions a physician’s order to administer a placebo to the patient. The nurse’s

action is based on which ethical principle?

• Autonomy.
• Beneficence.

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• Justice.
• Fidelity.

ANS: A

Autonomy is the freedom to make decisions without external control. In this case, the nurse questions the physician’s order for a placebo because such a decision was made without consultation with the patient. Beneficence refers to taking a positive action for others, and although it has implications in this situation, it is not the primary operating principle. Justice refers to fairness and is most often used in discussions about access to health care resources.Fidelity refers to the agreement to keep promises.

DIF: Understand REF: 91| 92 OBJ: Examine and clarify personal values.TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment

• The nurse finds it difficult to care for a patient whose advance directive states that no

extraordinary resuscitation measures should be taken. Which step may help the nurse to find resolution in this assignment?

• Calling for an ethical committee consult.
• Declining the assignment on religious grounds.
• Clarifying the nurse’s own personal values.
• Persuading the family to challenge the directive.

ANS: C

Values develop over time and are influenced by family, schools, religious traditions, and life experiences. The nurse must recognize that no two individuals have the same set of experiences, and so differences in values are more likely the norm than the exception. Closer inspection of one’s own values may be a step in gaining an understanding of another person’s perspective. Calling for a consult, declining the assignment, and persuading the family to challenge the patient’s directive are not ideal resolutions because they do not address the reason for the nurse’s discomfort, which is the conflict between the nurse’s values and those of the patient.

DIF: Apply REF: 88 OBJ: Examine and clarify personal values.TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• The nurse values autonomy above all other principles. With which patient will the nurse find

most difficult to deal with the situation?

• Teenager in labour who requests epidural anaesthesia.
• Middle-aged father of three with an advance directive declining life support.
• Elderly patient who requires dialysis.
• Family elder who is making the decisions for a 30-year-old female member.

ANS: D

Autonomy is the freedom to make decisions without external control. A nurse who values autonomy highly may find it difficult to accept situations in which the patient is not the primary decision maker regarding his or her care. A teenager requesting an epidural anaesthetic, a father with an advanced directive, and an elderly patient requiring dialysis all are patients who are making their own decisions and choices regarding care.

DIF: Analyze REF: 91 OBJ: Examine and clarify personal values.TOP: Evaluate MSC: NCLEX: Safe and Effective Care Environment

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• Which philosophy of health care ethics would be particularly useful for making ethical

decisions about vulnerable populations?

• Feminist ethics.
• Deontology.
• Bioethics.
• Utilitarianism.

ANS: A

Feminist ethics focuses particularly on the nature of relationships, especially those in which there is a power imbalance or in which a point of view is not routinely accepted. Examples of populations that are considered vulnerable include children, pregnant women, incarcerated persons, and minority groups. Deontology refers to making decisions or “right-making characteristics”; bioethics refers to consensus building; and utilitarianism refers to the greatest good for the greatest number.

DIF: Remember REF: 92

OBJ: Describe some basic ethical philosophies relevant to health care.

TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• A nurse argues that the health care system needs reform because a large number of patients

are uninsured and end up needing expensive emergency care when low-cost measures covered by insurance could have prevented their illnesses. What ethical framework is she using to make this case?

• Deontology.
• Ethics of care.
• Feminist ethics.
• Utilitarianism.

ANS: D

Utilitarianism is a system of ethics wherein value is determined by usefulness. This system of ethics focuses on the outcome of the greatest good for the greatest number of people.Deontology would not account for consequences of actions. The ethics of care would not be helpful because consensus on this issue is not achievable. Feminist ethics, which focus on relationships, is not addressed in this case.

DIF: Evaluate REF: 91

OBJ: Describe some basic ethical philosophies relevant to health care.

TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• The nurse has become aware that narcotics are missing in the patient care area. Which ethical

principle obligates the nurse to report the missing medications?

• Advocacy.
• Responsibility.
• Confidentiality.
• Accountability.

ANS: B

NURSINGTB.COM

Canadian Fundamentals of Nursing 6th Edition Potter Test Bank This study source was downloaded by 100000841743851 from CourseHero.com on 09-27-2022 09:34:01 GMT -05:00

https://www.coursehero.com/file/75347354/NCLEX-07pdf/