Chapter 06: Ethics Applied to Nursing: Personal Versus Professional Ethics
Knecht: Success in Practical/Vocational Nursing, 8th Edition
MULTIPLE CHOICE
1. The nurse states, “I like being part of the health care team caring for the traditional two-parent
family during the postpartum period as they bond with their newborn.” This statement reveals
the nurse’s
a. values.
b. duty.
c. fidelity.
d. ethics.
ANS: A
Values involve the worth assigned to an idea or action. In this statement the nurse reveals that
she values the traditional two-parent family. The statement does not clearly address any of the
other options. Duty refers to the nurse’s responsibility to provide care in an acceptable way.
Fidelity challenges the nurse to be faithful to the charge of acting in the patient’s best interest
when the capacity to make free choice is no longer available to the patient. Ethics is a system
of standards or moral principles that direct actions as being right or wrong.
DIF: Cognitive Level: Application
REF: p. 74
TOP: Values
KEY: Nursing Process Step: N/A
OBJ: 2
MSC: NCLEX: N/A
2. A student nurse asks, “What’s the difference between laws and ethics?” Which response best
explains the difference between nursing laws and ethics?
a. “Ethics refer to expected behavior of nurses, but laws require mandatory
observance by nurses.”
b. “Nursing ethics are formalized by statutes, whereas laws are permissive codes.”
c. “Ethics are derived from laws, whereas laws are enacted by nonnurse legislators.”
d. “Ethics are specific to individual agencies, but laws are state specific.”
ANS: A
Ethics refers to behaviors nurses “ought” to observe. Laws refer to statutes that must be
observed.
DIF: Cognitive Level: Application
REF: pp. 77-79
TOP: Ethical vs. legal aspects of practice
MSC: NCLEX: N/A
OBJ: 11
KEY: Nursing Process Step: N/A
3. The nurse providing care for patients or residents must act on the knowledge that a basic right
of a patient or a resident is to receive
a. considerate and respectful care from all care providers.
b. information about the diagnosis and prognosis from the practical nurse.
c. the medical care of their choice, regardless of their ability to pay.
d. any food requested and in as large a quantity as desired.
ANS: A
The individual rights of patients are an important ethical theme in health care. It is imperative
that nurses separate personal ethics from nursing ethics and provide appropriate care to
patients regardless of whether the nurse likes or dislikes the patient and regardless of the
nurse’s values relating to the patient’s lifestyle, ethnicity, or other factors. Receiving
information about the diagnosis and prognosis is not considered a right that is met by the
LPN/LVN. The remaining options are not rights.
DIF: Cognitive Level: Knowledge
REF: pp. 79-82
OBJ: 3
TOP: Individual rights
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
4. A major change in medical ethics that affected nursing occurred when the Western secular
belief system shifted emphasis from duties to
a. individual autonomy and rights.
b. satisfying Medicare regulations.
c. the cost-effectiveness of care.
d. nonmaleficence.
ANS: A
Freedom of choice (autonomy) and the ability to assert one’s individual rights have become
the major operative beliefs of the Western secular belief system affecting medical ethics
today. These beliefs, in turn, affect the way nurses interact with patients. Satisfying Medicare
regulations and the cost-effectiveness of care are not aspects of the Western secular belief
system. The remaining option is an ethical principle that has always been important in medical
ethics.
DIF: Cognitive Level: Comprehension
REF: p. 77
TOP: Impact of Western secular belief system
MSC: NCLEX: N/A
OBJ: 3
KEY: Nursing Process Step: N/A
5. The patient asks the nurse, “I overheard the instructor talking to a student about
accountability. What does the word ‘accountability’ really mean?” The best response by the
nurse would be
a. “It is a transfer of responsibility for wrong actions.”
b. “It is shared responsibility with the physician for wrongdoing.”
c. “It is taking personal responsibility for one’s nursing actions.”
d. “It is giving up responsibility when the situation dictates.”
ANS: C
Accountability means that one is personally answerable for specific actions. The other options
do not accurately explain accountability.
DIF: Cognitive Level: Application
TOP: Accountability
MSC: NCLEX: Psychosocial Integrity
REF: p. 77 | p. 78 OBJ: 5
KEY: Nursing Process Step: Implementation
6. When a student nurse prepares diligently for a clinical assignment, the ethical principle being
observed is
a. autonomy.
b. justice.
c. nonmaleficence.
d. fear of punishment.
ANS: C
Being prepared to provide skillful nursing care, anticipating problems that may occur, and
thinking through alternative solutions qualifies as observing the principle of doing no harm.
Autonomy and justice are not principles that apply. Fear of punishment is not an ethical
principle.
DIF: Cognitive Level: Comprehension
REF: p. 78 | p. 83 OBJ: 7
TOP: Nonmaleficence
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
7. Encouraging a patient to be involved in planning and carrying out his or her own care is a
nursing action that supports the ethical principle of
a. confidentiality.
b. privacy.
c. autonomy.
d. justice.
ANS: C
Autonomy means being free to choose. Possible patient choices include identifying goals and
care measures compatible with one’s culture, religion, and personal values. Confidentiality
means avoiding sharing patient information with anyone not directly involved in care without
the patient’s permission. Privacy is the patient’s right to choose care based on personal
beliefs, feelings, or attitudes. Justice means the nurse must deliver fair and equal treatment to
all patients, recognizing and avoiding personal bias.
DIF: Cognitive Level: Application
REF: p. 78 | p. 83 OBJ: 8
TOP: Autonomy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
8. Leaving an unconscious patient exposed during a treatment or procedure is a violation of the
ethical principle of
a. fidelity.
b. autonomy.
c. justice.
d. nonmaleficence.
ANS: B
Autonomy includes the patient’s right to privacy. It is assumed that an autonomous patient
would reject unnecessary exposure of the body. Fidelity challenges the nurse to be faithful to
the charge of acting in the patient’s best interest when the capacity to make free choice is no
longer available to the patient. Justice means the nurse must deliver fair and equal treatment to
all patients, recognizing and avoiding personal bias. Nonmaleficence is the ethical principle of
“first do no harm.”
DIF: Cognitive Level: Comprehension
REF: p. 80
TOP: Autonomy
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
OBJ: 8
9. When a treatment team decides to go to court to obtain permission to provide chemotherapy
for a child whose parents refuse to give consent for the treatment based on religious grounds,
the ethical principles that are in conflict are
a. fidelity and justice.
b. beneficence and autonomy.
c. justice and beneficence.
d. autonomy and fidelity.
ANS: B
The parents’ autonomy to make decisions for their child is in conflict with the beneficence
(doing good) of the health care team. The other principles are not relevant to the scenario.
DIF: Cognitive Level: Application
REF: p. 79 | p. 80
TOP: Role of religion in ethical decisions
MSC: NCLEX: N/A
OBJ: 8
KEY: Nursing Process Step: N/A
10. A way of practicing fidelity to a patient would be to
a. discuss the patient with friends at a social gathering.
b. document the patient’s expression of feelings and wishes.
c. categorize the patient as a “down-and-out alcoholic.”
d. develop the care plan without patient input.
ANS: B
The nurse who documents the patient’s expression of feelings or wishes without subjective
interpretation is demonstrating fidelity (being true) to the patient. The other options
demonstrate lack of fidelity.
DIF: Cognitive Level: Application
REF: p. 80 | p. 81 OBJ: 9
TOP: Fidelity
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
11. To provide justice to patients on the unit, the nurse must
a. treat all patients with the same diagnosis utilizing the same plan of care.
b. treat all patients with equal dignity and respect.
c. base care on the patient’s culture, religion, and social status.
d. determine who is most deserving of extra care.
ANS: B
Being fair does not mean giving every patient the same thing. It means treating them the
same; that is, with dignity and respect. Basing care on a patient’s culture, religion, and social
status and determining who is most deserving of extra care would result in care that is
provided based on subjective criteria.
DIF: Cognitive Level: Application
REF: p. 81
OBJ: 10
TOP: Justice
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
12. The patient asks the nurse what he should do about continuing cancer treatment. The nurse
responds, “You should stop before you get so weak you can’t enjoy a few good weeks with
your family.” This is an example of
a. fidelity.
b. beneficence.
c. nonmaleficence.
d. beneficent paternalism.
ANS: D
This response assumes the nurse knows what is right for the patient and robs the patient of
decision making. It discounts the patient’s knowledge of self. The scenario does not describe
the other ethical principles listed as options.
DIF: Cognitive Level: Application
TOP: Beneficent paternalism
MSC: NCLEX: Psychosocial Integrity
REF: p. 82
OBJ: 7
KEY: Nursing Process Step: N/A
13. What ethical principle underlies the statement in the National Federation of Licensed Practical
Nurses (NFLPN) Code for Licensed Practical/Vocational Nurses, “The practical nurse
provides health care to all patients regardless of race, creed, cultural background, disease, or
lifestyle”?
a. Autonomy
b. Confidentiality
c. Beneficence
d. Justice
ANS: D
Justice means treating all patients fairly according to their needs; that is, with dignity and
respect. The other principles listed in the options do not fit the scenario. Autonomy is having
control over personal decisions. Confidentiality means avoiding sharing patient information
with anyone not directly involved in care without the patient’s permission. Beneficence means
to “do good” with your nursing actions.
DIF: Cognitive Level: Comprehension
REF: p. 75
TOP: Justice
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
OBJ: 10
14. A nurse injects himself or herself with a narcotic prescribed for a patient. This is an example
of
a.
b.
c.
d.
unethical and illegal behavior.
ethical and legal behavior.
unethical but legal behavior.
ethical but illegal behavior.
ANS: A
It is unethical because the nurse has the ethical obligation to place the patient’s needs above
his or her own. It is illegal to use a narcotic prescribed for another person.
DIF: Cognitive Level: Application
TOP: Ethical vs. legal
MSC: NCLEX: N/A
REF: pp. 75-79
OBJ: 2 | 3 | 11
KEY: Nursing Process Step: N/A
15. A student nurse is assigned to care for a patient with complex nursing care needs. The student
was busy and did not prepare in advance for the assignment. In preconference, the student is
unable to describe the care to be given and admits not knowing how to execute one of the
treatments. The instructor would be ethically justified in
a. telling the student to be very careful during caregiving.
b. sending the student home and turning the patient’s care over to staff.
c. suspending the student.
d. dismissing the student from the program.
ANS: B
Nonmaleficence is the operative ethical principle. The student is ethically obligated to provide
safe care to assigned patients. The instructor is also obligated to do no harm. Sending the
student home and turning the patient’s care over to staff is a safe alternative to allowing the
student to care for the patient. Suspending or dismissing the student from the program does
not permit the student to have due process.
DIF: Cognitive Level: Analysis
REF: pp. 75-79
OBJ: 6
TOP: Nonmaleficence
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
16. Which situation can be identified as abandonment of patients by the nurse?
a. Calling in sick
b. Floating to a unit after a 2-day orientation to the unit
c. Starting to care for patients on wing A and being reassigned to wing B
d. Going off duty without giving report rather than care for patients on an unfamiliar
unit
ANS: D
The nurse cannot leave a unit unless able to turn the care of patients over to a qualified nurse.
DIF: Cognitive Level: Analysis
REF: p. 79
OBJ: 6
TOP: Abandonment
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
MULTIPLE RESPONSE
1. The nurse is asked to explain the meaning of ethics to a patient. The nurse should correctly
state, “Ethics is a system of standards that refer to ideas and actions in terms of being (Select
all that apply.):
a. right and wrong.”
b. moral and immoral.”
c. legal and illegal.”
d. good and bad.”
e. ought and ought not.”
f. like and dislike.”
g. rights and duties.”
ANS: A, B, D, E, G
Ethics is concerned with all of the options except “legal and illegal” and “like and dislike.”
Ethics and legalities are not the entirely the same, although some ethical principles may be
enacted into law. “Like and dislike” refer to values.
DIF: Cognitive Level: Application
REF: p. 74
OBJ: 2
TOP: Ethics
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
2. The introduction of the nursing process and critical thinking into nursing practice has resulted
in increased ethical and legal responsibilities for nurses in the areas of (Select all that apply.):
a. peer reporting.
b. accountability.
c. personal ethics.
d. patient advocacy.
e. cost containment.
ANS: A, B, D
Peer monitoring and reporting are essential to patient safety and professional integrity.
Accountability means being held accountable for all nursing actions performed. Because the
scope of practice has expanded, nursing accountability is greater. Patient advocacy requires
the nurse to provide more information to patients. Personal ethics and cost containment are
not included as areas of increased ethical and legal responsibility.
DIF: Cognitive Level: Comprehension
REF: p. 77
OBJ: 3 | 4
TOP: Ethical responsibilities of nurses
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
3. What actions should be taken by the nurse to increase the possibility of doing no harm while
caring for a patient? (Select all that apply.)
a. Never participate in any action that will deliberately harm the patient.
b. Question how to do the least amount of harm when doing something that is
expected to result in good.
c. Make sure the patient has agreed to the procedure verbally or in writing.
d. Perform new procedures without seeking supervision.
e. Become aware of side effects of commonly administered medications.
ANS: A, B, C, E
Each of these measures, except option D, would increase the potential for nonmaleficence in
practice. Performing new procedures without seeking supervision has an increased potential
for doing harm.
DIF: Cognitive Level: Comprehension
REF: p. 78 | p. 79 OBJ: 6
TOP: Nonmaleficence
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
4. Which nursing actions are examples of use of the ethical principle of beneficence? (Select all
that apply.)
a. The LPN/LVN tells a patient to ask for a second doctor’s opinion.
b. The LPN/LVN provides emotional support when the patient cries.
c. The LPN/LVN places the bed in a low position before leaving the room.
d. The LPN/LVN places medication the patient brought from home at the nurses’
station.
e. The LPN/LVN provides report for the staff of the oncoming shift.
ANS: B, C, D
Beneficence means to do good. It also involves preventing harm, removing harm, and putting
the patient’s interests first.
DIF: Cognitive Level: Application
REF: p. 79 | p. 80 OBJ: 7
TOP: Beneficence KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
5. Which statements would the nurse evaluate as suggesting that the patient’s decision has not
been autonomous? (Select all that apply.)
a. “I wish I knew for sure that I had all the facts about the treatment.”
b. “I thought through all the alternatives.”
c. “My son told me emphatically what he thought would be best for the family.”
d. “I am going to refuse to take the treatment because it will prolong life.”
ANS: A, C
Autonomy means being free to choose. The statement, “I wish I knew for sure that I had all the
facts about the treatment,” suggests that the patient may not have had all the relevant facts.
The statement, “My son told me emphatically what he thought would be best for the family,”
suggests undue influence from the family. Thinking through all the facts is part of
autonomous decision making, as is acting on one’s personal decision.
DIF: Cognitive Level: Analysis
REF: p. 80
OBJ: 8
TOP: Autonomy
KEY: Nursing Process Step: Assessment (Data Collection)
MSC: NCLEX: Psychosocial Integrity
COMPLETION
1. A system of standards or moral principles that direct actions as being right or wrong is called
___________.
ANS:
ethics
Ethics is a system of standards or moral principles that direct actions as being right or wrong.
Ethics is concerned with the meaning of words such as right, wrong, good, bad, ought, and
duty.
DIF: Cognitive Level: Knowledge
REF: p. 74
TOP: Ethics
KEY: Nursing Process Step: N/A
OBJ: 2
MSC: NCLEX: N/A