Chapter 09: Ethical and Bioethical Issues in Nursing and Health Care
Cherry: Contemporary Nursing: Issues, Trends, and Management, 9th Edition
MULTIPLE CHOICE
1. How is the term Ethics as applied to nursing best defined?
a. Doing what is best for the client
b. Making good decisions about care
c. Care based on keeping with the values of the client
d. Rules for providing competent care that is based on scientific principles
ANS: C
Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her relationships with clients, clients’
family members, other health care providers, policymakers, and society as a whole. A nurse must make an attempt to understand
what values are inherent in the situation.
DIF:
Knowledge
2. A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in
place. The nurse respects this decision in keeping with the principle of what client right?
a. Accountability
b. Autonomy
c. Nonmaleficence
d. Veracity
ANS: B
Autonomy is the principle of respect for the individual person. Within the concept of autonomy, people are free to form their own
judgments and perform whatever actions they choose. They are self-determining agents who are entitled to decide their own
destiny.
DIF:
Comprehension
3. An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and
notices her mother’s hand moves when she is talking to her. The daughter asks the nurse, “Is mother responding to my voice?” The
nurse, attempting to console the daughter, knows the movement was involuntary but states, “It does appear she did.” The nurse is
violating which principle of ethics?
a. Autonomy
b. Veracity
c. Utilitarianism
d. Deontology
ANS: B
Veracity is the principle of telling the truth in a given situation.
DIF:
Comprehension
4. In attempting to decide which services should be offered to a community, the public health nurse decides to implement
hypertension screening and treatment because most of the residents are hypertensive. This decision is based on what ethical
principle?
a. Veracity
b. Values
c. Utilitarianism
d. Autonomy
ANS: C
Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible
balance of good consequences or to the least possible balance of bad consequences. On the basis of this principle, an attempt is
made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the situation.
DIF:
Comprehension
5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his or her own values as they relate
to this issue. What action should the nurse take to address this barrier to providing effective care to the client?
a. Reflect on one’s personal values and how these values relate to beliefs and the
philosophy of nursing.
b. Be prepared to defend his or her value system.
c. Ignore his or her own values and provide care.
d. Realize that values do not change and that they cannot be influenced by others
and so decline this assignment.
ANS: A
Nurses must make a deliberate effort to recognize their own values and must learn to consider and respect the values of others.
Health care decisions are seldom made independently of other people. Decisions are made with the client, the family, other nurses,
and other health care providers.
DIF:
Application
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6. When assessing an ethical issue, what is the nurse’s first intervention?
a. Ask, “What is the issue?”
b. Identify all possible alternatives.
c. Select the best option from a list of alternatives.
d. Justify the choice of action or inaction.
ANS: A
The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension
of the situation—the feelings, emotions, attitudes, and opinions. Assessment can be applied to all areas of patient care, including
ethics. Trying to understand the full picture of a situation is time consuming and requires examination from many different
perspectives, but it is worth the time and effort.
DIF:
Comprehension
7. A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college
sophomores. The researcher was applying which ethical principle?
a. Beneficence
b. Human dignity
c. Justice
d. Human rights
ANS: A
Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to
others by promoting their good.
DIF:
Comprehension
8. The primary health care provider who insists on providing treatment in spite of the client’s wishes because “I know best” is
reflecting an attitude referred to as what?
a. Autonomy
b. Beneficence
c. Justice
d. Paternalism
ANS: D
Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client and believes that his or her actions
are justified because of a commitment to act in the best interest of the client. Paternalism is a reflection of the “father knows best”
way of thinking.
DIF:
Comprehension
9. The nurse who admits making a medication error and immediately files an incident report is demonstrating what ethical principle?
a. Accountability
b. Individuality
c. An injustice
d. Values clarification
ANS: A
Accountability is an ethical duty that states that one should be answerable legally, morally, ethically, or socially for one’s actions.
DIF:
Comprehension
10. Two individuals with no health insurance or money sustained life-threatening injuries during an automobile accident. The decision
was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The care of the
two critical clients was based on what ethical principle?
a. Utilitarianism
b. Deontology
c. Autonomy
d. Veracity
ANS: B
Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and
objective and that compel them to do what is right. Deontological theory claims that a decision is right only if it conforms to an
overriding moral duty and wrong only if it violates that moral duty.
DIF:
Comprehension
11. A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The
pregnant client states, “I want to have this baby and give it up for adoption.” However, the father is adamant that she will disgrace
the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her
from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves what ethical principle?
a. Deontology
b. Veracity
c. Autonomy
d. Beneficence
ANS: B
Veracity is telling the truth in personal communication as a moral and ethical requirement.
DIF:
Comprehension
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12. During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a
violation of the ethical principle of autonomy?
a. An older person with advanced stages of Alzheimer’s disease is denied the right
to ambulate in the hallway.
b. A mentally competent adult refuses medical treatment for the autoimmune disease
lupus erythematosus, stating that this condition reflects the will of a higher power.
c. A mentally competent visitor fell during visiting hours but refused to be examined
by the physician on call.
d. A mentally competent adult with a broken wrist refuses to be given a local
anesthetic prior to a procedure.
ANS: A
Autonomy is defined as personal freedom, the right to make choices. However, in this case, the patient is not able to be fully
informed so they can clearly understand the choices being offered.
DIF:
Application
13. A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by
deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating what ethical prin ciple?
a. Veracity
b. Beneficence
c. Nonmaleficence
d. Autonomy
ANS: C
Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and
eliminating threats. The nurse is definitely violating this principle through her actions.
DIF:
Comprehension
14. A client and her husband used in-vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have
more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She
comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks
that the sperm be destroyed because her husband’s faith prohibited remarrying, and allowing another person to use the sperm would
conflict with her late husband’s beliefs. When considering this scenario, the nurse realizes what?
a. The client is in the second step of ethical decision making and that the client’s
value system is influencing her choices of alternative actions.
b. A logical line of reasoning has led to validation of the decision to destroy the
husband’s sperm.
c. The client has not been able to navigate the complicated issues inherent in this
situation.
d. A rational decision was reached that was based on reflection and on the value
systems of the wife and the husband.
ANS: D
After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase, the
person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings
of the justification, and will anticipate objections to the justification.
DIF:
Analysis
15. A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain.
The nurse injects saline into the client’s IV line and takes the morphine for herself. The nurse is violating which principle of ethics?
a. Autonomy
b. Utilitarianism
c. Beneficence
d. Dilemmas
ANS: C
Beneficence is providing benefit to others by promoting their good. In general terms, to be beneficent is to promote goodness,
kindness, and charity. By taking the client’s pain medication and substituting saline, the nurse did harm, not good, for this client.
DIF:
Comprehension
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16. The Health Care Reform Act provides insurance for all U.S. citizens and legal residents presenting far-reaching ethical
considerations related to diverse individual patient health care beliefs for those delivering nursing care. Nurses must consider their
civil rights under the rights of conscience and how new health care agendas such as the Patient Protection and Affordable Care Act
(PPACA) could affect their practice in situations that may conflict with their own belief system. What action demonstrates a nurse
attempt to act in accordance with this responsibility?
a. Remembering it is one’s professional duty to render patient-centered care—even
when it is in direct conflict with the nurse’s own beliefs—or be held liable for
withholding treatment.
b. Considering whether the right to act according to one’s inner beliefs will continue
to be permissible when federal health insurance becomes fully enacted.
c. Discussing with the patient and family different options in hopes they will accept
the nurse’s health care beliefs.
d. Suggesting to the hospital administration that they not accept federal funding to
prevent controversial health practices.
ANS: B
With federal funding, many controversial health care services will be covered and provided as part of patient care when desired by
the patient; therefore, whether a nurse has autonomy to refuse to provide care may not be as clear even when one might request
another patient.
DIF:
Application
17. A patient returning from a procedure was somehow “skipped” when daily baths were performed and requests that care now be
provided now. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change
the bed, and help make the patient comfortable. These staff members are demonstrating what ethical concept?
a. Altruism
b. Veracity
c. Autonomy
d. Whistle-blowing
ANS: A
Altruism is concern for the welfare of others, including willingness to help others when they are unable to get their assignments
completed to ensure that the patient receives high-quality care.
DIF:
Comprehension
18. In which case does the nurse act as “whistle-blower”?
a. One staff member on the unit covers for another nurse, who leaves the premises to
b.
c.
d.
purchase illegal substances.
The nurse reports that another nurse is taking medications out of stock medicine
for herself or himself.
A nurse informs respiratory therapy that a patient is now due a treatment.
The nurse delegating care to unlicensed assistive personnel makes rounds to
ensure all care was rendered properly.
ANS: B
Whistle-blowing is the reporting of acts or situations that violate the principle of beneficence such as a chemical impairment,
negligence, abusiveness, incompetence, or cruelty.
DIF:
Comprehension
MULTIPLE RESPONSE
1. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience from formal nursing school classes,
clinical experiences, and the ethical issues they encounter in their clinical practice. What are the ideal outcomes of these ongoing
experiences with cultural decision making? (Select all that apply.)
a. Increased trustworthiness
b. Enhanced ability to take into consideration many aspects of ethical situations
c. Confidence to make decisions based on experience and ethical intelligence
d. Improved clinical decision making and advocacy for patient autonomy
e. Authority to make ethical decisions independently that meet personal moral
beliefs
ANS: A, B, C, D
The desired outcomes of ethics acculturation across the years are integrity, personal growth, practical wisdom, and effective
problem solving on behalf of patients and their families. These are the qualities that are characteristics of an ethically sensitive and
morally mature person. Trustworthiness is a characteristic of integrity. The ability to take into consideration many aspects of ethical
situations is due in part to personal growth and practical wisdom. The confidence to make ethically sensitive decisions comes from
experience founded on personal growth and personal wisdom. The ability to be the patient’s advocate in ethical decision making is
one test of cultural acculturation.
DIF:
Application
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COMPLETION
1. Practicing nurses participate in employer-sponsored professional development classes that provide case studies related to ethical
situations and decision making. Ethical considerations are debated among teams, and an expert helps the class arrive at the “best
practices.” The nurses are experiencing ethics ______________.
ANS:
acculturation
Ethics acculturation is the didactic and experiential process of developing ethical reasoning abilities as a part of ongoing
professional education.
DIF:
Knowledge
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