Transcript
Critical Care Nursing
Ethical Issues
MULTIPLE CHOICE
1. The difference between morals and ethics is that ethics
a.
is more concerned with the “why” of behavior.
b.
distinguishes the good or right in conduct.
c.
is broader in scope.
d.
concentrates on the right or wrong of behavior.
ANS: A
Ethics are derived from an evaluation of an action based on a set of standards; morals are codes of conduct, determining right or wrong actions.
Level: Comprehension REF: {Differences between Morals and Ethics}
OBJ: Nursing Process Step: General
2. A client’s wife has been informed by the physician that her spouse has a permanent C2-3 spinal injury resulting in permanent quadriplegia. The wife states that she does not want the physician or nursing staff to tell the client about his injury. The client is awake, alert, and oriented when he asks his nurse to tell him what has happened. The nurse has conflicting emotions about how to handle the situation and is experiencing
a.
powerlessness.
b.
moral distress.
c.
moral doubt.
d.
frustration.
ANS: B
The nurse has been placed in a situation initially causing moral distress and is struggling with determining the ethically appropriate action to take. Emotions that follow moral distress can include powerlessness, frustration, and even doubt in the ability to make an immediate decision.
Level: Comprehension REF: {Moral Distress}
OBJ: Nursing Process Step: General
3. The critical care nurse can best enhance the principle of autonomy by
a.
allowing the client to do as much for himself or herself as possible.
b.
assisting with only those tasks that cannot be done by the client.
c.
providing the client with all information and facts.
d.
guiding the client toward the best choices for care.
ANS: C
Clients and families must have all the information about a certain situation to make an autonomous decision that is best for them.
Level: Synthesis REF: {Autonomy}
OBJ: Nursing Process Step: General
4. Which of the following ethical principles is most important when soliciting informed consent from a client?
a.
Nonmaleficence
b.
Fidelity
c.
Beneficence
d.
Veracity
ANS: D
Veracity is important when soliciting informed consent because the client needs to be aware of all potential risks of and benefits to be derived from specific treatments or their alternatives.
Level: Comprehension REF: {Veracity}
OBJ: Nursing Process Step: General
5. Fidelity includes faithfulness and promise-keeping to clients, and incorporates the added concepts of
a.
confidentiality and privacy.
b.
truth and reflection.
c.
autonomy and paternalism.
d.
beneficence and nonmaleficence.
ANS: A
Confidentiality is a right involving the sharing of client information with only those involved in the client’s care. Privacy includes confidentiality but goes further to include the right to privacy of person and personal space, such as ensuring that a client is adequately covered during a procedure.
Level: Comprehension REF: {Fidelity}
OBJ: Nursing Process Step: General
6. Which statement best reflects the concept of allocation of resources within the critical care setting?
a.
Limitations of resources force reexamination of goals of critical care for clients.
b.
Care is provided equally to all those who need the resources.
c.
Equal access is available for those with the same condition or diagnosis.
d.
Technologic advances are available to most of those in a given community.
ANS: A
Limited resources force society and critical care health practitioners to reexamine goals of critical care for clients.
Level: Comprehension REF: {p 16}
OBJ: Nursing Process Step: General
7. When deciding whether to withdraw or withhold treatment, it is important to
a.
examine one's own beliefs to guide the family to a correct decision.
b.
approach the family with honesty and provide clear information.
c.
simply follow the advance directive if available.
d.
allow the physician to approach the family.
ANS: B
This is a difficult time and the nurse needs to be attuned to the family’s needs by providing timely information, honesty, and clear treatment options, and by listening to the family.
REF: {Withholding and Withdrawing Treatment}
OBJ: Nursing Process Step: General
8. The Code of Ethics for Nursing provides a framework for the nurse in ethical decision making. This code
a.
is usurped by state or federal laws.
b.
allows the nurse to focus on the good of society rather than the uniqueness of the client.
c.
was recently adopted by the American Nurses Association.
d.
describes the nurse's role in advocating for client rights and safety.
ANS: D
The Code of Ethics for Nursing describes the professional role of the nurse in advocating for and protecting clients' rights to health and safe care.
Level: Comprehension REF: {Figure 2-2}
OBJ: Nursing Process Step: General
9. Ethical decisions are best made by
a.
following the guidelines of a framework or model.
b.
having the client discuss alternatives with the physician or nurse.
c.
prioritizing the greatest good for the greatest number of persons.
d.
careful consideration by the Ethics Committee once all diagnostic data are reviewed.
ANS: A
To facilitate the ethical decision-making process, a model or framework must be used so that all involved will consistently and clearly examine the multiple ethical issues that arise in critical care.
Level: Comprehension REF: {p. 18}
OBJ: Nursing Process Step: General
10. The first step of the ethical decision-making process is
a.
consulting with an authority.
b.
identifying the health problem.
c.
delineating the ethical problem from other types of problems.
d.
identifying the client as the primary decision maker.
ANS: B
Step one involves identifying the major aspects of the client's medical and health problems.
REF: {p. 18}
OBJ: Nursing Process Step: General
11. Values clarification can assist the client to clarify his or her own values to facilitate effective decision making. Which of the following nursing activities is incorporated into this intervention?
a.
Avoid the use of open-ended questions.
b.
Use multiple sessions to cross-examine the client to ensure he or she is clear about personal values.
c.
Use appropriate questions to assist the client in reflecting on the situation and what is personally important.
d.
Encourage members of the health care team to relate how they would make the decision.
ANS: C
Appropriate questions should be used to assist the client in reflecting on the situation and what is personally important.
Level: Comprehension REF: {p. 19}
OBJ: Nursing Process Step: General
MSC: NCLEX: Psychosocial Integrity
12. Nursing ethics committees often differ from institutional ethics committees in what way?
a.
They do not involve specific client situations.
b.
Their recommendations for action are binding.
c.
Staff education is an important component.
d.
Their primary role is to create policies for the hospital on ethical issues.
ANS: C
Nursing ethics committees provide a forum for nurses to discuss various ethical issues, serve as a staff resource, and provide education.
REF: {p. 20}
OBJ: Nursing Process Step: General
13. Institutional ethics committees (IECs) review ethical cases that are problematic for the practitioner. Major functions of IECs include all of the following except
a.
consultation with purely binding recommendations.
b.
support and education to health care providers.
c.
conflict resolution for ethical dilemmas.
d.
recommendations to policy-making bodies.
ANS: A
The IEC can function in a variety of ways, serving as consultants, providing education, and helping resolve ethical conflicts or dilemmas for health care providers. Recommendations from the formal IEC may or may not be binding and are relative to the situation at hand.
REF: {Institutional Ethics Committees}
OBJ: Nursing Process Step: General
14. Which of the following is NOT a criteria for defining an ethical dilemma?
a.
An awareness of different options
b.
An issue in which only one viable option exists
c.
The choice of one option compromises the option not chosen
d.
An issue that has different options
ANS: B
The criteria for identifying an ethical dilemma is threefold: (1) an awareness of the different options, (2) an issue that has different options, and (3) the choice of one option over another compromises the option not chosen.
REF: {p. 18}
OBJ: Nursing Process Step: Assessment
TRUE/FALSE
1. If a treatment achieves a predictable outcome then, by definition, it is NOT futile.
ANS: F
Unless the treatment has shown some benefit to the client, despite having achieved the predicted outcome, the treatment is still deemed futile.
REF: {p. 17}
OBJ: Nursing Process Step: General
MATCHING
Match the following terms with their definitions:
a.
Beneficence
b.
Veracity
c.
Justice
d.
Objectivity
e.
Subjectivity
1. Synonymous with the concept of allocation of resources
2. Analyzes a person’s psychosocial state
3. Preventing harm and promoting the well-being of clients
4. Examining a person’s ability to function
5. Telling the truth
1. ANS: C
OBJ: Nursing Process Step: General
2. ANS: E
OBJ: Nursing Process Step: General
3. ANS: A
OBJ: Nursing Process Step: General
4. ANS: D
OBJ: Nursing Process Step: General
5. ANS: B
OBJ: Nursing Process Step: General
MULTIPLE RESPONSE
1. Place the following steps in ethical decision making in the order in which they should be carried out:
a.
Identify the health problem.
b.
Implement decisions.
c.
Identify the decision maker.
d.
Define the ethical issue.
e.
Evaluate actions and decisions.
f.
Gather additional information.
g.
Examine moral and ethical principles.
h.
Explore alternative options.
ANS: A, B, C, D, E, F, G, H
The steps in ethical decision making mirror those in the nursing process.
Level: Synthesis REF: {p. 18}
OBJ: Nursing Process Step: General
COMPLETION
1. A professional ethic is based on three elements: __________, __________, and __________.
ANS:
the professional code of ethics, the purpose of the profession, the standards of practice of the profession
The three elements that form the basis for a professional ethic are the existence of a professional code of ethics, a defined professional purpose, and an identified standard of practice.
Level: Comprehension REF: {p. 17}
OBJ: Nursing Process Step: General
2. _____ _____ educate the staff to problems and provide for discussion identifying potential problems and determining actions that can be taken to decrease or prevent the incidence of a problem.
ANS:
Ethics rounds
Ethics rounds at the unit level regarding patients educate the staff to problems and serve to be “preventive” when facilitated appropriately. During the discussion, potential problems may be identified early and actions can be taken to decrease or prevent the incidence of a problem.
Level: Comprehension REF: {Ethics Rounds and Conferences}
OBJ: Nursing Process Step: General
