Chapter 15: Ethical Issues and Dilemmas in Nursing Practice Flashcards
Which of the following factors has contributed to the increasing complexity of ethical
dilemmas faced by nurses?
a. Increased specialization in nursing
b. Lack of knowledge about health conditions
c. Workload and stress among nurses
d. Increased numbers of nurse practitioners
ANS: C
Factors that contribute to the complexity of ethical dilemmas are knowledge about health and illness, new technologies, finite and insufficient resources to meet all needs, and workload and stress among nurses.
Which one of the following assumes that ethical action can be determined through the use of reason and application of generalist principles?
a. Ethics
b. Bioethics
c. Nursing ethics
d. Medical ethics
ANS: B
Bioethics assumes that ethical action can be determined through the use of reason and application of generalist principles to clinical situations.
Which following division of ethics provides principles and rules to bring about good in
society?
a. Descriptive ethics
b. Virtue ethics
c. Normative ethics
d. Applied ethics
ANS: C
Normative ethics is the division of ethics that provides principles and rules to bring about good in society.
Which of the following circumstances represents an example of not respecting a patient’s autonomy?
a. Posting pictures on social media with identifying information
b. Documenting the patient’s refusal of treatment for an infected wound
c. Stopping a treatment midway through a procedure because the patient has
requested it
d. Discussing the patient’s refusal of a blood transfusion for religious reasons
ANS: A
Respect for autonomy grants patients the right to expect that information shared for the purposes of competent and compassionate care will remain confidential and will only be shared within the parameters included in the consent to care.
Which following moral principle refers to doing no harm?
a. Nonmaleficence
b. Existentialism
c. Paternalism
d. Legal moralism
ANS: A
The moral principle of nonmaleficence refers to avoiding harm or doing no harm.
It is important to have a full discussion of the patient’s and family’s wishes for a do not resuscitate order (DNR) when developing an end-of-life treatment plan for which of the following reasons?
a. It will ensure that proper medications are given.
b. It will ensure actions are consistent with the patient’s and family’s wishes.
c. It will cover all of the legal issues and prevent malpractice.
d. It will support the standing orders for nursing care.
ANS: B
It is important to include a full discussion of DNR orders because too broad or narrow
interpretation of those orders could result in the application of basic or advanced life
support in ways that may be inconsistent with the patient’s and family’s wishes.
Which of the following statements by a registered nurse would indicate following the
Canadian Nurses Association (CNA) Code of Ethics when conscientiously objecting to
providing care?
a. “I refuse to take care this of this patient because she has HIV.”
b. “I am going to tell my patient I don’t agree with his decision.”
c. “I don’t agree, but I will implement the treatment anyway.”
d. “I am going to discuss this with my manager right away.”
ANS: D
The CNA Code of Ethics advises nurses to notify their employers as soon as possible of their conscientious objection and to ensure that the care of patients is not compromised, which may mean transferring care, in a respectful way, to an alternative provider.
Which of the following is true in relation to advance directives?
a. Advance directives document a patient’s health care preferences.
b. An advance directive is exactly the same as a power of attorney.
c. Advance directives are consistent between provinces and territories.
d. An advance directive determines who can make decisions for the patient.
ANS: A
A personal directive or advance directive (or living will) enables a person, in advance of
incapacity or serious illness or injury, to name a personal agent who will enforce the
person’s health care preferences and to outline values and beliefs that affect treatment and care.
Nurses often struggle with distinguishing between active euthanasia and palliative
sedation. The assertion that some actions have both good and bad effects, the action itself ought to be good, good is intended, and there must be sufficient reasons to engage in the action is known as which of the following?
a. Moral biomedical ethics
b. The principle of nonmaleficence
c. The principle of black and white
d. The doctrine of double effect
ANS: D
The doctrine of double effect is a moral principle that is sometimes evoked to further
distinguish between active euthanasia and palliative sedation. This doctrine asserts that some actions have both good and bad effects, and the doctrine relies on the following four conditions:
* The action itself is good or at least indifferent.
* A good, and not evil, effect is intended.
* The good effect cannot be produced by the evil effect.
* There must be sufficiently grave reasons to permit the evil effect.
Which of the following reflects the principle of justice within the framework of bioethics?
a. Futile treatment should always be provided.
b. A superior level of health care should be provided to everyone.
c. Scarce health care resources should be divided equally.
d. Resource allocation is based on the amount of research funds received.
ANS: C
Justice within the framework of bioethics is primarily concerned with the fair division of scarce resources or equal shares.
Assisted reproductive technology offers a range of services, but which of the following is prohibited under Canadian federal law?
a. In vitro fertilization
b. Selecting the sex to prevent sex-linked disorders
c. Payment for surrogacy
d. Genetic testing
ANS: C
Sex selection, except for prevention of sex-linked disorders, payment for surrogacy, or
creation of an embryo for purposes other than to create a human, and cloning are
prohibited under federal law, or in case of Quebec, provincial law.
Which of the following is a value outlined in the Canadian Nurses Association (CNA)
Code of Ethics (2017)?
a. Preserving dignity
b. Promoting autonomy
c. Maintaining anonymity
d. Maintaining social equity
ANS: A
One of the seven values outlined in the CNA Code of Ethics is preserving dignity.
Which of the following is one of the primary legal arguments in support of physician
assistance with dying?
a. It is against the law to allow patients to continue to suffer.
b. It counteracts the moral principles of autonomy and self-determination.
c. It interferes with the rights of persons under the Canadian Charter of Rights and
Freedoms.
d. It has a negative effect on the nurse–patient relationship.
ANS: C
The Supreme Court held that laws preventing physician assistance with dying interfered with the rights of persons under the Canadian Charter of Rights and Freedoms because not having the liberty to freely make decisions as personal as whether or not to end intolerable suffering threatened their security.
Which of the following situations reflects active euthanasia?
a. Withholding of intravenous or tube feedings
b. Withholding a lifesaving medical procedure
c. Administering an excessive dose of barbiturates
d. Withholding lifesaving medications
ANS: C
Euthanasia is the putting to death, by painless method, of a terminally ill or severely
debilitated person through omission (intentionally withholding a lifesaving medical
procedure or passive euthanasia, such as the withholding of intravenous or tube feedings) or commission of an act (active euthanasia), such as intentional administration of an excessive dose of barbiturates.
Margaret is caring for an older resident who has requested medical assistance in dying (MAID) and is awaiting the decision of the health care team. Which of the following is required in Canada before MAID would be permitted?
(Select all that apply.)
a. Financial hardship
b. Unbearable mental or physical suffering
c. Unable to obtain home care
d. Grievous and irremediable medical condition
e. Drug addiction
f. Natural death is foreseeable
g. Unable to obtain home health care services
ANS: B, D, F
A grievous and irremediable medical condition is considered one in which decline cannot be reversed, there is unbearable physical or mental suffering, and natural death is reasonably foreseeable.
