Chapter 4

Question 1

Which statement best describes ethics?
A) How our lives and relationships are led in our reality
B) How people make decisions they see as legally and morally appropriate
C) The conflict, power, and interdependency associated with the way we live
D) What our conduct and actions should be regarding what is right and good

Answer 1

D) What our conduct and actions should be regarding what is right and good

Ethics is the systematic study of what a person’s conduct and actions should be with
regard to self, other human beings, and the environment; it is the justification of what is
right or good and the study of what a person’s life and relationships should be, not
necessarily what they are.

Question 2

What is an ethical dilemma?
A) A problem that can be solved using empirical data
B) A situation that has clearly delineated facts for decision making
C) A problem that when handled effectively has a mutually agreed-upon solution
D) A situation that requires choosing between two or more undesirable alternatives

Answer 2

D) A situation that requires choosing between two or more undesirable alternatives

The most difficult of all moral issues is termed a moral or ethical dilemma, which may
be described as being forced to choose between two or more undesirable alternatives.
The problem is not generally solved with a solution that is mutually satisfying nor does
it lend itself to empirical or delineated facts.

Question 3

The practice of allocating organs for transplantation based on a person’s ìworth to
societyî is an example of what ethical principle for decision making?
A) Autonomy
B) Beneficence
C) Utility
D) Justice

Answer 3

D) Justice

Justice: Seek fairness, treat ìequalsî equally, and treat ìunequalsî according to their
differences. Autonomy: Promotes self-determination and freedom of choice.
Beneficence: Actions are taken in an effort to promote good. Utility: The good of the
many outweighs the wants or needs of the individual.

Question 4

The only treatment alternative left for a patient diagnosed with advanced cancer is a
rare, highly experimental bone marrow transfusion with a 10% success rate. The
insurance company refuses to authorize payment for the $200,000 procedure, arguing
that the money could be better spent providing well-baby screening for 2,000 residents
in the service area. What does this decision by the insurance company reflect?
A) Unethical conduct
B) Maleficence
C) Paternalism
D) Utility

Answer 4

D) Utility

The principle of utility states that what is best for the common good outweighs what is
best for the individual. There is no indication of unethical or maleficence behavior on
the part of the insurance company. Paternalism would be characterized by the insurance
company making treatment decision without the patient having input.

Question 5

Which statement regarding the MORAL decision-making model is true?
A) It is a problem-solving model
B) It does not include an evaluation step
C) The identification and analysis of multiple alternatives for action is required
D) The decision is arrived upon with only the involvement of the decision maker

Answer 5

C) The identification and analysis of multiple alternatives for action is required

MORAL is a decision-making model that is useful in clarifying ethical problems, and it
requires the identification and analysis of multiple alternatives for action. The other
options are not true statements regarding this decision-making model.

Question 6

Which ethical framework would most likely be used to arrive at the nurse’s decision to
work overtime in spite of previous social plans?
A) Utilitarianism
B) Duty based
C) Rights based
D) Intuitionism

Answer 6

B) Duty based

The duty framework says that some things should be done just because there is a duty to
do them or refrain from doing them. Utilitarianism states that the good of the many
outweighs the wants or needs of the individual. The remaining options are not relevant
to the situation.

Question 7

What is the role of the American Nurses Association Code of Ethics and Interpretive
Statements?
A) Outlines minimum levels of ethical behavior that nurses must maintain
B) Functions as a guide to the highest standards of ethical practice for nurses
C) Is a legally binding document that directs a nurse’s ethical and moral behavior
D) Mandates the ethical behavior prerequisite for maintaining a nursing licensure

Answer 7

B) Functions as a guide to the highest standards of ethical practice for nurses

The ANA Code of Ethics outlines the important general values, duties, and
responsibilities that flow from the specific role of being a nurse in order to achieve and
maintain the highest standards. The document is not legally binding nor is it a mandate
of behavior.

Question 8

Which statement regarding ethical decision making is true?
A) Outcomes are the basic criterion for evaluating ethical decision making
B) Only desirable alternatives are identified when solving ethical dilemmas
C) Critical ethical decisions are made quickly so the situation does not worsen
D) Accepting some ambiguity and uncertainty are a part of ethical decision making

Answer 8

D) Accepting some ambiguity and uncertainty are a part of ethical decision making

Ethical decision makers choose between two or more undesirable alternatives, and
because they can use only the information and resources available at the time, they must
live with some ambiguity and uncertainty. The remaining options are not true statements
regarding the ethical decision-making process.

Question 9

Which ethical framework involves an individualized decision-making framework?
A) Duty based
B) Rights based
C) Utilitarian
D) Intuitionist

Answer 9

D) Intuitionist

Intuitionist states that each case weighed on a case-by-case basis to determine relative
goals, duties, and rights. Utilitarian provides the greatest good for the greatest number of
people. Duty based is a duty to do something to refrain from doing something. Rightsbased
individuals have basic inherent rights that should not be interfered with.

Question 10

What does the morale principle of autonomy govern?
A) A person’s right to make his or her own decision
B) The obligation to do good and prevent harm
C) Doing what is right and fair
D) Truth telling

Answer 10

A) A person’s right to make his or her own decision

Autonomy, or self-determination, is also referred to as freedom of choice and accepting
the responsibility for one’s choice. None of the other options addresses this concept.

Question 11

Protecting patient confidentiality respects the client's right to
A) self-esteem
B) self-defense
C) self-determination
D) self-incrimination

Answer 11

C) self-determination

Confidentiality is a foundation of both medical and nursing ethics, and it respects the
client’s right to self-determination. While the other options are worthy of respect, they
are not associated with confidentiality.

Question 12

Much of the difficulty people have in making ethical decisions results from a lack of
formal education about problem solving. Research at the University of Pennsylvania
found what percentage of the nurses and social workers reported having no ethics
training?
A) 15
B) 20
C) 25
D) 30

Answer 12

C) 25

Research done at the University of Pennsylvania found that nearly 25% of the nurses
and social workers reported having received no ethics training.

Question 13

Which factor should be considered when assessing the quality of ethical problem
solving? Select all that apply.
A) Outcomes
B) Decision-making process
C) Multiple alternatives
D) Data gathering

Answer 13

A) Outcomes
B) Decision-making process

Outcomes should never be used as the sole criterion for assessing the quality of ethical
problem solving, because many variables affect outcomes that have no reflection on
whether the problem solving was appropriate. Quality, instead, should be evaluated both
by the outcome and the process used to make the decision. If a structured approach to
problem solving is used, multiple alternatives are analyzed, and data gathering is
adequate, then, regardless of the outcome, the manager should feel comfortable that the
best possible decision was made at that time with the information and resources
available. The satisfaction of the involved parties is not a reliable factor.

Question 14

Collecting data about the ethical problem and identifying who should be involved in the
decision-making process is accomplished in which phase of the MORAL decisionmaking
model?
A) Massage the dilemma
B) Outline options
C) Review criteria and resolve
D) Affirm position and act

Answer 14

A) Massage the dilemma

Massage the dilemma: Collect data about the ethical problem and who should be
involved in the decision-making process. Outline options: Identify alternatives, and
analyze the causes and consequences of each. Review criteria and resolve: Weigh the
options against the values of those involved in the decision. This may be done through a
weighting or grid. Affirm position and act: Develop the implementation strategy.

Question 15

Which statement is correct regarding the distinction between legal and ethical
obligations in decision making?
A) Ethical controls are clearer and philosophically impartial
B) Ethical controls are much clearer and individualized
C) Legal controls are clearer and philosophically impartial
D) Legal controls are much less clear and individualized

Answer 15

C) Legal controls are clearer and philosophically impartial

In general, legal controls are clearer and philosophically impartial; ethical controls are
much less clear and individualized.

Question 16

Which member of the health-care team is often placed in situations where they are
expected to be agents for patients, physicians, and the organization simultaneously, all
of which may have conflicting wants and goals?
A) Physicians
B) Nurses
C) Nurse practitioners
D) Social workers

Answer 16

B) Nurses

Nurses are often placed in situations where they are expected to be agents for patients,
physicians, and the organization simultaneously, all of which may have conflicting
needs, wants, and goals. The nature of the patient contact of a nurse is more direct and
involves more time than the other members of the health-care team.

Question 17

To make appropriate ethical decisions the nurse-manager must have knowledge of what
items to assist in making decisions? Select all that apply: 1, 2, 3, 4.
A) Organizational processes 1, 2
B) Proven decision-making models 1, 2, and 3
C) Professional approach that eliminates trial and error
D) Ethical principles and frameworks

Answer 17

A) Organizational processes 1, 2
B) Proven decision-making models 1, 2, and 3
C) Professional approach that eliminates trial and error
D) Ethical principles and frameworks

To make appropriate ethical decisions then, the manager must have knowledge of
ethical principles and frameworks, use a professional approach that eliminates trial and
error and focuses on proven decision-making models, and use available organizational
processes to assist in making such decisions. Knowledge of the involved parties’ wishes
is not a focus of the decision-making process.

Question 18

Using both a systematic approach and proven ethical tools and technology allows
managers to make better decisions and increases the probability that they will feel
confident about the decisions they have made. Leadership roles and management
functions are involved in management ethics. What is an example of a leadership role?
A) Uses a systematic approach to problem solving and decision making when faced
with management problems with ethical ramifications
B) Identifies outcomes in ethical decision making that should always be sought or
avoided
C) Uses established ethical frameworks to clarify values and beliefs
D) Role models ethical decision making, which is congruent with the American
Nurses Association Code of Ethics and Interpretive Statements and Professional
standard

Answer 18

D) Role models ethical decision making, which is congruent with the American
Nurses Association Code of Ethics and Interpretive Statements and Professional
standard

A leadership role is role models ethical decision making, which is congruent with the
American Nurses Association Code of Ethics and Interpretive Statements and
Professional standard. Uses a systematic approach to problem solving and decision
making when faced with management problems with ethical ramification, identifies
outcomes in ethical decision making that should always be sought or avoided, and uses
established ethical frameworks to clarify values and beliefs are examples of
management functions.

Question 19

Using both a systematic approach and proven ethical tools and technology allows
managers to make better decisions and increases the probability that they will feel
confident about the decisions they have made. Leadership roles and management
functions are involved in management ethics. What is an example of a management
function?
A) Is self-aware regarding own values and basic beliefs about the rights, duties, and
goals of human beings
B) Accepts that some ambiguity and uncertainty must be a part of all ethical decision
making
C) Accepts that negative outcomes occur in ethical decision making despite highquality
problem solving and decision making
D) Identifies outcomes in ethical decision making that should always be sought or
avoided

Answer 19

D) Identifies outcomes in ethical decision making that should always be sought or
avoided

Management function identifies outcomes in ethical decision making that should always
be sought or avoided. Leadership roles include the following: Is self-aware regarding
own values and basic beliefs about the rights, duties, and goals of human beings; accepts
that some ambiguity and uncertainty must be a part of all ethical decision making;
accepts that negative outcomes occur in ethical decision making despite high-quality
problem solving and decision making.

Question 20

There are many terms used to describe moral issues faced by nurses, including moral
uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. Which
statement describes how moral uncertainty occurs?
A) Occurs when an individual is unsure which moral principles or values apply and
may even include uncertainty as to what the moral problem is
B) Occurs when the individual knows the right thing to do but organizational
constraints make it difficult to take the right course of action
C) Occurs when an individual witnesses the immoral act of another but feels
powerless to stop it
D) Occurs when being forced to choose between two or more undesirable alternatives

Answer 20

A) Occurs when an individual is unsure which moral principles or values apply and
may even include uncertainty as to what the moral problem is

Moral uncertainty occurs when an individual is unsure which moral principles or values
apply and may even include uncertainty as to what the moral problem is. Moral distress
occurs when the individual knows the right thing to do but organizational constraints
make it difficult to take the right course of action. Moral outrage occurs when an
individual witnesses the immoral act of another but feels powerless to stop it. Ethical
dilemma is being forced to choose between two or more undesirable alternatives.

Question 21

Which characteristic of an organization has influence on the ethical decisions its
managers' make? Select all that apply.
A) Purpose
B) Societal role
C) Societal constraints
D) Values

Answer 21

A) Purpose
B) Societal role
C) Societal constraints

The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of
the organization is linked to the function that it fills in society and the constraints
society places on it. So, the responsibilities of the nurse-manager emerge from a
complex set of interactions. Society helps to define the purposes of various institutions,
and the purposes, in turn, help to ensure that the institution fulfills specific functions.
However, the specific values and norms in any particular institution determine the focus
of its resources and shape its organizational life. The values of people within institutions
influence actual management practice. The organization’s societal status should not be
considered when making ethical decisions.

Question 22

Which ethical principle associated with an adult child is legally given the right to make
medical decisions for a cognitively impaired parent?
A) Justice
B) Fidelity
C) Paternalism
D) Beneficence

Answer 22

C) Paternalism

Paternalism is when one individual assumes the right to make decisions for another.
Justice requires that a person seek fairness, treat ìequalsî equally, and treat ìunequalsî
according to their differences. Fidelity involves the need to keep promises. Beneficence
involves actions that are taken in an effort to promote good.

Question 23

Which term is used to identify a person’s feelings of powerlessness to stop unethical
behavior in another person or institution?
A) Moral conflict
B) Moral outrage
C) Ethical relativism
D) Ethical universalism

Answer 23

B) Moral outrage

Moral outrage occurs when an individual witnesses the immoral act of another but feels
powerless to stop it. Moral uncertainty or moral conflict occurs when an individual is
unsure which moral principles or values apply and may even include uncertainty as to
what the moral problem is. Ethical relativism suggests that individuals make decisions
based only on what seems right or reasonable according to their value system or culture.
Ethical universalism holds that ethical principles are universal and constant and that
ethical decision making should not vary as a result of individual circumstances or
cultural differences.

Question 24

Which statement concerning autonomy and the employee is true? Select all that apply.
A) It is a form of personal liberty
B) Its legal equivalent is self determination
C) It is based on a person’s right to make a choice
D) It is supported by the process of progressive employee discipline

Answer 24

A) It is a form of personal liberty
B) Its legal equivalent is self determination
C) It is based on a person’s right to make a choice
D) It is supported by the process of progressive employee discipline

A form of personal liberty, autonomy is also called freedom of choice or accepting the
responsibility for one’s choice. The legal right of self-determination supports this moral
principle. The use of progressive discipline recognizes the autonomy of the employee.
The employee, in essence, has the choice to meet organizational expectations or to be
disciplined further. If the employee’s continued behavior warrants termination, the
principle of autonomy says that the employee has made the choice to be terminated by
virtue of his or her actions, not by that of the manager. Therefore, nurse-managers must
be cognizant of the ethical component present whenever an individual’s decisional
capacity is in question. To take away a person’s right to self-determination is a serious
but sometimes necessary action.

Question 25

Which activity best demonstrates a nursing unit manager’s attention to the ethics
standards of practice required of that position?
A) Membership on the institution’s ethic board
B) Terminates a staff member for absenteeism
C) Assures staff and patients that unit decisions are ethically sound
D) Holds membership in the local and state American Nurses Association (ANA)

Answer 25

A) Membership on the institution’s ethic board

ANA standards for ethics related to nurse administrators identifies participants on
multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and
outcomes as a criteria measurement. The remaining options while addressing ethical
behaviors on the administrator’s part are not as directly identified by the ANA.