Chapter 6: Ethical Issues

Question 1

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee’s good qualities and that they give positive direction for professional growth. This belief is an example of:
a. Justice.
b. Fidelity.
c. Beneficence.
d. Nonmaleficence.

Answer 1

ANS: D
Nonmaleficence refers to “doing no harm.” By focusing only on good qualities, the manager seeks to do no harm to the employee.

Question 2

Normative ethics is concerned with the:
a. Broader theory and meaning of morality.
b. Foundation and scope of moral values, words, and practice.
c. Standards that most people use to guide their behaviours.
d. Relationship of ethical principles to real-life moral issues.

Answer 2

ANS: C
Normative ethics is concerned with the standards that most people use to guide their behaviours (e.g., “murder is wrong”) and how they are determined. Metaethics concerns the broader theory and meaning of morality and the foundation and scope of moral values, words, and practice. In applied ethics, ethical principles are studied in relation to real-life moral issues, such as how to provide nursing care and how to conduct research on human subjects.

Question 3

A patient refuses a simple procedure that you believe is in the patient’s best interest. The two ethical principles that are directly in conflict in such a situation are:
a. Fidelity and justice.
b. Veracity and fidelity.
c. Autonomy and beneficence.
d. Paternalism and respect for others.

Answer 3

ANS: C
Autonomy refers to the freedom to make a choice (e.g., to refuse a procedure), and beneficence refers to doing good (performing a procedure that will benefit the patient).

Question 4

Three gravely ill patients are candidates for the only available bed in the intensive care unit. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles?
a. Beneficence.
b. Autonomy.
c. Veracity.
d. Nonmaleficence.

Answer 4

ANS: A
Beneficence refers to doing what is good for the patient; in this situation, doing what is good means providing care to the patient with the best likelihood of recovery.

Question 5

Which ethical principle is primarily involved in informed consent? a. Veracity.
b. Autonomy.
c. Beneficence.
d. Nonmaleficence.

Answer 5

ANS: B
Autonomy refers to the right to choose freely, which is inherent in informed consent.

Question 6

Which of the following is a key area of ethical nursing practice?
a. Nursing process.
b. Therapeutic relationship.
c. Decision-making model.
d. Embodied knowledge.

Answer 6

B

Question 7

The nurse manager organizes interprofessional team meetings on a weekly basis. This action is demonstrating which aspect of relational ethics?
a. Embodied knowledge.
b. Interdependent environment.
c. Engaged interactions.
d. Mutual respect.

Answer 7

ANS: D
Nurse managers show respect for students, nurses, and the health care team by facilitating interprofessional team meetings to discuss and plan patient care. Team meetings provide an opportunity to value everyone’s contributions and foster mutual respect, which is a critical aspect of effective teamwork.

Question 7

Which question reflects the essence of relational ethics?
a. “What can I do to maintain my professional practice?”
b. “What should I do for others?”
c. “What techniques can I use to empower my colleagues?”
d. “What ethical decision-making model will work best for me?”

Answer 7

B
Relational ethics involves asking not only “What should I do?” but also “What should I do for others?”

Question 8

According to relational ethics, what is critical in the development and maintenance of the roles and actions of the nurse manager?
a. Time management skills.
b. Professional relationships.
c.Understanding biomedical ethics
d. Comprehension of the Quebec Nurses Association’s Code of Ethics for nursing.

Answer 8

B

Question 9

Which of the following is a criticism of the principle of autonomy?
a. It is not culturally sensitive.
b. It can lead to focus on the needs of one person at the expense of the needs of
others.
c. It is not applicable with entire groups.
d. It can be viewed as advancing professional directives rather than patient desires

Answer 9

B
One criticism of the principle of autonomy is that it can lead to a focus on the rights or needs of one individual at the expense of the rights or needs of others (including entire groups).

Question 10

Autonomy is best promoted through which of the following, in taking a relational approach to autonomy?
a. Specific roles within the relationship.
b. Social change.
c. Protecting an individual’s freedom of choice.
d. The necessity of treating everyone fairly.

Answer 10

ANS: B
A relational approach to autonomy suggests that autonomy is best promoted through social change rather than through protecting an individual’s freedom of choice.

Question 11

Sue, a staff nurse, consistently arrives 15 minute late for her shift, and the nurse manager has talked to her about it several times. Sue does not take the comments seriously because there are two other nurses who also arrive late all the time, and the unit manager does not reprimand them. In this situation, the nurse manager is violating the ethical principle of:
a. Beneficence.
b. Nonmaleficence.
c. Justice.
d. Autonomy.

Answer 11

C

Question 12

Which element of the Code of Ethics of the International Council of Nurses is reflected in the following statement: “The nurse manager sets policies and procedures to guide ethical nursing practice?”
a. People.
b. Practice.
c. Profession. d. Coworkers.

Answer 12

ANS: C
The element of the Code of Ethics of the International Council of Nurses that is reflected in the question statement is the element of profession.

Question 13

Which element of the Code of Ethics of the International Council of Nurses is reflected when the nurse manager establishes a system for performance appraisals?
a. People.
b. Practice.
c. Profession.
d. Coworkers.

Answer 13

ANS: B
The element of the Code of Ethics of the International Council of Nurses that is reflected in the creation of performance appraisals is the element of practice.

Question 14

What is reflected when a nurse feels a lack of clarity or is unable to know even what the moral problem is, whereas at the same time feeling uneasy or uncomfortable about the situation?
a. Moral distress.
b. Moral uncertainty.
c. Ethical dilemma.
d. Ethical distress.

Answer 14

ANS: B
At the simplest level, an ethical experience is a situation that creates a sense of moral uncertainty: when a nurse feels indecision or a lack of clarity or is unable to even know what the moral problem is, while at the same time feeling uneasy or uncomfortable.

Question 15

A patient’s husband asks to speak with the nursing manager. He is visibly upset and tells the nursing manager that while at the corner store, he overheard two nurses discussing his wife’s health issues and is certain that others around him also heard the discussion. This is an example of:
a. Ethical distress.
b. An ethical violation.
c. Moral inappropriateness.
d. An ethical dilemma.

Answer 15

ANS: B
Ethical violations reflect a nurse’s neglect of moral obligations and a breach of duty (e.g., when a nurse discusses patient information in the cafeteria).

Question 16

Sally, a fourth year nursing student, was assigned to a maternal child unit. Upon reporting for an assignment she was informed her patient would be having an abortion because of severe medical issues with the unborn child. She approached her preceptor immediately and asked to be reassigned to another patient because Sally was opposed to abortion for any reason. This is an example of:
a. Competent nursing care.
b. Staffing availability.
c. Conflict of conscience.
d. Fatigue.

Answer 16

ANS: C
In case where the nurse’s personal values do not allow for moral acceptance of practices of the patient, a nurse is permitted to step back from the situation that involves a “conflict with their conscience” (CNA, 2017, p. 35) to work with the team and allow another nurse to take over care.

Question 17

Michael a novice nurse has been assigned to four medically ill patients. There is a nursing staff shortage on his unit and more experienced nurses have as highly acute a workload as he does. As the shift progresses he becomes more distraught and unable to provide the type of care he knows his patients need. Michael is experiencing:
a. Moral distress.
b. Moral fatigue.
c. Values conflict.
d. Therapeutic relationship

Answer 17

ANS: A
There are a number of both internal and external factors that can interfere or threaten the integrity of the nurse-patient relationship. External factors such as high rates of turnover or casual nursing staff, staff shortages, consistently high workloads, unhealthy or hostile work environments, or poor staff morale might make it difficult to establish and sustain nurse-patient relationships. Internal factors might include fatigue, moral residue, moral distress, or a values conflict.

Question 18

Mr. and Mrs. Bennett are attending a consult for reproductive assistance. Although there is a positive chance the method will result in a pregnancy, they are not able to cover the cost of the procedure. This situation denies which of the following ethical principles?
a. Autonomy.
b. Nonmaleficence. c. Justice.
d. Beneficence.

Answer 18

C

Question 19

To perform treatment on a patient not requiring a formal written consent a nurse must conduct which of the following? (Select all that apply.)
a. Asking permission to do a treatment.
b. Explaining the procedure.
c. Stopping the procedure if patient is uncomfortable.
d. Confirming understanding of the treatment.

Answer 19

ANS: A, B, C, D
For many type of routine nursing procedures, written informed consent is not necessary but consent should still be obtained from the patient, in a less formal way. Each time a nurse approaches a patient to administer a medication, to check vital signs or to change a dressing, the nurse should always first check in with the patient that they understand what is about to happen and that the immediate plan of care is acceptable to them at that point in time. Respecting patient autonomy means always ensuring that patients are not passive recipients
of care, but rather that they are as involved as possible in all decisions that are part of their
own health care experience.

Question 20

Nursing management actions and decisions are guided by (Select all that apply.)
a. The law.
b. Ethical principles.
c. Leadership style.
d. Professional accountabilities.
e. Staff preferences.

Answer 20

ANS: A, B, D
Nursing management decisions and actions are guided by three elements: ethical principles, professional accountabilities, and the law.

Question 21

Which of the following are core elements of relational ethics? (Select all that apply.)
a. Mutual respect.
b. Justice and beneficence.
c. Informed consent.
d. interdependent environment

Answer 21

ANS: A, D
The core elements of relational ethics are engaged interactions, mutual respect, embodied knowledge, uncertainty and vulnerability, and interdependent environment.