Ethics Flashcards
A terminally ill 15-year-old tells the nurse that she wants to stop all treatments and go home despite her parents’ directives to provide extraordinary means to keep their child alive. What is the best resource available to this nurse to help solve this dilemma?
- An institutional ethics committee
- The local Joint Commission on Accreditation of Healthcare Organizations branch
- The American Association of Nurses
- A nurse mentor
The correct answer is: An institutional ethics committee
Every institution has an Institutional Ethics Committee (IEC), which is required by the Joint Commission. The IEC should always be consulted in difficult or unusual cases when conflict and lack of agreement exists between parents and physicians or among the professional staff as to the course of action that is in the best interests of the child.
The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter’s physician is “pushing them” to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse’s best response to this situation?
- Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved
- Tell the parents to state in writing that they will not participate in the treatment and give the letter to their physician
- Tell the doctor that the procedure is not in the best interests of this girl and ask him to respect the rights of the family
- Reassure the family that the doctor is acting in their best interests and they should reconsider the treatment
The correct answer is: Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved.
When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.
The nurse is caring for a terminally ill client in the intensive care unit that is on life support measures. The family members are opposed in their decision to take the client off of life support. What option does the nurse discuss with the nurse manager?
- Ask the family to go out of the unit and make a decision that is final
- Contact the ethics committee for their input
- Have the health care provider inform the family that they are not responsible for the decision
- Take the client off of life support when the family is not present
The correct answer is: Contact the ethics committee for their input.
The ethics committee may be called on to act as an advocate for clients who no longer are mentally capable of making their own decisions. Ethics committees are a valuable resource for reviewing difficult cases and helping ensure a careful and unbiased decision.
The nurse is not practicing within the scope of practice by taking the client off of life support.
The nurse does not mandate to the health care provider decisions that should be made.
It is nontherapeutic for the nurse to ask the family to go out and make a decision.
Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for physician-assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide?
- Administering a lethal dose of medication
- Administering a morphine infusion
- Granting a client’s request not to initiate enteral feeding when the client is unable to eat
- Neglecting to resuscitate a client with a do not resuscitate status
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Coursework Go to the previous assignment Previous Your assignments Next Go to the next assignment PNC3 Ethics Case Study Homework: Assignments in Unit 5: Ethics Your final grade is 18/22, C (81.82%) Add a comment For more workflow details, see your full historyFor the full assignment information, read the instructions
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Section 1
1)
3/3
Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene on her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly prescriptions for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion.
The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until her death. The patient has no complaints of shortness of breath or discomfort.
- What ethical dilemma exists?
(3pts)
Your answer
The ethical dilemma is whether or not to keep the patient alive or to give a blood transfusion to keep her alive. Giving the blood transfusion could be considered going against the patient’s advanced directive, but not giving the blood transfusion could be seen as killing the patient.
Word count: 48 words
The ethical dilemma is whether to treat the critically low laboratory value with a blood transfusion that would prolong the patient’s life long enough to require amputation of her right foot.
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2)
2/3
Who are the stakeholders and what gains or losses do each have?
(3pts)
Your answer
The stakeholders are hospice and the medical power of attorney. Hospice would lose a patient if not giving the blood transfusion, the medical power of attorney would not get what was wished by the patient if she had the blood transfusion and limb removed, hospice would keep their patient alive and giving them care if they gave her the blood transfusion, and the medical power of attorney would keep the legal wishes of the patient if the blood transfusion and limb were kept on.
Word count: 84 words
The patient is the primary stakeholder
she is confused and her medical power of attorney is acting on her behalf to carry out her wishes.
The medical power of attorney wants to fulfill the patient’s wishes to die with dignity and not to suffer by having an amputation of her right foot.
The medical power of attorney and physician discussed the situation beforehand and decided to stop all laboratory studies and treatments and to provide comfort only measures.
the patient’s physiological status will not support the amputation
the patient has no signs or symptoms of suffering in relation to the low hemoglobin or hematocrit.
the patient’s gain by having the blood transfusion does not outweigh the losses, that include suffering through a risky surgery, suffering after the surgery, and going against her autonomy (predetermined end-of-life choice not to have the amputation.
The medical power of attorney is a stakeholder
the dilemma causes distress for the person ultimately responsible for making the decision
The hospice nurse is a stakeholder
has an ethical dilemma that needs to be resolved because of making the mistake of obtaining the laboratory results.
the nurse has an obligation to treat the critically low laboratory value and obligation to treat the patient and medical power of attorney’s wishes for end-of-life care.
The physician is a stakeholder
critically low laboratory value needs to be addressed and a decision must be made whether or not to treat the patient with a blood transusion.
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3)
3/3
What strategies should the hospice nurse take to resolve the ethical dilemma?
(3pts)
Your answer
Explain to the patient, family, physician, healthcare team, and others involved in the ethical dilemma; understand the advanced directive completely; understand the policies of the employer completely; contact an ethics committee; refer to the ANA Code of Ethics for Nurses.
Word count: 40 words
The Hospice nurse
The hospice nurse needs to use the steps of ethical analysis with the stakeholders involved.
The hospice nurse needs to take responsibility for the error
Follow ANA protocols related to ethics violations
Be aware of state and federal laws related to this issue
Assess and understand the patient’s values and beliefs
Offer support
Asking for support of fellow colleagues or consult with an ethics committee
The medical power of attorney acting on behalf of the patient will have the final say in the decision since the patient is confused and determined by her physician to be unable to make her own decisions regarding medical treatment.
The ethical decision-making process should be used to help the medical power of attorney to make an informed ethical decision.
Additional support to help the medical power of attorney would include a hospital ethics committee.
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4)
0/1
A terminally ill 15-year-old tells the nurse that she wants to stop all treatments and go home despite her parents’ directives to provide extraordinary means to keep their child alive. What is the best resource available to this nurse to help solve this dilemma
(1pts)
Student Results Multiple Choice Multiple Choice Options
Unscored Unselected
An institutional ethics committee
Unselected
The local Joint Commission on Accreditation of Healthcare Organizations (JCAHO) branch
Incorrect Selected
The American Association of Nurses
Unselected
A nurse mentor
The correct answer is: An institutional ethics committee
Every institution has an Institutional Ethics Committee (IEC), which is required by the Joint Commission. The IEC should always be consulted in difficult or unusual cases when conflict and lack of agreement exists between parents and physicians or among the professional staff as to the course of action that is in the best interests of the child.
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5)
1/1
The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter’s physician is “pushing them” to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse’s best response to this situation?
(1pts)
Student Results Multiple Choice Multiple Choice Options
Correct Selected
Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved.
Unselected
Tell the parents to state in writing that they will not participate in the treatment and give the letter to their physician.
Unselected
Tell the doctor that the procedure is not in the best interests of this girl and ask him to respect the rights of the family.
Unselected
Reassure the family that the doctor is acting in their best interests and they should reconsider the treatment.
The correct answer is: Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved.
When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.
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6)
1/1
A palliative care nurse is caring for a client with end-stage pancreatic cancer who is reporting severe pain. The healthcare provider orders morphine sulfate 4mg IV stat followed by morphine sulfate 2mg IV q 1h prn pain. The drug is available in a multidose ampule of 2mg/mL. How many mL does the nurse administer for the initial dose? Record your answer as a whole number.
(1pts)
Order Your answer Student Results Answer Field
2
Correct
The ANA Code of Ethics for Nurses provision 3 states that the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. This is crucial during medicating a palliative client.
The initial dose ordered is 4 mg. The dose available is 2 mg. The quantity is 1mL.
It is a multiple dose vial. 4mg/2 mg x 1 mL = 2 mL
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7)
1/1
The nurse is caring for a terminally ill client in the intensive care unit that is on life support measures. The family members are opposed in their decision to take the client off of life support. What option does the nurse discuss with the nurse manager?
(1pts)
Student Results Multiple Choice Multiple Choice Options
Unselected
Ask the family to go out of the unit and make a decision that is final.
Correct Selected
Contact the ethics committee for their input.
Unselected
Have the health care provider inform the family that they are not responsible for the decision.
Unselected
Take the client off of life support when the family is not present.
The correct answer is: Contact the ethics committee for their input.
The ethics committee may be called on to act as an advocate for clients who no longer are mentally capable of making their own decisions. Ethics committees are a valuable resource for reviewing difficult cases and helping ensure a careful and unbiased decision.
The nurse is not practicing within the scope of practice by taking the client off of life support.
The nurse does not mandate to the health care provider decisions that should be made.
It is nontherapeutic for the nurse to ask the family to go out and make a decision.
Feedback on your answerCollapse this question Collapse
8)
1/1
Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for physician-assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide?
(1pts)
Student Results Multiple Choice Multiple Choice Options
Correct Selected
Administering a lethal dose of medication
Unselected
Administering a morphine infusion
Unselected
Granting a client’s request not to initiate enteral feeding when the client is unable to eat
Unselected
Neglecting to resuscitate a client with a “do not resuscitate” status
The correct answer is: Administering a lethal dose of medication
Assisted suicide refers to providing another person the means to end his or her own life, such as administering a lethal dose of a medication. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual.
Administering a morphine infusion may be used to assist with a client’s pain near the end of life.
Granting a client’s request not to initiate enteral feeding when the client is unable to eat is an example of wishes of a terminally ill client, and the agreed-upon measures near the end of life.
Neglecting to resuscitate a client with a “do not resuscitate” status is following the prescribed, mutually agreed-upon decisions about care.
A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?
- I can’t do that, I will go to jail
- I am surprised that you would ask me to do something like that
- I will see if the physician will order enough for that to occur
- I will notify the physician that the current dose of medication is not relieving your pain
The correct answer is: “I will notify the physician that the current dose of medication is not relieving your pain.”
Palliative sedation is distinguished from euthanasia and physician-assisted suicide in that the intent of palliative sedation is to relieve symptoms, not to hasten death. Palliative sedation is most commonly used when the patient exhibits intractable pain, dyspnea, seizures, or delirium, and it is generally considered appropriate in only the most difficult situations.
A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following?
- Participating in assisted suicide violates the Code of Ethics for Nurses
- Nurses may administer medications prescribed by physicians to hasten the end of life
- A client has the right to make independent decisions about the timing of his or her death
- Most states have enacted laws that allow for physician-assisted suicide
The correct answer is: Participating in assisted suicide violates the Code of Ethics for Nurses.
The American Nurses Association Position Statement on Assisted Suicide acknowledges the complexity of the assisted suicide debate but clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. Legally, nurses are not allowed to administer medications even if prescribed by a physician if that medication will hasten the client’s end of life.
Proponents of physician-assisted suicide argue that terminally ill people should have a legally sanctioned right to make independent decisions about the value of their lives and the timing and circumstances of their deaths. However, this is not the case at the present time. Two states have enacted legislation for physician-assisted suicide. These laws provide access to physician-assisted suicide by terminally ill clients under very controlled circumstances.
A nurse is caring for a terminally ill client inquiring about physician-assisted suicide. Which statement made by the nurse would correctly inform the client of this practice?
- the healthcare provider administers a lethal dose of medication via IV
- The health care provider provides the means for the clients to take their life
- The healthcare provider provides the means and waits to pronounce them dead
- The healthcare provider provides counseling and has a third party physician assist in the suicide
The correct answer is: The health care provider provides the means for the clients to take their life.
Physician-assisted suicide is the practice of providing a means by which a client can end his or her life. Much controversy exists concerning the practice. California, Vermont, Oregon, Washington, and Montana are the only states that permit physician-assisted suicide.
The physician does not personally administer the dose, wait until the client is dead, or have a third party physician involved.
A home health nurse is caring for a client of the Catholic faith with Amyotrophic Lateral Sclerosis (ALS) who is asking for assistance ending his life. Using the Code of Ethics for Nurses, what responses by the nurse are appropriate? Select all that apply.
- I understand wanting to alleviate your suffering, but that is not the right way
- Participation in assisted suicide violates my nursing code of ethics
- The is not a state that has enacted laws for physician-assisted suicide
- Why you aren’t thinking clearly, Catholics can’t go to heaven after suicide
- Can you rate your pain on a 1-10 scale so I can give you pain medication now?
The correct answers are: “Participation in assisted suicide violates my nursing code of ethics.” and “This is not a state that has enacted laws for physician-assisted suicide.”
Explaining that helping with assisted suicide violates the code of ethics explains to the client why you are unable to help him. Informing him that assisted suicide is illegal in that state is important.
Nurses should not be judgmental, accusatory, or offer opinions on religious choices or care options. The client did not state that they were in pain.
The nurse has been caring for a 4-year-old child with a severe traumatic brain injury. Which statement made by the parents prompts the nurse to discuss the possibility of organ donation?
- We wonder if there is any good that can come from this tragedy
- We’re hopeful that our child will make a complete recovery
- We’re confident that the healthcare team is doing all they can
- We’re confident that the healthcare team is doing all they can
The correct answer is: “We wonder if there there is any good that can come from this tragedy.”
Statements indicating that the family has accepted the grave condition of their child indicate the parents may be ready to discuss organ donation.
Statements that represent a family’s nonacceptance of the child’s prognosis, a lack of understanding of treatments that are being given, or a misunderstanding of organ and tissue donation are indications that the family isn’t ready to be approached or to make a decision.
The nurse is speaking with the parents of a terminally ill child about organ donation. Which statement by a parent indicates a need for further education?
- We will not have to pay for any of the expenses of the organ procurement
- Nothing will be taken from my son until after he has died
- If we do donate my son’s organs, we won’t have to postpone the funeral
- If I choose to donate my child’s organs, we will need to have a closed casket at the funeral
The correct answer is: “If I choose to donate my child’s organs, we will need to have a closed casket at the funeral.”
Procurement of the organs does not mar the child’s appearance so that an open casket at the child’s funeral is still possible if the family desires.
The donating child will not suffer further because of organ donation. The organs or tissues will be harvested in a timely fashion after the declaration of death, so the family need not worry about the delay of the wake or funeral.
All expenses for organ procurement are borne by the recipient’s family, not the donor’s.
A nurse is assisting with the clinical examination for the determination of brain death for a client, related to potential organ donation. All 50 states in the United States recognize uniform criteria for brain death. The nurse is aware that the three cardinal signs of brain death on clinical examination are all of the following except:
- Coma
- Absence of brain stem reflexes
- Apnea
- Glasgow Coma Scale of 6
The correct answer is: Glasgow Coma Scale of 6
The three cardinal signs of brain death on clinical examination are coma, absence of brain stem reflexes, and apnea.
The Glasgow Coma Scale is a tool for determining the client’s level of consciousness. A score of 3 indicates a deep coma, and a score of 15 is normal.
A nurse is caring for a client declared brain dead following a motor vehicle accident. When the nurse enters the client’s room, the spouse and family are talking with friends about the possibility of organ donation. Which statement by the nurse reflects an ethical practice dilemma?
- The healthcare team will support you in your decision on this difficult subject
- I can ask someone to come by to talk with you and answer any questions you may have
- If you’re thinking about organ donation, my sister is waiting for a kidney transplant. She’d be an excellent recipient. I can give you her phone number
- I can come back after you’ve finished your visit
The correct answer is: “If you’re thinking about organ donation, my sister is waiting for a kidney transplant. She’d be an excellent recipient. I can give you her phone number.”
The nurse demonstrates unethical behavior when discussing personal information with the client’s family and suggesting the nurse’s sister as an organ recipient. Offering to find resources, answer questions, and provide support to the client’s family are within the scope of nursing practice.
What is an ethical dilemma?
Two or more conflicting rights, values, obligations, or responsibilities
What are some issues that can occur with organ transplantation?
- Allocation of organs
- Selling of body parts
- Involvement of children (donors, recipients)
- Consent
- Clear definition of death
- conflicts of interest, religion
What is Euthanasia?
Assisted suicide
