Four patients in labor all request epidural analgesia to manage their pain at the same
time. Which ethical principle is compromised when only one nurse anesthetist is on
call?
a.Justice
b.Nonmaleficence
c.Beneficence
d.Fidelity
ANS: A
Justice refers to fairness and is used frequently in dis...
Four patients in labor all request epidural analgesia to manage their pain at the same
time. Which ethical principle is compromised when only one nurse anesthetist is on
call?
a.Justice
b.Nonmaleficence
c.Beneficence
d.Fidelity
ANS: A
Justice refers to fairness and is used frequently in discussion regarding access to health
care resources. Here the just distribution of resources, in this case pain management,
cannot be justly apportioned. Nonmaleficence means do no harm, beneficence means
to do good, and fidelity means to be true to, or honest. Each of these principles is
partially expressed in the question; however, justice is most comprised because not all
laboring patients have equal access to pain management owing to lack of personnel
resources.
The patient tells the nurse that she is afraid to speak up regarding her desire to end
care for fear of upsetting her husband and children. Which principle in the nursing code
of ethics ensures that the nurse will promote the patients cause?
a.Responsibility
b.Advocacy
c.Confidentiality
d.Accountability
ANS: B
Nurses advocate for patients when they support the patients cause. A nurses ability to
adequate advocate for a patient is based on the unique relationship that develops and
the opportunity to better understand the patients point of view. Responsibility refers to
respecting ones professional obligations and following through on promises.
Confidentiality deals with privacy issues, and accountability refers to owning ones
actions.
The patients son requests to view the documentation in his mothers medical record.
What is the nurses best response to this request?
a.Ill be happy to get that for you.
b.You will have to talk to the physician about that.
c.You will need your mothers permission.
d.You are not allowed to see it.
,ANS: C
The nurse understands that sharing health information is governed by HIPAA
legislation, which defines rights and privileges of patients for protection of privacy.
Private health information cannot be shared without the patients specific permission.
The other three responses either are outright false and/or use poor communication
techniques.
When people work together to solve ethical dilemmas, individuals must examine their
own values. This step is crucial to ensure that
a.The group identifies the one correct solution.
b.Fact is separated from opinion.
c.Judgmental attitudes are not provoked.
d.Different perspectives are respected.
ANS: D
Values are personal beliefs that influence opinions. To be able to negotiate differences
in opinions, the nurse must first be clear about personal values, which will influence
behaviors, decisions, and actions. Ethical dilemmas are a problem in that no one right
solution exists.
Ethical dilemmas are common occurrences when caring for patients. The nurse
understands that dilemmas are a result of
a.Presence of conflicting values.
b.Hierarchical systems.
c.judgmental perceptions of patients.
d.Poor communication with the patient.
ANS: A
Poor communication and the hierarchical systems that exist in health care, such as
reporting structures within the hospital or the historically unequal relationship between
physicians and nurses, may complicate dilemmas. The primary, underlying reason that
ethical dilemmas occur is that there are no clear cut, universally accepted solutions to a
problem when participating individuals do not share the same values. Without
clarification of values, the nurse may not be able to distinguish fact from opinion or
value, and this can lead to judgmental attitudes.
The nurse questions a physicians order to administer a placebo to the patient. The
nurses action is based on which ethical principle?
a.Autonomy
b.Beneficence
c.Justice
d.Fidelity
ANS: A
Autonomy refers to the freedom to make decisions free of external control. In this case,
the nurse questions the physicians order for a placebo because it supports the patients
autonomy. Although beneficence, taking a positive action for others, has implications
here, it is not the primary operating principle. Justice refers to fairness and is most often
, used in discussions about access to health care resources. Fidelity refers to the
agreement to keep promises.
The nurse finds it difficult to care for a patient whose advance directive states that no
extraordinary resuscitation measures should be taken. Which step may help the nurse
to find resolution in this assignment?
a.Call for an ethical committee consult.
b.Decline the assignment on religious grounds.
c.Scrutinize her own personal values.
d.Convince the family to challenge the directive.
ANS: C
Values develop over time and are influenced by family, schools, religious traditions, and
life experiences. The nurse must recognize that no two humans have the same set of
experiences, and so differences in values are more likely the norm than the exception.
Closer inspection of ones values may be a step in gaining understanding of another
persons perspective. Calling for a consult, declining the assignment, and convincing the
family to challenge the patients directive are not ideal resolutions because they do not
address the reason for the nurses discomfort, which is the conflict between the nurses
values and those of the patient.
The nurse values autonomy above all other principles. Which patient assignment will
the nurse find most difficult to accept?
a.Teenager in labor who requests epidural anesthesia
b.Middle-aged father of three with an advance directive declining life support
c.Elderly patient who requires dialysis
d.Family elder who is making the decisions for a 30-year-old female member
ANS: D
Autonomy refers to freedom from external control. A person who values autonomy
highly may find it difficult to accept situations where the patient is not the primary
decision maker regarding his or her care. A teenager requesting an epidural, a father
with an advanced directive, and an elderly patient requiring dialysis all describe a
patient or family that can make their own decisions and choices regarding care.
Which philosophy of health care ethics would be particularly useful when making ethical
decisions about vulnerable populations?
a.Feminist ethics
b.Deontology
c.Bioethics
d.Utilitarianism
ANS: A
Feminist ethics particularly focuses on the nature of relationships, especially those
where there is a power imbalance or a point of view that is not routinely accepted.
Examples of populations that are considered vulnerable include children, pregnant
women, incarcerated persons, and minority groups. Deontology refers to making
decisions or right-making characteristics, bioethics focuses on consensus building, and
utilitarianism speaks to the greatest good for the greatest number.
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