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Hill Howlett Chapt 19 Ethics Applied in Nursing

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Autonomy
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Beneficence
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Beneficent Paternalism
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Ethics
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Fidelity
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Justice
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Morals
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Nonmalficience
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Nursing ethics
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Privacy
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Values
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The nurse states, “I like being part of the health care team caring for the traditional two-parent family during the postpartum period as they bond with their newborn.” This statement reveals the nurse’s 1. values. 3. fidelity. 2. duty. 4. ethics.
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1.values. Values involve the worth assigned to an idea or action. In this statement the nurse reveals that she values the traditional two-parent family. The statement does not clearly address any of the other options.
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A student nurse asks, “What’s the difference between laws and ethics?” Which response best explains the difference between nursing laws and ethics? 1. “Ethics refer to ideal behavior of nurses, but laws require mandatory observance by nurses.” 2. “Nursing ethics are formalized by statutes, whereas laws are permissive codes.” 3. “Ethics are derived from laws, whereas laws are enacted by non-nurse legislators.” 4. “Ethics are specific to individual agencies, but laws are state specific.”
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1.”Ethics refer to ideal behavior of nurses, but laws require mandatory observance by nurses.” Ethics refers to behaviors nurses “ought” to observe. Laws refers to statutes that must be observed. None of the other options state this.
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The nurse providing care for patients/residents must act on the knowledge that a basic right of patients/residents is to receive 1. considerate and respectful care from all care providers. 2. information about diagnosis and prognosis from the practical nurse. 3. medical care of their choice regardless of ability to pay. 4. any food requested and in as large a quantity as desired.
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1.considerate and respectful care from all care providers. The individual rights of patients are an important ethical theme in health care. It is imperative that nurses separate personal ethics from nursing ethics and provide appropriate care to patients regardless of whether the nurse likes or dislikes the patient and regardless of the nurse’s values relating to the patient’s lifestyle, ethnicity, or other factors. Option 2 is not considered a right that is met by the LPN/LVN. Options 3 and 4 are not rights.
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A major change in medical ethics that affected nursing occurred when the Western secular belief system shifted emphasis from duties to 1. individual autonomy and rights. 3. cost-effectiveness of care. 2. satisfying Medicare regulations. 4. nonmaleficence.
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1.individual autonomy and rights. Freedom of choice (autonomy) and the ability to assert one’s individual rights have become the major operative beliefs of the Western secular belief system affecting medical ethics today. These beliefs, in turn, affect the way nurses interact with patients. Options 2 and 3 are not aspects of the Western secular belief system. Option 4 is an ethical principle that has always been important in medical ethics.
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The patient asks the nurse, “I overheard the instructor talking to a student about accountability. What does the word accountability really mean?” The best response by the nurse would be, “It is 1. a transfer of responsibility for wrong actions.” 2. shared responsibility with the physician for wrongdoing.” 3. personal responsibility for one’s nursing actions.” 4. giving up responsibility when the situation dictates.”
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3.personal responsibility for one’s nursing actions.” Accountability means that one is personally answerable for specific actions. The other options do not accurately explain accountability.
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When a student nurse prepares diligently for a clinical assignment, the ethical principle being observed is 1. autonomy. 3. nonmaleficence. 2. justice. 4. fear of punishment.
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3.nonmaleficence. Being prepared to provide skillful nursing care, anticipating problems that may occur, and thinking through alternative solutions qualifies as observing the principle of doing no harm. Options 1 and 2 are not principles that apply. Option 4 is not an ethical principle.
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Encouraging a patient to be involved in planning and carrying out their own care is a nursing action that supports the ethical principle of 1. confidentiality. 3. autonomy. 2. privacy. 4. justice.
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3.autonomy. Autonomy means being free to choose. Possible patient choices include identifying goals and care measures compatible with one’s culture, religion, and personal values.
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Leaving an unconscious patient exposed during a treatment or procedure is a violation of the ethical principle of 1. fidelity. 3. justice. 2. autonomy. 4. veracity.
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2.autonomy. Autonomy includes the patient’s right to privacy. It is assumed that an autonomous patient would reject unnecessary exposure of their body.
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When a treatment team decides to go to court to obtain permission to provide chemotherapy for a child whose parents refuse to give consent for the treatment based on religious grounds, the ethical principles that are in conflict are 1. fidelity and justice. 3. justice and beneficence. 2. beneficence and autonomy. 4. autonomy and fidelity.
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4.autonomy and fidelity. The parents’ autonomy to make decisions for their child is in conflict with the beneficence of the health care team. The other principles are not relevant to the scenario.
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A way of practicing fidelity to a patient would be to 1. discuss the patient with friends at a social gathering. 2. document the patient’s expression of feelings and wishes. 3. categorize the patient as a “down-and-out alcoholic.” 4. develop the care plan without patient input.
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2.document the patient’s expression of feelings and wishes. The nurse who documents the patient’s expression of feelings or wishes without subjective interpretation is demonstrating fidelity (being true) to the patient. The other options demonstrate lack of fidelity.
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To provide justice to patients on the unit, the nurse must 1.give all patients with the same diagnosis the same level of care. 2.treat all patients with equal dignity and respect. 3.base care on patient culture, religion, and social status. 4.determine who is most deserving of extra care.
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2.treat all patients with equal dignity and respect. Being fair does not mean giving every patient the same thing. It means treating them the same, e.g., with dignity and respect. Options 3 and 4 would result in providing care based on subjective criteria.
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The patient asks the nurse what he should do about continuing cancer treatment. The nurse responds, “You should stop before you get so weak you can’t enjoy a few good weeks with your family.” This is an example of 1.fidelity. 3.nonmaleficence. 2.beneficence. 4.beneficent paternalism.
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4.beneficent paternalism. This response assumes the nurse knows what is right for the patient and robs the patient of decision making. It discounts the patient’s knowledge of self. The scenario does not describe the other ethical principles listed as options.
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What ethical principle underlies the statement in the National Federation of Licensed Practical Nurses (NFLPN) Code for Licensed Practical/Vocational Nurses, “The practical nurse provides health care to all patients regardless of race, creed, cultural background, disease, or lifestyle”? 1.autonomy 3.beneficence 2.confidentiality 4.justice
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4.justice Justice means treating all patients fairly according to their needs, e.g., with dignity and respect. The other principles listed in the options do not fit the scenario.
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A nurse injects himself or herself with a narcotic prescribed for a patient. This is an example of 1.unethical and illegal behavior. 2.ethical and legal behavior. 3.unethical but legal behavior. 4.ethical but illegal behavior.
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1.unethical and illegal behavior. It is unethical because the nurse has the ethical obligation to place the patient’s needs above his or her own. It is illegal to use a narcotic prescribed for another person.
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A student nurse is assigned to care for a patient with complex nursing care needs. The student was busy and did not prepare in advance for the assignment. In preconference, the student is unable to describe the care to be given, and admits not knowing how to execute one of the treatments. The instructor would be ethically justified in 1.telling the student to be very careful during caregiving. 2.sending the student home and turning the patient’s care over to staff. 3.suspending the student. 4.dismissing the student from the program.
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2.sending the student home and turning the patient’s care over to staff. Nonmaleficence is the operative ethical principle. The student is ethically obligated to provide safe care to assigned patients. The instructor is also obligated to do no harm. Option 2 is a safe alternative to allowing the student to care for the patient. Options 3 and 4 do not permit the student to have due process.
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Which situation can be identified as abandonment of patients by the nurse? 1.calling in sick 2.floating to a unit after a 2-day orientation to the unit 3.starting to care for patients on wing A & being reassigned to wing B 4.going off duty without giving report rather than care for patients on an unfamiliar unit
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4.going off duty without giving report rather than care for patients on an unfamiliar unit The nurse cannot leave a unit unless able to turn the care of patients over to a qualified nurse.
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A system of standards or moral principles that direct actions as being right or wrong is ____________________.
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ANS: ethics Ethics is a system of standards or moral principles that direct actions as being right or wrong. Ethics is concerned with the meaning of words such as right, wrong, good, bad, ought, and duty.
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The nurse is asked to explain the meaning of ethics to a patient. The nurse should correctly state, “Ethics is a system of standards that refer to ideas and actions in terms of being (Select all that apply) 1.right and wrong.” 2.moral and immoral.” 3.legal and illegal.” 4.good and bad.” 5.ought and ought not.” 6.like and dislike.” 7.rights and duties.”
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1.right and wrong.” 2.moral and immoral.” 4.good and bad.” 5.ought and ought not.” 7.rights and duties.” Ethics is concerned will all of the above with the exception of options 3 and 6. Ethics and legalities are not the entirely the same, although some ethical principles may be enacted into law (option 3.). Option 6 refers to values.
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The introduction of nursing process and critical thinking into nursing practice has resulted in increased ethical and legal responsibilities for nurses in the areas of (Select all that apply) 1.peer reporting. 2.accountability. 3.personal ethics. 4.patient advocacy. 5.cost containment.
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1.peer reporting. 2.accountability. 4.patient advocacy. Peer monitoring and reporting are essential to patient safety and professional integrity. Accountability means being held accountable for all nursing actions performed. Since the scope of practice has expanded, nursing accountability is greater. Patient advocacy requires the nurse to provide more information to patients. Options 3 and 5 are not included as areas of increased ethical and legal responsibility.
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What actions should be taken by the nurse to increase the possibility of doing no harm while caring for a patient? (Select all that apply.) 1.Never participate in any action that will deliberately harm the patient. 2.Question how to do the least amount of harm when doing something that is expected to result in good. 3.Make sure the patient has agreed to the procedure verbally or in writing. 4.Perform new procedures without seeking supervision. 5.Become aware of side effects of commonly administered medications
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1.Never participate in any action that will deliberately harm the patient. 2.Question how to do the least amount of harm when doing something that is expected to result in good. 3.Make sure the patient has agreed to the procedure verbally or in writing. 5.Become aware of side effects of commonly administered medications Each of these measures will increase the potential for nonmaleficence in practice. Option 4 has an increased potential for doing harm.
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Which nursing actions are examples of use of the ethical principle of beneficence? The LPN/LVN (select all that apply) 1.tells a patient to ask for a second doctor’s opinion. 2.provides emotional support when the patient cries. 3.places the bed in a low position before leaving the room. 4.places medication the patient brought from home at the nurses’ station. 5.provides report for the staff of the oncoming shift.
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2.provides emotional support when the patient cries. 3.places the bed in a low position before leaving the room. 4.places medication the patient brought from home at the nurses’ station. Beneficence means to do good (option 2). It also involves preventing harm (option 3), removing harm (option 4), and putting patient interests first (option 5).
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Which statement or statements would the nurse evaluate as suggesting that the patient’s decision has not been autonomous? 1.”I wish I knew for sure that I had all the facts about the treatment.” 2.”I thought through all the alternatives.” 3.”My son told me emphatically what he thought would be best for the family.” 4.”I am going to refuse to take the treatment because it will prolong life.”
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1.”I wish I knew for sure that I had all the facts about the treatment.” 3.”My son told me emphatically what he thought would be best for the family.” Autonomy means being free to choose. Option 1 suggests that the patient may not have had all the relevant facts. Option 3 suggests undue influence from the family. Option 2, thinking through all the facts, is part of autonomous decision making, as is option 4, acting on one’s personal decision.