Chapter 022

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

Chapter 22: Ethics and Values

MULTIPLE CHOICE

1. The client states that she needs to exercise regularly, watch her weight, and reduce her fatintake. This demonstrates that the client:1. Values health promotion activities2. Believes she will not become sick3. Believes she will have a heart attack 4. Has unrealistic expectations for herself

ANS: 1A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. The client is expressing her value of health promotion activities. A belief is a conviction of the truth or reality of a thing. The client does not state she believes these health promotion activities will keep her from becoming sick. A belief is a conviction of the truth of a thing. The client’s statement does not indicate she believes she will have a heart attack. These are not unrealistic expectations.

DIF: A REF: 315 OBJ: ComprehensionTOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

2. A client has actively picketed for gun control. During a robbery of his business, he was shot in the leg. As the nurse assists him with morning care, which statement would the nurse expect him to make that coincides with his values?1. “Firearms may have a place in our society.”2. “Individuals should arm themselves for protection.”3. “Prosecution should be the maximum for that felon.”4. “Protection is a necessary evil for the good guy of the world.”

ANS: 3Individual experience influences what we come to value. The client who experienced a gunshot during a robbery of his business may value gun control and verbalize a desire to have his attacker prosecuted for the violent crime. The client who has picketed for gun control and who was gunshot is unlikely to value firearms in our society. The individual who has actively picketed for gun control is unlikely to desire the use of guns. The individual would be more likely to believe that if there were gun control, there would be no need for guns. The individual who has actively picketed for gun control is unlikely to desire the use of guns. The individual would be more likely to believe that if there were gun control, there would be no need for guns.


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Test Bank

3. A secondary school teacher with advanced multiple sclerosis insists on teaching from a wheelchair and being treated the same as other colleagues. The teacher is demonstrating which of the following?1. Prizing her choice2. Choosing from alternatives3. Considering all consequences4. Acting with a pattern of consistency

ANS: 1The teacher is demonstrating prizing her choice. She cherishes her choice of being treatedlike everyone else despite her medical condition and publicly affirms the choice by teaching from a wheelchair and insisting she be treated the same as her colleagues. At thispoint, the teacher is not choosing from alternatives. She could have chosen to quit teaching, but she did not. She has already made her choice. The teacher is not demonstrating considering all consequences. She has already made her choice. At this point, the teacher is not demonstrating acting with a pattern of consistency. She is not repeating a behavior.


4. The nurse recognizes that values clarification interventions are beneficial for the client when:1. The client and nurse have different beliefs2. The client is experiencing a values conflict3. The nurse is unsure of a client’s personal values4. The client has chosen to reject the normal values

ANS: 2Values clarification can help clients gain an awareness of personal priorities, identify ambiguities in values, and resolve major conflicts between values and behavior. Values clarification for nurses can help nurses strengthen their ability to advocate for a client because nurses are better able to identify personal values and accurately identify the values of the client. Values clarification is not necessarily beneficial for the client when the client and nurse have different beliefs. Values clarification for the client will not necessarily help the nurse who is unsure of the client’s values. Values clarification interventions for the client will help the client, not the nurse, gain awareness. The values that an individual holds reflect cultural and social influences, relationships, and personal needs. Values vary among people and develop and change over time. Therefore it may be inappropriate to state a client has rejected “normal” values when value systems vary among people. What is considered normal to one person may not be to another.



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5. The nurse is working with the client and trying to clarify the client’s values regarding his care. Which of the following statements reflects an example of the type of response a nurse should use in a values clarification situation?1. “Your questions were pretty blunt.”2. “Tell me what you’re thinking right now.”3. “I’ve felt that way before. I’d be upset, too.”4. “You seem concerned about your tests. Let me explain them.”

ANS: 2“Tell me what you’re thinking right now” is correct. Values clarification is a process of self-discovery in which the nurse should assist the client. The goal of values clarification with a client is effective nurse-client communication. As the client becomes more willing to express problems and feelings, the nurse can better establish an individualized plan of care. The character of a nurse’s response to a client can motivate the client to examine personal thoughts and actions. When the nurse makes a clarifying response, it should be brief and nonjudgmental. “Your questions were pretty blunt” is incorrect. Values clarification is a process of self-discovery in which the nurse should assist the client. The character of a nurse’s response to a client can motivate the client to examine personal thoughts and actions. When the nurse makes a clarifying response, it should be brief and nonjudgmental. The client is being judgmental in this response. “I’ve felt that way before.I’d be upset, too” is incorrect as well. The nurse should not influence the client with his or her own values, even if they are similar. “You seem concerned about your tests. Let meexplain them” is also incorrect. This statement is therapeutic in that it is reflective of a client’s feeling, and offers information. However, it does not encourage the client to examine their values.


6. A nurse’s use of ethical responsibility can best be seen in which of the following nursing actions?1. Delivery of competent care2. Formation of interpersonal relationships3. Correct application of the nursing process4. Evaluation of new computerized technologies

ANS: 1The term responsibility refers to the characteristics of reliability and dependability. In professional nursing, responsibility includes a duty to perform actions well and thoughtfully. When the nurse provides competent care, the nurse is demonstrating ethical responsibility. Formation of interpersonal relationships is not an ethical responsibility. Application of the nursing process is not an ethical responsibility. Evaluation of new computerized technologies is not an ethical responsibility.

DIF: A REF: 314-315 OBJ: Comprehension


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TOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

7. A nursing student that immediately informs her clinical instructor after she realizes that she has administered the wrong dose of medication to a patient is best described professionally as:1. Confident2. Trustworthy3. Compliant4. Accountable

ANS: 4Accountability refers to the ability to answer for one’s own actions. The goal is the prevention of injury to the client. The student nurse who informs her instructor of an erroris being accountable for her actions and has a goal to prevent injury to the client. The student nurse would not be described professionally as confident (i.e., sure of oneself). The student is not best described as trustworthy. To be trustworthy, one is worthy of trust or confidence and reliable. In this case, the student was not reliable to administer medication correctly. This student nurse is not best described professionally as compliant.The student is not acting in accordance with wishes, commands, or requirements.


8. A client who is recently diagnosed with cancer is encouraged to consider sharing the information with her family so they can support her through the decisions she will need to make regarding her care. The nurse is using the principle of:1. Confidentiality2. Fidelity3. Veracity4. Justice

ANS: 3Veracity in general means accuracy or conformity to truth. The nurse is encouraging the client to be truthful with the client’s family. Confidentiality means to not impart private matters. Fidelity refers to the agreement to keep promises. Justice refers to fairness.

DIF: A OBJ: ComprehensionTOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

9. The correct sequence for attaining the resolution of an ethical problem is:1. Examine values, evaluate, and identify the problem2. Evaluate the outcomes, gather data, and consider actions3. Gather facts, verbalize the problem, and consider actions4. Recognize the dilemma, evaluate, and gather information


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ANS: 3The correct sequence for resolving ethical problems is recognizing the dilemma, gathering facts, examining one’s own values, verbalizing the problem, considering actions, negotiating the outcome, and evaluating the action.


10. A nurse is ambivalent as to the need to vigorously suction the secretions of a terminal client in a comatose state. Which of the following is an appropriate statement by the nurse in regard to processing an ethical dilemma?1. “I just feel like I should not suction this client.”2. “I need to know the legalities of the living will of this client.”3. “I cannot figure out what’s right in this situation. I need to collect more data.” 4. “My spiritual beliefs mandate that I continue to provide all the interventions in my

scope of practice.”

ANS: 3The first step in processing an ethical dilemma is determining whether the problem is an ethical one. The nurse who cannot figure out what is right, is stating a characteristic of an ethical dilemma, which is that the problem is perplexing. The next step is to gather as much information as possible that is relevant to the case. “I just feel like I should not suction this client” is the nurse is stating the problem according to her feelings. “I need toknow the legalities of the living will of this client” is the nurse who wants to know the legalities of the living will of a client is collecting some, but not all, data pertaining to theproblem. “My spiritual beliefs mandate that I continue to provide all the interventions in my scope of practice” is the nurse stating her own beliefs.

DIF: A REF: 316-317 OBJ: ComprehensionTOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

11. Which of the following statements best illustrates the deontological ethical theory?1. “I believe this disease was allowed by a supreme being.”2. “He has become a stronger individual through experiencing the loss of his father.”3. “Under no circumstances would it ever be right for a person to stop CPR efforts.”4. “The chemotherapy did not cure this person, but it provided a better life for him.”

ANS: 3


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“Under no circumstances would it ever be right for a person to stop CPR efforts” is correct. Deontology defines actions as right or wrong based on their right-making characteristics, such as fidelity to promises, truthfulness, and justice. Deontology does not look at consequences of actions to determine rightness or wrongness. Fidelity to promises and beneficence may be principles upon which this statement is based on determining wrongness. “I believe this disease was allowed by a supreme being” does notreflect the deontological ethical theory. Because it reflects a relationship between disease and a supreme being, it follows the feminist ethical theory. “He has become a stronger individual through experiencing the loss of his father” does not best illustrate the deontological ethical theory because it is citing a consequence. It follows the utilitarian ethical theory. “The chemotherapy did not cure this person, but it provided a better life for him” does not best illustrate the deontological ethical theory because it is citing a consequence. It follows the utilitarian ethical theory.


12. On admission to the hospital, a terminal cancer patient says he has a living will. This document functions to state the client’s desire to:1. Receive all technical assistance to prolong his life2. Have his wife make the decisions regarding his care3. Be allowed to die without life-prolonging techniques4. Have a lethal injection administered to relieve his suffering

ANS: 3A living will is an advance directive, prepared when the individual is competent and able to make decisions, regarding that person’s specific instructions about end-of-life care. Living wills allow people to specify whether they would want to be intubated, treated with pressor drugs, shocked with electricity, and fed or hydrated intravenously. A living will specifies what interventions the client does not want, so that his or her life will not beprolonged. If his wife has power of attorney she would be able to make decisions regarding the client’s care. Assisted suicide, such as a lethal injection, is not a function of a living will. A living will defines a client’s wishes for withholding treatment that would prolong his or her life.


13. At an accident scene a nurse stopped and began to provide emergency care for the victims. Her actions are best labeled ethically as:1. Triage 2. Beneficence3. Nonmaleficence4. Respect for persons


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ANS: 2Beneficence refers to taking positive actions to help others, as in providing emergency care at an accident scene. Triage is the screening and classification of casualties to make optimal use of treatment resources and to maximize the survival and welfare of clients. Nonmaleficence is the avoidance of harm or hurt. Respect for persons has to do with treating people equally despite their social standing, for example.


14. The nurse is aware that an ethics committee in a health care facility serves to:1. Interview all persons involved in a case2. Illustrate circumstances that demonstrate malpractice3. Serve as a resource for specific situations that may occur4. Examine similar previous instances for comparison of outcome decisions

ANS: 3Ethics committees serve as a resource to support the processing of ethical dilemmas. Ethics committees serve several purposes: education, policy recommendation, and case consultation or review. Although an ethics committee may gather further information, ethics committees do not interview all persons involved in a case. Rather, they offer consultation or case review. Illustrating circumstances that demonstrate malpractice is nota purpose of an ethics committee. Examining similar previous instances for comparison of outcome decisions may be part of data gathering to help process an ethical dilemma or for policy recommendation, but it is not the purpose of an ethics committee.


15. In the emergency department a client feels that she has been waiting longer than the otherindividuals due to the fact that she has no insurance. The ethical principle that is involvedin this exact situation is:1. Justice2. Autonomy3. Beneficence4. Nonmaleficence

ANS: 1Justice refers to treating people fairly. Allocation of resources and access to health care involves the ethical principle of justice. The client without medical insurance should not have to wait longer to receive health care than those with insurance. Autonomy refers to aperson’s independence. Autonomy represents an agreement to respect another’s right to determine a course of action. Beneficence refers to taking positive actions to help others. Nonmaleficence refers to the avoidance of harm or hurt.


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16. Regarding the nurse’s use of the specific ethical principle of autonomy in a client situation, an example would be:1. Learning to do a procedure safely and effectively2. Returning to speak to a client at an agreed upon time3. Preparing the client’s room for comfort and privacy4. Supporting a client’s right to refuse a specific type of therapy

ANS: 4Following the ethical principle of autonomy, the nurse allows a client to make his or her own decisions regarding care and then supports that decision. Learning how to perform a procedure safely and effectively is a nurse’s use of ethical responsibility. Returning to speak to a client at an agreed upon time demonstrates the ethical principle of fidelity. Preparing the client’s room for comfort and privacy is a nurse’s use of ethical responsibility.


17. Which of the following statements reflects application of the specific ethical principle of confidentiality?1. “I’m concerned that funding may affect the outpatient program.”2. “I’m going to make sure that the client understands the instructions.”3. “I cannot share that information with you about the client’s condition.”4. “I need to get more information about the client’s personal health history.”

ANS: 3“I cannot share that information with you about the client’s condition” reflects the application of the ethical principle of confidentiality. Information is not to be shared with others without specific client consent. “I’m concerned that funding may affect the outpatient program” reflects a concern regarding allocation of resources. It is not a confidentiality issue. The nurse who makes sure a client has gained understanding is being ethically responsible. “I need to get more information about the client’s personal health history” reflects data gathering. Information gathered is to be used for the purpose of providing competent health care. It should not be shared with others without specific consent of the client.



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18. The client has been diagnosed with malignant bone cancer and the treatment involves chemotherapy on an outpatient basis. While treating the cancer the client unfortunately becomes very ill, experiences significant side effects from the therapy, and has a severe reduction in the quality of life. The specific ethical principle that is in question in this situation is:1. Veracity2. Fidelity3. Justice4. Nonmaleficence

ANS: 4Nonmaleficence is the avoidance of harm or hurt. Whether the discomforts of treatment are benefiting the client or are worse than the disease itself have to be considered. The health care professional tries to balance the risks and benefits of a plan of care while striving to do the least harm possible. Veracity refers to truthfulness. This situation is not questioning truthfulness. Fidelity refers to the agreement to keep promises. This situation does not question fidelity. Justice refers to fairness. This situation is not a matter of justice.


19. Which of the following statements best reflects the nurse’s ethical concern for nonmaleficence regarding the client’s treatment plan?1. “The radiation therapy has not substantially decreased the client’s tumor related

pain.”2. “The client expressed the idea that this treatment was definitively going to cure her

cancer:3. “The client’s family requested that she not be informed of the seriousness of her

cardiac condition.”4. “The procedure is quite invasive, and there is little chance that it will improve the

client’s quality of life.”

ANS: 4Nonmaleficence is the avoidance of harm or hurt. Whether the discomforts of treatment are benefiting the client or are worse than the disease itself have to be considered. The health care professional tries to balance the risks and benefits of a plan of care while striving to do the least harm possible. The remaining options are related to veracity (truthfulness), fidelity (keeping a promise), and possibly fairness.

DIF: A REF: 314 OBJ: AnalysisTOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

20. Which of the following statements related to confidentiality made by a nurse requires immediate follow-up by the nurse manager?


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1. “I believe the client is eligible for both Medicare and Medicaid.”2. “The client with pneumonia has tested positive for TB (tuberculosis).”3. “Did you know that the client in Room 45 has a daughter who has type 1 diabetes

mellitus?”4. “I arranged for the client’s information to be faxed to the assistive living facility

she will be transferred to.”

ANS: 3This information is private and the nurse is violating the client’s right to confidentiality because the information has no bearing on the care needs of the client. The remaining options are not reflective of an ethical breech because the exchange of that information has a direct bearing on the client’s care.

DIF: C REF: 315 OBJ: AnalysisTOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

21. Which of the following nursing actions best reflects a nurse’s commitment to the ethical principle of fostering autonomy regarding an older client living in an extended care facility?1. Providing options regarding the furniture arrangement of the client’s room2. Supporting a client’s decision to adopt a DNR (do not resuscitate) status3. Allowing sufficient time for the client to independently accomplish morning

hygiene4. Consulting the client regarding personal preferences regarding treatment options

ANS: 2Following the ethical principle of autonomy, the nurse facilitates a client’s decision-making process in order to make their own decisions regarding all aspects of life, including their care, and then supports those decisions. The most important and possibly controversial decision is that of DNR status and thus shows the greatest commitment on the nurse’s part.


22. Which of the following statements made by a terminally ill client reflects the best understanding of the purpose of a living will?1. “It will make sure my wishes are respected.”2. “My family won’t be burdened with making those hard decisions.”3. “I don’t want strangers making those kinds of decisions for me.” 4. “I can make my wishes known while I still have the ability to express them.”

ANS: 4A living will is an advance directive, prepared when the individual is competent and able to make and communicate personal decisions, regarding specific instructions about end-of-life care. The remaining options represent motivation for implementing a living will.


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DIF: C REF: Chapter 23, 328 OBJ: AnalysisTOP: Nursing Process: EvaluationMSC: NCLEX® test plan designation: Safe, Effective Care Environment

23. The nurse is showing respect for a client’s right to autonomy regarding an invasive procedure by:1. Obtaining consent for the procedure2. Performing the procedure appropriately3. Providing client education regarding the procedure4. Being frank when discussing the pros and cons of the procedure

ANS: 1The signed consent ensures that the nurse obtained the client’s permission before proceeding with the procedure. The remaining options are examples of nonmaleficence, client right to be informed, and veracity.


24. The nurse holds a client’s hand during a painful procedure. This action shows a positive act towards the client that is referred to as: 1. Veracity 2. Fidelity3. Beneficence4. Nonmaleficence

ANS: 3Beneficence refers to taking positive actions to help others. The practice of beneficence encourages the urge to do good for others. The agreement to act with beneficence also requires that the best interests of the client remain more important than self-interest. The remaining options reflect truthfulness, keeping true to a promise, and doing no harm.


25. When a nurse considers the possible positive effect a treatment will have against the pain it may cause the client, the nurse is displaying:1. Justice2. Fidelity3. Beneficence4. Nonmaleficence

ANS: 4


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Nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good but also the equal commitment to do no harm. The remainingoptions refer to fairness, truthfulness, and kindness.


26. When a client who is in need of a lung transplant is placed on the organ donor registry according to his current health needs, this is an example of ethical:1. Justice2. Fidelity3. Beneficence4. Nonmaleficence

ANS: 1Health care providers agree to strive for fairness in health care. Criteria set by a national multidisciplinary committee make every effort to ensure justice by ranking client organ recipients according to need. The remaining options refer to keeping a promise, kindness,and doing no harm.


27. Abandoning a client would be an example of a nurse’s failure to professionally display: 1. Justice2. Fidelity3. Beneficence4. Nonmaleficence

ANS: 2Fidelity refers to the agreement to keep promises. A commitment to fidelity supports the reluctance to abandon clients. The remaining options refer to fairness, kindness, and doing no harm.


28. The nursing professional code of ethics is best defined as:1. The criteria for judging nursing professionalism 2. A benchmark for professional nursing deeds and actions3. The nursing profession’s expectations of its members’ behavior4. A document that holds nurses responsible for professional behavior

ANS: 3


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It is a collective statement about the group’s expectations and standards of behavior. The remaining options are not accurate or complete descriptions of the nursing professional code of ethics.


29. The nurse has successfully completed a distance learning class on ECG (electrocardiogram) interpretation. This is an example of the nurse exhibiting the professional principle of:1. Advocacy2. Responsibility3. Accountability4. Confidentiality

ANS: 2The word responsibility refers to a willingness to respect obligations and to follow through on promises. The nurse has a responsibility to remain competent to practice so that he or she is able to reliably follow through on responsibilities. The remaining optionsare reflective of other professional principles.i


30. The nurse is explaining the rationale for seeking the family’s permission to apply a physical restraint to a combative client. This is an example of the nurse exhibiting the professional principle of:1. Advocacy2. Responsibility3. Accountability4. Confidentiality

ANS: 3Accountability refers to the ability to answer for one’s own actions. Nurses should ensurethat their professional actions are explainable to their clients and to their employer. The remaining options are reflective of other professional principles.


31. The nurse realizes that sharing one’s computer password is a violation of which of the professional nursing principles?1. Advocacy2. Responsibility


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3. Accountability4. Confidentiality

ANS: 4When medical records are computerized, computer security measures include special access codes for all authorized users; sharing private passwords is a breech of client confidentiality because it allows unauthorized individuals to access client information. The remaining options are reflective of other professional principles.


32. The belief that all life is sacred and must be preserved regardless of the quality of that lifeis an example of: 1. Cultural bias2. Personal value3. Universal truth4. Individual preference

ANS: 2A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. A cultural bias refers to interpreting and judging phenomena in terms particular to one’s own culture while a universal truth is so overwhelmingly true that all mankind respects and acknowledges the validity of the statement. An individual preference is a personal choice.


33. The nurse realizes that an individual client’s value system is most affected by:1. Life experiences2. Economic status3. Spiritual beliefs4. Formal education

ANS: 1Development of values begins in childhood, shaped by experiences within the family unit, especially dramatic events during the formative years. The other options may influence the value system, but not to the same extent.


34. An older client is experiencing the greatest problem with the concept of autonomy when he has difficulty:


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1. Expressing his need for pain medication2. Disagreeing with his health care provider3. Participating in discussions regarding his treatment4. Discussing his need for assistive living arrangements

ANS: 2Older people are usually not as familiar with the concept of autonomy as people from younger generations. As a result, older adults are sometimes uncomfortable disagreeing with doctors or nurses. They view assertiveness as a violation of trust. The remaining options reflect autonomy problems but management of personal health issues is the most important issue.


MULTIPLE RESPONSE

1. Which of the following elements are essential among a group working towards the successful resolution of a conflict of opinion? (Select all that apply.) 1. Similar value systems 2. Presumption of good will3. Similar cultural background 4. Client-centered decision making5. Strict adherence to confidentiality6. Participation of all involved parties

ANS: 2, 4, 5, 6The resolution of conflicting opinions works best when the following elements are part ofthe process: the presumption of good will on the part of all participants, strict adherence to confidentiality, client-centered decision making, and the welcome participation of families and primary caregivers. The remaining options represent group characteristics that usually minimize conflict in decision making.


2. Although the American Nurses Association’s (ANA’s) code of ethics is reviewed and revised regularly to reflect changes in nursing practice, the basic principles that remain constant are: (Select all that apply)1. Advocacy2. Reliability 3. Responsibility4. Accountability5. Confidentiality6. Professionalism


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ANS: 1, 3, 4, 5The American Nurses Association (ANA) established the first code of nursing ethics decades ago. The ANA reviews and revises the Code regularly to reflect changes in practice. Basic principles remain constant; however, responsibility, accountability, advocacy, and confidentiality. Although admirable, the remaining options are not considered core principles of the code.


3. The nurse knows that when making choices concerning the adoption of evidence-based practice, the literature must be reviewed regarding its: (Select all that apply)1. Content2. Relevance 3. Reliability4. Ethical soundness5. Economic feasibility6. Transcultural versatility

ANS: 1, 2, 3, 4Nurses make choices regarding evidence-based practice proposals based on content, relevance, reliability, and the ethical implications to their practice. The remaining options are not typically considered when evaluating the global usefulness of research findings.



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Chapter 022

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