Question 1

The nurse manager has identified high levels of moral distress on the nursing unit. Which change would be helpful in assisting nurses to cope?
A) Relieving the nurses from service on ethics committees
B) Increasing compensation for overtime hours worked
C) Sending nurses home when they exhibit signs of moral distress
D) Encouraging free discussion of ethical concerns

Accepted Answer

Rationale 1: Allowing nurses to serve on ethics committees gives the group active participation in the issues.
Rationale 2: While everyone likes to be adequately compensated for work done, simply raising the rate of pay without addressing the causative factors will not have a positive impact on moral distress.
Rationale 3: Sending nurses home may increase their personal stress and will likely increase stress on nurses left to care for more patients to cover.
Rationale 4: Open communications assists nurses in dealing with moral distress.

Question 2

A nurse manager has started a dialogue regarding the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements among staff nurses. Which staff nurse statements would the manager evaluate as indicating poor understanding of this document?
A) "This document describes nursing's own understanding of its commitments to society."
B) "This document is so out of date, they never revise it."
C) "At least the ANA understood that professional ethics are different in different regions of the country."
D) "It is interesting that the ANA first addressed this code over 50 years ago."
E) "This document has established standards by which we should practice."

Accepted Answer

Rationale 1: The ANA's Code of Ethics for Nurses with Interpretive Statements is an expression of nursing's own understanding of its commitments to society.
Rationale 2: The document has been revised, most recently in 2001.
Rationale 3: The statements in the document are inclusive of all nurses and do not change according to region.
Rationale 4: This document was first published in 1950, well over 50 years ago.
Rationale 5: This document gives direction for those entering the nursing profession about their ethical accountability, sets a nursing standard for ethical practice, and informs the consumer about nursing's ethical standards.

Question 3

The patient who has been diagnosed with metastatic cancer declines chemotherapy treatments. The nurse assists this patient in explaining this position to other health care providers. What advocacy model is this nurse exemplifying?
A) Patient advocate model
B) Values-based decision model
C) Rights protection model
D) Jurisprudence model

Accepted Answer

Rationale 1: The patient advocate model is also known as the respect for persons model and focuses on inherent human dignity and respect. This model is not as specific as the other models.
Rationale 2: In the values-based decision model, the nurse assists the patient by discussing his or her needs and desires and helps the patient make choices that are most consistent with those wishes.
Rationale 3: The rights protection model is also known as the autonomy model, in which nurses assist patients in asserting their autonomy rights. In this situation the nurse is advocating for the patient's right to direct care and to make care decisions.
Rationale 4: The jurisprudence model is not an advocacy model.

Question 4

Nurses are revising the policy and procedure manual for the nursing unit. They work to ensure that the policies address more than one person and more than one set of circumstances. Which aspect of policy does this reflect?
A) Generality
B) Scale
C) Normativity
D) Decision determination

Accepted Answer

Rationale 1: A policy has generality when it addresses more than one person and more than one set of circumstances.
Rationale 2: A policy has scale in that policies apply at different levels of an organization or society, and policies at one level can supersede policies at lesser levels.
Rationale 3: A policy has normativity when it formalizes judgments about what course of action is better among alternatives and the rules under which those alternatives will be determined.
Rationale 4: Decision determination is not an aspect of policy.

Question 5

Nurses believe that there is a need to change policy for their clinical unit. What is the first step these nurses should take when considering this need for new policy?
A) Determining how many people are affected by the policy
B) Identifying the problem
C) Looking for ethical arguments regarding the policy
D) Finding out who has authority to change the policy

Accepted Answer

Rationale 1: There are steps that are necessary before determining how many people will be affected by the policy.
Rationale 2: Changing and writing policy is a thoughtful and methodical process that should follow a distinct framework. The first step of this framework is identifying the problem.
Rationale 3: Determining the ethical arguments involved in the policy or policy change is important, but this is not the first step.
Rationale 4: It will be very important for these nurses to determine who has the authority to change the policy, but this is not their first step.

Question 6

The nurse believes that a physician's order written at the end of a shift is contrary to the accepted standard of care and could potentially harm the patient. What should the nurse do?
A) Ask the nurse manager what to do.
B) Question the physician regarding the order.
C) Let the next shift make the decision regarding implementation of the order.
D) Complete the order as directed.

Accepted Answer

Rationale 1: The nurse should not have to rely on the nurse manager for direction in this situation. The nurse might inform the manager of the situation and the intended action, but would not need to ask for permission or direction.
Rationale 2: Nurses should be aware of hospital policy and procedures, as well as standards of care. If an order appears to violate either of these types of standards or appears dangerous to the patient, the nurse should question the physician about the order.
Rationale 3: Deferring the implementation to the next shift does not protect patient safety.
Rationale 4: Following orders without question is dangerous for the patient and legally dangerous for the nurse.

Question 7

Unrest on the nursing unit has progressed to moral outrage among the nursing staff. Which statements made by the nurse manager to the chief nursing officer indicates an understanding of this issue?
A) "I am concerned that the quality of care we are providing will reduce if this unrest continues."
B) "We may experience turnover in staff positions if this tension continues."
C) "I think we need to hire some more unlicensed personnel to shift the direct patient care work off the registered nurses."
D) "This will be a good opportunity to get rid of the unit trouble-makers."
E) "I am going to try to divert this energy by asking the nurses to help rewrite the policy and procedures manual."

Accepted Answer

Rationale 1: Moral outrage may cause the nurses to be unable to effectively care for patients.
Rationale 2: Moral outrage on a nursing unit may increase turnover as nurses resign to rid themselves of stress.
Rationale 3: Most nurses get into the profession because they like to care for patients, so asking nurses to stop caring for patients and start managing more unlicensed personnel will not decrease stress.
Rationale 4: When terminations occur, even justified terminations, it increases unit stress. This is not a time to increase stress.
Rationale 5: Moral energy takes maximum energy, so it is not a good time to ask the nurses to take on new responsibilities.

Question 8

In which ways can the nurse best act as a patient advocate?
A) Participate in continuing education offerings pertinent to the current position.
B) Follow all physician orders precisely and completely.
C) Practice with the patient as priority concern.
D) Educate the patient throughout the hospitalization or other nurse-patient contact.
E) Become active in changing outdated policies or procedures.

Accepted Answer

Rationale 1: The nurse must remain aware of acceptable standards of care. One method of remaining current is participating in continuing education offerings.
Rationale 2: The nurse must be vigilant in determining if the physician order is appropriate and safe for the patient. If not, the nurse must use independent nursing judgment to decide on action.
Rationale 3: The patient should always be the nurse's priority concern.
Rationale 4: The nurse should begin education early in the contact with patients and should continue education until discharge.
Rationale 5: The nurse must actively work to change any outdated policy or procedure still being followed by the institution.

Question 9

In nursing school, the student learns that the nurse should always consider the possible outcomes of any nursing action taken. What ethical concept does this consideration support?
A) Slippery slope arguments
B) Perception model
C) Autonomy model
D) Therapeutic jurisprudence

Accepted Answer

Rationale 1: Slippery slope arguments are concerns that one decision may lead to it being taken for granted that other actions are also considered ethical.
Rationale 2: There is not an ethical model titled perception model.
Rationale 3: The autonomy model refers to protecting the patient's rights of self-direction.
Rationale 4: The essence of therapeutic jurisprudence as it applies to nursing is that the nurse should always consider the possible outcomes of any nursing action.

Question 10

The hospital administration asks nursing services to assume housekeeping duties from midnight until 6:00 a.m. Nurses are fearful that this is the first step to shifting complete 24-hour-per-day responsibility for housekeeping duties to nursing services. The nurses believe this would take away from their ability to provide quality nursing care to their patients. This scenario is an example of which ethical concept?
A) The MORAL argument
B) Slippery slope thinking
C) Relevance thinking
D) Reluctance model

Accepted Answer

Rationale 1: MORAL is an ethical decision-making model.
Rationale 2: Slippery slope thinking or arguments suggest that an action will initiate a chain of events that cumulate in an undesirable event later.
Rationale 3: Relevance thinking is not an ethical concept.
Rationale 4: Reluctance model is not an ethical concept.

Question 11

The nurse is providing care for a patient who was just diagnosed with diabetes mellitus. Which statements reflect this nurse's use of the values-based decision model in this situation?
A) "Tell me about what foods are important to your family celebrations."
B) "Let me help you select your lunch menu as I know you are not familiar with your diet yet."
C) "You can make the decision of when you want to take your daily oral medication dose."
D) "I have written down several websites that will provide accurate information about your disease."
E) "Is there anything you want me to talk to your physician about today?"

Accepted Answer

Rationale 1: This statement helps the nurse determine the patient's needs and desires. It will assist the nurse planning education for this patient.
Rationale 2: When the patient is not able to assist in making care decisions the nurse intervenes as an advocate for the patient's best interests. This is an example of the respect for persons model.
Rationale 3: This statement best reflects the rights protection model or autonomy model.
Rationale 4: The values-based decision model is predicated on the sharing or information and assisting the individual to become empowered to speak on his or her own behalf.
Rationale 5: In the values-based decision model the nurse would educate the patient to speak for himself instead of relying on the nurse.

Question 12

The nurse intends to lobby the state legislature to write a new code of ethics for the nurses in the state. Is this an appropriate idea?
A) No, federal lawmakers have jurisdiction over codes of ethics.
B) No, the code of ethics is the product of hospital associations across the nation.
C) No, professional nursing organizations write the code of ethics for nurses.
D) Yes, the code of ethics is written and published by individual state legislatures.

Accepted Answer

Rationale 1: Federal lawmakers do not write codes of ethics for other professional groups such as nurses.
Rationale 2: Hospital organizations do not band together and write nursing codes of ethics.
Rationale 3: Codes of ethics for nursing are written by nursing organizations.
Rationale 4: State legislatures do not write the nursing code of ethics.

Question 13

The nurse uses the MORAL model for ethical decision making at the bedside. Which option reflects the first step (M) of this model?
A) The nurse investigates the opinions of everyone involved in the issue.
B) The nurse evaluates the situation after an intervention is implemented.
C) The nurse implements an intervention and thinks about its impact.
D) The nurse considers the benefits and risks of possible solutions to the problem.

Accepted Answer

Rationale 1: In the first step of the MORAL model the participants "massage the problem," thinking of it from everyone's point of view.
Rationale 2: Evaluation is the last step, occurring in the "L" stage.
Rationale 3: Implementation occurs in the "A" step.
Rationale 4: Considering benefits and risks occurs in the "O" stage.

Question 14

The nurse manager of an oncology unit is interviewing nurses for a position. Which statements, made by nurse applicants, would the manager evaluate as indicating ability to respond appropriately to the ethical dilemmas?
A) "I think nurses and physicians should discuss care decisions with patients and families."
B) "I worked an oncology unit for 10 years before we moved here."
C) "I think that most dilemmas can be solved by taking the option that is most logical."
D) "At my last job, we were required to take ethics training each year."
E) "As long as nurses follow orders and policy and procedures ethical dilemmas are unlikely to arise."

Accepted Answer

Rationale 1: The nurse that perceives she has influence within the health care setting is more likely to be able to respond appropriately to ethical dilemmas.
Rationale 2: A nurse with clinical expertise and competence will be more likely to respond appropriately to ethical dilemmas.
Rationale 3: A nurse that is concerned more about logical actions may not fully understand the ethics involved in a situation. Lack of ethical concern will adversely impact the nurse's ability to respond appropriately to ethical dilemmas.
Rationale 4: Past experience with ethics education will make the nurse more likely to respond appropriately to ethical dilemmas.
Rationale 5: By making this statement, the nurse is dismissing the importance of monitoring for development of ethical problems. This nurse is not as likely to recognize her role in these issues.

Question 15

The nurse manager is conducting a performance review with a nurse who has worked on the unit for 10 years. During the review, the nurse begins to cry and tells the manager, "I just can't do this anymore. I can't sleep because I have such bad nightmares about patients. I can't eat and I've already lost 15 pounds." The nurse manager identifies these findings as being possible signs of which problem?
A) Moral distress
B) Too much focus on the patient
C) Developing incompetence
D) Problems at home

Accepted Answer

Rationale 1: Signs and symptoms of moral distress include powerlessness, guilt, loss of self-worth, self-criticism, low self-esteem, and physiologic responses such as crying, depression, loss of sleep, nightmares, and loss of appetite.
Rationale 2: These statements do not indicate that the nurse has too much focus on patients.
Rationale 3: These comments by the nurse are a call for help and are not indicative developing incompetence.
Rationale 4: There is no evidence that this nurse is experiencing problems at home.

Quiz 4: Application of Ethics in Nursing Practice Settings

The nurse manager has identified high levels of moral distress on the nursing unit. Which change would be helpful in assisting nurses to cope?

A nurse manager has started a dialogue regarding the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements among staff nurses. Which staff nurse statements would the manager evaluate as indicating poor understanding of this document?

The patient who has been diagnosed with metastatic cancer declines chemotherapy treatments. The nurse assists this patient in explaining this position to other health care providers. What advocacy model is this nurse exemplifying?

Nurses are revising the policy and procedure manual for the nursing unit. They work to ensure that the policies address more than one person and more than one set of circumstances. Which aspect of policy does this reflect?

Nurses believe that there is a need to change policy for their clinical unit. What is the first step these nurses should take when considering this need for new policy?

The nurse believes that a physician's order written at the end of a shift is contrary to the accepted standard of care and could potentially harm the patient. What should the nurse do?

Unrest on the nursing unit has progressed to moral outrage among the nursing staff. Which statements made by the nurse manager to the chief nursing officer indicates an understanding of this issue?

In which ways can the nurse best act as a patient advocate?

In nursing school, the student learns that the nurse should always consider the possible outcomes of any nursing action taken. What ethical concept does this consideration support?

The nurse is providing care for a patient who was just diagnosed with diabetes mellitus. Which statements reflect this nurse's use of the values-based decision model in this situation?

The nurse intends to lobby the state legislature to write a new code of ethics for the nurses in the state. Is this an appropriate idea?

The nurse uses the MORAL model for ethical decision making at the bedside. Which option reflects the first step (M) of this model?

The nurse manager of an oncology unit is interviewing nurses for a position. Which statements, made by nurse applicants, would the manager evaluate as indicating ability to respond appropriately to the ethical dilemmas?