Chapter 6: Application of Ethics in the Community

MULTIPLE CHOICE

1. Which statement about Florence Nightingale’s ideas about ethics is correct?

a. Nursing is a call to service, and the moral character of persons entering nursing is important.
b. Ethical principles are based on the values of the individual nurse.
c. Society will dictate the ethical principles to which nurses must adhere.
d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers.
ANS: A
Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as
important.

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2. When nurses apply the knowledge and processes of ethics to the examination of ethical problems in health care,
they are using:
a. Values
b. Morality
c. Ethics
d. Bioethics
ANS: D
Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care.

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3. A nurse in the 1960s would have referred to which code of ethics to guide ethical decision making?
a. Nightingale Pledge
b. Code for Professional Nurses
c. Code of Ethics for Nurses with Interpretive Statements
d. International Council of Nurses (ICN) Code of Ethics for Nurses
ANS: B
Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics
for Nurses with Interpretive Statements was adopted in 2001, and the International Council of Nurses (ICN) Code of
Ethics for Nurses was adopted in 2000.

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4. An orderly process that considers ethical principles, client values, and professional obligations is:
a. Accountability
b. Ethical decision making
c. Moral principles
d. Code for Nursing Practice
ANS: B
Ethical decision making is defined as an orderly process that considers ethical principles, client values, and
professional obligations.

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5. The growing multiculturalism of American society can contribute to ethnicity conflicts when:
a. Cultural standards are congruent with professional standards.
b. Cultural traditions within an ethnic group align with those of the community.
c. Ethnic groups overburden the health care system.
d. The greater community’s values are jeopardized by specific ethnic values.
ANS: D
Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral
persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in
American culture.
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6. There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin.
There is only enough for one client. Which action does the nurse take first?
a. Identify all options.
b. Make a decision.

c. Gather additional information.

d. Act and assess decisions made.
ANS: C
One must have all information before looking at options and making a decision.

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7. An example of an ethical dilemma is:

a. Whether or not to set up a community health center in a rural area
b. Allocating resources in a natural disaster
c. Deciding to withdraw care on a hospice patient
d. Applying the principles of Florence Nightingale in Bangladesh
ANS: B
When resources are scarce, a dilemma may exist as to how to allocate them.

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8. The steps of the ethical decision making process are similar to the steps of:
a. Healthy People 2010
b. Deontology
c. The nursing process
d. Advocacy
ANS: C
The nursing process involves the same basic steps: assessment, diagnosis, planning, implementation, and
evaluation.

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9. Which ethical principle requires “doing no harm”?

a. Respect for autonomy
b. Non-maleficence
c. Beneficence
d. Distributive justice
ANS: B
Non-maleficence refers to doing no harm.

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10. Which statement fits the Liberal Democratic Theory of John Rawls?
a. Rejection of any idea that societies, states, or collectives of any form can be the bearers of rights or can owe
duties.
b. Inequalities result from birth, natural endowment, and historic circumstances.
c. Everyone has a right to private property.
d. Government should be limited.
ANS: B
Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in
which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result
from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

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11. According to Leininger and Watson, the moral ideal of nursing is:
a. Caring
b. Advocacy
c. Responsibility
d. Accountability
ANS: A
This conceptualization occurred as a response to the technological advances in health care science and the desire
of nurses to differentiate nursing practice from medical practice.

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12. Which statement about feminist ethics is correct?

a. Feminists include only women in their worldview.
b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process.
c. Feminists believe that men should not be nurses.
d. Women’s thinking and moral experiences are important and should be taken into account.
ANS: D
Feminist theory ascribes to the idea that women’s thinking and moral experiences are important and should be
considered.

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13. Examples of the benefits of distributive justice are:

a. Basic needs, material and social goods, liberties, rights, and entitlements
b. Taxes, military service, location of incinerators or power plants
c. Entitlement to equal rights and equal treatment
d. The right to private property and personal assets
ANS: A
Justice requires that the distribution of benefits and burdens on a society be fair or equal. the third option refers to
egalitarianism, and the last option refers to libertarianism. Taxes, military service, and location of incinerators or
power plants are not benefits associated with justice.

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14. A nurse believes everyone is entitled to equal rights and equal treatment in society when applying:
a. Distributive or social justice
b. Egalitarianism
c. Libertarian view of justice
d. Communitarianism
ANS: B
Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society.

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15. When using the principles of virtue ethics in decision making, a nurse would:
a. Provide efficient and effective nursing care.
b. Identify the meaningful facts in the situation.
c. Seek ethical community support to enhance character development.
d. Plan ways to restructure the social practices that oppress women.
ANS: C
According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence,
compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to
enhance character development.

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16. A nurse applies the ethical principle of non-maleficence when:

a. Administering medications using the “five rights”
b. Allowing clients to be active participants in their care
c. Providing patient privacy when delivering care
d. Referring a client to a physical therapist
ANS: A
Non-maleficence requires that one do no harm. It requires that health care professionals act according to the
standards of due care, always seeking to produce the least amount of harm possible.

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17. A nurse providing care using the idea of “servicing citizens, not customers” is applying the:
a. Ethical tenets of policy development
b. Basic concepts of the feminist theory
c. Underlying premise of virtue ethics
d. Components of distributive justice
ANS: A
There are three tenets of both policy and ethics. The approach is based on the voice of the community as the
foundation on which policy is developed.

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18. Public health administrators in a community provide a health department to serve an indigent population of
immigrants providing translators on certain days of the week. This is an example of:
a. Policy
b. Quality
c. Assurance
d. Libertarian philosophy
ANS: C
Assurance refers to the role of public health in making sure that essential community-oriented health services are
available, which may include providing essential personal health services for those who would otherwise not receive
them.

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19. Which core function supports the belief that all Americans should receive basic health care services?
a. Assessment
b. Assurance
c. Policy development
d. Advocacy
ANS: B
Assurance purports that all persons should receive essential personal health services.

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20. Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements?
a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates
for office.
b. The nurse’s primary focus is on acute bedside nursing, followed by community health care to promote seamless
care.
c. The nurse owes duty primarily to the physician to strive to protect health, safety, and the rights of the patient.
d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the
profession, and for shaping social policy.
ANS: D
Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing
profession to address national and global health concerns as well as be involved with shaping policies through
political action.

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21. Why would a nurse refer to the Code of Ethics for Nurses or the Public Health Code of Ethics?
a. To provide answers for ethical dilemmas
b. To guide professional practice related to ethics
c. To increase moral leadership in ethics
d. To find a framework for ethical decision making
ANS: B
These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the
profession.

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22. Which nursing action demonstrates advocacy?

a. Offering a smoking cessation program
b. Screening for hypertension
c. Lobbying for health care reform
d. Conducting home visits
ANS: C
Nurses should participate in implementing new directions for health care and help envision these new directions.
Nurses can be an important voice in advocating for access to consistent, effective, efficient health care for all.

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23. The community leaders in a lesser-developed country decide not to tell the citizens of a small village about a
chemical spill at a major industrial facility that could produce harmful effects. Which principle are they violating?
a. Policy
b. Advocacy
c. Caring
d. Virtue
ANS: B
Advocacy requires that the community be properly informed, and this was violated in the above scenario.

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MULTIPLE RESPONSE

1. The ethical tenets that underlie the core function of assessment are (select all that apply):
a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and
populations
b. Moral character: the persons selected to develop, assess, and disseminate community knowledge possess
integrity
c. Service to others over self: a necessary condition of what is “good” or “right” policy
d. “Do no harm”: disseminating appropriate information about groups and populations is morally necessary and
sufficient
ANS: A, B, D
Service to others over self is an ethical tenet of policy development. Competency, moral character, and “do no
harm” are the ethical tenets of assessment.

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2. How can a community health nurse apply the Ethical Principles for Effective Advocacy? Select all that apply.
a. Act in the health care provider’s best interest.
b. Keep the client (group, community) properly informed.
c. Maintain client confidentiality.
d. Carry out instructions with diligence and competence.
ANS: B
Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with
diligence and competence are ethical principles for effective advocacy.
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