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.

DIF: COG: Understanding REF: 126 OBJ: 1

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.

DIF: COG: Applying REF: 127 OBJ: 1

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.

DIF: COG: Applying REF: 127 OBJ: 1

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.
DIF: COG: Understanding REF: 127 OBJ: 2

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.

DIF: COG: Understanding REF: 128 OBJ: 2

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.

DIF: COG: Applying REF: 128 OBJ: 2

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.

DIF: COG: Applying REF: 127 OBJ: 2

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.

DIF: COG: Evaluating REF: 128 OBJ: 2

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.

DIF: COG: Remembering REF: 129 OBJ: 3

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.

DIF: COG: Understanding REF: 130-131 OBJ: 3

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.

DIF: COG: Understanding REF: 131 OBJ: 3

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.

DIF: COG: Understanding REF: 132 OBJ: 3

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.

DIF: COG: Applying REF: 130 OBJ: 3

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.

DIF: COG: Applying REF: 130 OBJ: 3

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.

DIF: COG: Analyzing REF: 131 OBJ: 3

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.

DIF: COG: Analyzing REF: 129|131 OBJ: 3

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.

DIF: COG: Applying REF: 133 OBJ: 4

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.

DIF: COG: Applying REF: 133-134 OBJ: 4

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.

DIF: COG: Applying REF: 133-134 OBJ: 4

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.

DIF: COG: Understanding REF: 134 OBJ: 5

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.

DIF: COG: Applying REF: 135 OBJ: 5

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.

DIF: COG: Applying REF: 137-138 OBJ: 6

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.

DIF: COG: Evaluating REF: 137 OBJ: 6

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.

DIF: COG: Understanding REF: 133 OBJ: 4

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.

DIF: COG: Applying REF: 137 OBJ: 6