PART 11

1. The patient for whom you are caring needs a liver transplant to survive. This patient has been out of
work for several months and doesn't have health insurance or enough cash. Even though several ethical
principles are at work in this case, list the principles from highest to lowest priority.
1. Accountability: You as the nurse are accountable for the well-being of this patient.
2. Respect for autonomy: This patient's autonomy will be violated if he does not receive the liver
transplant.
3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver
transplant.
4. Justice: The greatest question in this situation is how to determine the just distribution of
resources.

2. Fill in the Blank. The point of the ethical practice is an agreement to reassure the public that in all ways
the health care team not only works to heal patients but agrees to do this in the least painful and harmful
way possible. This principle is commonly called the principle of ________?

3. A child's immunization may cause discomfort during administration, but the benefits of protection from
disease, both for the individual and society, outweigh the temporary discomforts. Which principle is
involved in this situation?
1. Fidelity
2. Beneficence
3. Nonmaleficence
4. Respect for autonomy
4. When designing a plan for pain management for a postoperative patient, the nurse assesses that the
patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan
to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's
priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the
pain?
1. Fidelity
2. Beneficence
3. Nonmaleficence
4. Respect for autonomy
5. A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses
the patient to determine the exact fears and then establishes interventions designed to reduce these fears.
In this setting how is the nurse practicing patient advocacy?
1. Seeking out the nursing supervisor to talk with the patient
2. Documenting patient fears in the medical record in a timely manner
3. Working to change the hospital environment
4. Assessing the patient's point of view and preparing to articulate it
6. The application of utilitarianism does not always resolve an ethical dilemma. Which of the following
statements best explains why?
1. Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values.
2. In a diverse community it can be difficult to find agreement on a definition of usefulness, the
focus of utilitarianism.
3. Even when agreement about a definition of usefulness exists in a community, laws prohibit an
application of utilitarianism.
4. Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.
7. The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How
does this differ from other ethical practices? (Select all that apply.)
1. Ethics of care pays attention to the environment in which caring occurs.
2. Ethics of care pays attention to the stories of the people involved in the ethical issue.
3. Ethics of care is used only in nursing practice.
4. Ethics of care focuses only on the code of ethics for nurses
5. Ethics of care focuses only on understanding relationships.
8. In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among
members of the health care team. Why is the nurse's point of view valuable?
1. Nurses understand the principle of autonomy to guide respect for a patient's self-worth.
2. Nurses have a scope of practice that encourages their presence during ethical discussions.
3. Nurses develop a relationship with the patient that is unique among all professional health care
providers.
4. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about
patient care.
9. Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can
help people in conflict find common ground. All of the following actions can help resolve conflict. What
is the best order of these actions in order to promote the resolution of an ethical dilemma?
1. List the actions that could be taken to resolve the dilemma.
2. Agree on a statement of the problem or dilemma that you are trying to resolve.
3. Agree on a plan to evaluate the action over time.
4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.
5. Take time to clarify values and distinguish between facts and opinions—your own and those of
others involved.
6. Negotiate a plan.

10. The ANA code of nursing ethics articulates that the nurse “promotes, advocates for, and strives to
protect the health, safety, and rights of the patient.” This includes the protection of patient privacy. On the
basis of this principle, if you participate in a public online social network such as Facebook, could you
post images of a patient's x-ray film if you obscured or deleted all patient identifiers?
1. Yes, because patient privacy would not be violated since patient identifiers were removed
2. Yes, because respect for autonomy implies that you have the autonomy to decide what constitutes
privacy
 3. No, because, even though patient identifiers are removed, someone could identify the patient on
the basis of other comments that you make online about his or her condition and your place of
work
4. No, because the principle of justice requires you to allocate resources fairly

11. What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct
order.
Clarify values.
1. Ask the question, Is this an ethical dilemma?
2. Verbalize the problem.
3. Gather information.
4. Identify course of action.
5. Evaluate the plan.
6. Negotiate a plan
12. Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and
participants from all health care disciplines. Which of the following best describes the role of the nurse in
the resolution of ethical dilemmas?
1. To articulate the nurse's unique point of view, including knowledge based on clinical and
psychosocial observations.
2. To study the literature on current research about the possible clinical interventions available for
the patient in question.
3. To hold a point of view but realize that respect for the authority of administrators and physicians
takes precedence over personal opinion.
4. To allow the patient and the physician to resolve the dilemma on the basis of ethical principles
without regard to personally held values or opinions.
13. It can be difficult to agree on a common definition of the word quality when it comes to quality of
life. Why? (Select all that apply.)
1. Average income varies in different regions of the country.
2. Community values influence definitions of quality, and they are subject to change over time.
3. Individual experiences influence perceptions of quality in different ways, making consensus
difficult.
4. The value of elements such as cognitive skills, ability to perform meaningful work, and
relationship to family is difficult to quantify using objective measures.
5. Statistical analysis is difficult to apply when the outcome cannot be quantified.
6. Whether or not a person has a job is an objective measure, but it does not play a role in
understanding quality of life.
14. Which of the following properly applies an ethical principle to justify access to health care? (Select all
that apply.)
1. Access to health care reflects the commitment of society to principles of beneficence and justice.
2. If low income compromises access to care, respect for autonomy is compromised.
3. Access to health care is a privilege in the United States, not a right.
 4. Poor access to affordable health care causes harm that is ethically troubling because
nonmaleficence is a basic principle of health care ethics.
5. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack
of personal accountability.
6. If a new drug is discovered that cures a disease but at great cost per patient, the principle of
justice suggests that the drug should be made available to those who can afford it.
15. Match the examples with the professional nursing code of ethics:
1. Advocacy
2. Responsibility
3. Accountability
4. Confidentiality
A. You see an open medical record on the computer and close it so no one else can read the record
without proper access.
B. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However,
you contact the primary care provider and your head nurse and follow agency procedure.
C. A patient at the end of life wants to go home to die, but the family wants every care possible. The
nurse contacts the primary care provider about the patient's request.
D. You tell your patient that you will return in 30 minutes to give him his next pain medication.

ANSWERS:
1. 4,2,3,1
2. Nonmaleficence
3. Beneficence
Fidelity
Assessing the patient's point of view and preparing to articulate it
2. In a diverse community it can be difficult to find agreement on a definition of usefulness, the
focus of utilitarianism.
1. Ethics of care pays attention to the environment in which caring occurs.
2. Ethics of care pays attention to the stories of the people involved in the ethical issue.
5. Ethics of care focuses only on understanding relationships.
8. 3. Nurses develop a relationship with the patient that is unique among all professional health care
providers.
9. 4,5,2,1,6,3
10. 3. No, because, even though patient identifiers are removed, someone could identify the patient on the
basis of other comments that you make online about his or her condition and your place of work
11. 2,4,1,3,5,7,6
12. 1. To articulate the nurse's unique point of view, including knowledge based on clinical and
psychosocial observations.
13. 2. Community values influence definitions of quality, and they are subject to change over time.
3. Individual experiences influence perceptions of quality in different ways, making consensus difficult.
4. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to
family is difficult to quantify using objective measures.
5. Statistical analysis is difficult to apply when the outcome cannot be quantified.
14. 1. Access to health care reflects the commitment of society to principles of beneficence and justice.
2. If low-income compromises access to care, respect for autonomy is compromised.
4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is
a basic principle of health care ethics.
15. 1,d; 2,c; ;3,a; 4,b