Test Bank for Contemporary Nursing, 6th Edition, By

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Test Bank for Contemporary Nursing, 6th Edition, By Barbara Cherry, Susan R. Jacob,

Chapter 09: Ethical and Bioethical Issues in Nursing and Health Care
Test Bank

MULTIPLE CHOICE

1. Ethics applied to nursing can best be defined as:

a. doing what is best for the client.
b. making good decisions about care.
c. care based on what should be done in keeping with the values of the client.
d. rules for providing competent care that is based on scientific principles.
ANS: C
Correct: Nursing ethics is a system of principles intended to guide the actions of the nurse in
his or her relationships with clients, clients’ family members, other health care providers,
policy makers, and society as a whole. A nurse must make an attempt to understand what
values are inherent in the situation.
Incorrect:
a. “Doing what is best for the client” is not a definition of ethics.
b. “Making good decisions about care” is not a definition of ethics.
d. “Rules for providing competent care that is based on scientific principles” is not a
definition of ethics.

DIF: Knowledge REF: p. 168

2. A family requests that no additional heroic measures be instituted for their terminally ill
mother who has advance directives in place. The nurse respects this decision in keeping with
the principle of:
a. accountability.
b. autonomy.
c. nonmaleficence.
d. veracity.
ANS: B
Correct: Autonomy is the principle of respect for the individual person. Within the concept of
autonomy, people are free to form their own judgments and perform whatever actions they
choose. They are self-determining agents who are entitled to decide their own destiny.
Incorrect:
a. Accountability is inherent in the nurse’s ethical obligation to uphold the highest standards of
practice and care, assume full personal and professional responsibility for every action, and
commit to maintaining quality in the skill and knowledge base of the profession.
c. Nonmaleficence is a principle that implies a duty not to inflict harm. In ethical terms, it
means to abstain from injuring others and to help others further their own well-being by
removing harm and eliminating threats.
d. Veracity means telling the truth as a moral and ethical requirement.

DIF: Application REF: p. 173; Table 9-1 | p. 174

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3. An older adult client is comatose and had one electroencephalogram that indicated no activity.
The daughter is very distraught and notices her mother’s hand moves when she is talking to
her. The daughter asks the nurse, “Is mother responding to my voice?” The nurse, attempting
to console the daughter, knows the movement was involuntary but states, “It does appear she
did.” The nurse is violating which principle of ethics?
a. Autonomy
b. Veracity
c. Utilitarianism
d. Deontology
ANS: B
Correct: Veracity is the principle of telling the truth in a given situation.
Incorrect:
a. Autonomy is the principle of respect for the individual person; this concept states that
humans have incalculable worth or moral dignity.
c. Utilitarianism is an approach that is rooted in the assumption that an action or practice is
right if it leads to the greatest possible balance of good consequences or to the least possible
balance of bad consequences. Giving the daughter false reassurance is not a good
consequence.
d. Deontological theory claims that a decision is right only if it conforms to an overriding
moral duty and wrong only if it violates that moral duty. Persons are to be treated as ends in
themselves and never as means to the ends of others.

DIF: Application REF: p. 175

4. In attempting to decide which services should be offered to a community, the public health
nurse decides to implement hypertension screening and treatment because most of the
residents are hypertensive. This decision is based on the principle of:
a. veracity.
b. values.
c. utilitarianism.
d. autonomy.
ANS: C
Correct: Utilitarianism is an approach that is rooted in the assumption that an action or
practice is right if it leads to the greatest possible balance of good consequences or to the least
possible balance of bad consequences. On the basis of this principle, an attempt is made to
determine which actions will lead to the greatest ratio of benefit to harm for all persons
involved in the situation.
Incorrect:
a. Veracity is defined as the moral and ethical requirement to always tell the truth in personal
communication. Although the public health nurse did not lie, she did not use the concept of
veracity to decide which health care issue to address with this group.
b. Values account for our moral decisions and actions. The nurse based the decision on the
needs of the group, not on her personal values.
d. Respecting autonomy means respecting people’s right to make decisions based on their
values. The nurse did not base her decision for this group on her respect for them, but on what
the needs of the majority were.

DIF: Application REF: p. 167 |p. 174

5. A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of
his/her own values as they relate to this issue. The nurse must:
a. know his/her own values and how these values relate to beliefs and the philosophy
of nursing.
b. rid the impurities in his/her value system.
c. ignore his/her own values.
d. realize that values do not change and that they cannot be influenced by others.
ANS: A
Correct: Nurses must make a deliberate effort to recognize their own values and must learn to
consider and respect the values of others. Health care decisions are seldom made
independently of other people. Decisions are made with the client, the family, other nurses,
and other health care providers.
Incorrect:
b. There is no need to get rid of impurities in the value system; everyone’s system is unique,
and there really are no impurities.
c. The nurse cannot ignore her own values; these are what shape the nurse’s ethics and morals.
d. Values can change as a person matures and passes through different life experiences.
Values also are often influenced by those around us, especially authority figures.

DIF: Application REF: p. 171

6. When assessing an ethical issue, the nurse must first:

a. ask, “What is the issue?”
b. identify all possible alternatives.
c. select the best option from a list of alternatives.
d. justify the choice of action or inaction.
ANS: A
Correct: The first step in the situational assessment procedure is to find out the technical and
scientific facts and assess the human dimension of the situation—the feelings, emotions,
attitudes, and opinions. Assessment can be applied to all areas of patient care, including
ethics. Trying to understand the full picture of a situation is time consuming and requires
examination from many different perspectives, but it is worth the time and effort.
Incorrect:
b. Identifying alternatives is the second step in the situation assessment procedure. A set of
alternatives cannot be established until an assessment has been completed.
c. Selecting the best option is actually the third step in the situation assessment procedure.
Options cannot be selected until an assessment has been done to define the issue.
d. Justifying the action or inaction is the final step in the situational assessment procedure. No
justification can be made until the assessment and action phases have been completed.

DIF: Comprehension REF: p. 176

7. A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were
associated with a survey of college sophomores. The researcher was applying the principles
of:
a. beneficence.
b. human dignity.
c. justice.
d. human rights.
 ANS: A
Correct: Beneficence is defined as promoting goodness, kindness, and charity. In ethical
terms, beneficence means to provide benefit to others by promoting their good.
Incorrect:
b. Human dignity is the inherent worth and uniqueness of a person.
c. Justice involves upholding moral and legal principles.
d. Human rights are the basic rights of each individual.

DIF: Application REF: p. 175

8. The physician who insists on providing treatment in spite of the client’s wishes because he
“knows best” is reflecting:
a. autonomy.
b. beneficence.
c. justice.
d. paternalism.
ANS: D
Correct: Paternalism is an action and an attitude wherein the provider tries to act on behalf of
the client and believes that his or her actions are justified because of a commitment to act in
the best interest of the client. Paternalism is a reflection of the “father knows best” way of
thinking.
Incorrect:
a. Autonomy is the principle of respect for the individual person.
b. Beneficence means promoting goodness, kindness, and charity.
c. Justice states that like cases should be treated alike and equals ought to be treated equally.

DIF: Application REF: p. 179

9. The nurse who admits making a medication error and immediately files an incident report is
demonstrating:
a. accountability.
b. individuality.
c. an injustice.
d. values clarification.
ANS: A
Correct: Accountability is an ethical duty that states that one should be answerable legally,
morally, ethically, or socially for one’s actions.
Incorrect:
b. Individuality is something that distinguishes one person or thing from others.
c. Injustice is when a person is denied a right or entitlement.
d. Values clarification is a tool that allows the nurse to examine personal values in terms of
ethical situations.

DIF: Application REF: p. 166| pp. 180-181

10. Three illegal immigrants with no health insurance or money sustained life-threatening injuries
during an automobile accident. Two of these individuals had head trauma and lacerated
internal organs. The decision was made to provide extended care in the trauma center after
emergency surgery was performed to save their lives. The third individual received only
minor injuries, which were treated in the emergency department. The care of the two critical
clients was based on the ethical principle of:
a. utilitarianism.
b. deontology.
c. autonomy.
d. veracity.
ANS: B
Correct: Deontology is an approach that is rooted in the assumption that humans are rational
and act out of principles that are consistent and objective and that compel them to do what is
right. Deontological theory claims that a decision is right only if it conforms to an overriding
moral duty and wrong only if it violates that moral duty.
Incorrect:
a. Utilitarianism is an approach that is rooted in the assumption that an action or practice is
right if it leads to the greatest possible balance of good consequences or to the least possible
balance of bad consequences. An attempt is made to determine which actions will lead to the
greatest ratio of benefit to harm for all persons involved in the dilemma.
c. Autonomy is the principle of respect for the individual person. People are free to form their
own judgments and perform whatever actions they choose.
d. Veracity is defined as telling the truth in personal communication as a moral and ethical
requirement.

DIF: Application REF: p. 167 |p. 174

11. A 13-year-old female is brought to the family planning clinic by her enraged father, who has
just learned that she is pregnant. The pregnant client states, “I want to have this baby and give
it up for adoption.” However, the father is adamant that she will disgrace the family and
demands that the health care providers tell his daughter that she has a physical condition that
would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a
conflict that involves the ethical principle of:
a. deontology.
b. veracity.
c. autonomy.
d. beneficence.
ANS: B
Correct: Veracity is telling the truth in personal communication as a moral and ethical
requirement.
Incorrect:
a. Deontology is an approach that is rooted in the assumption that an action or practice is right
if it leads to the greatest possible balance of good consequences or to the least possible
balance of bad consequences.
c. Autonomy is the principle of respect for the individual person. All persons have
unconditional intrinsic value. People are self-determining agents who are entitled to decide
their own destiny.
d. Beneficence means promoting goodness, kindness, and charity.
 DIF: Analysis REF: p. 175

12. During a seminar on ethics, the educator realizes that more information is needed when a
participant describes which situation as a violation of the ethical principle of autonomy?
a. An older person with advanced stages of Alzheimer’s disease is denied the right to
ambulate in the hallway.
b. A mentally competent adult refuses medical treatment for the autoimmune disease
lupus erythematosus, stating that this condition reflects the will of a higher power.
c. A mentally competent visitor fell during visiting hours but refused to be examined
by the physician on call.
d. A mentally competent adult with a broken wrist refuses to be given a local
anesthetic prior to a procedure.
ANS: A
Correct: Autonomy is defined as personal freedom, the right to make choices. However, in
this case, the patient is not able to be fully informed so they can clearly understand the choices
being offered.
Incorrect:
b. Allowing a mentally competent adult to refuse medical treatment is an example of
autonomy. As long as the actions do not infringe on the autonomous actions of others, that
person should be free to decide whatever he or she wishes. This freedom should be applied
even if the decision creates risk to his or her health and even if the decision seems unwise to
others.
c. The visitor has the right to refuse treatment even if the decision creates a risk to his or her
health or seems unwise to others.
d. A mentally competent adult refusing anesthetic prior to a procedure demonstrates
autonomy. The patient has the right to refuse the anesthetic even if it creates a risk to his or
her health; in this case, the risk of pain.

DIF: Analysis REF: p. 181

13. A nurse who is infected with human immunodeficiency virus (HIV) while working in the
operating room seeks revenge by deliberately placing clients at risk by not adhering to
universal precautions. This nurse is violating the ethical principle of:
a. veracity.
b. beneficence.
c. nonmaleficence.
d. autonomy.
ANS: C
Correct: Nonmaleficence means to abstain from injuring others and to help others further their
own well-being by removing harm and eliminating threats. The nurse is definitely violating
this principle through her actions.
Incorrect:
a. Veracity is telling the truth in personal communication.
b. Beneficence is promoting goodness, kindness, and charity.
d. Autonomy is the principle of respect for the individual person. This concept maintains that
all persons have unconditional intrinsic value.

DIF: Application REF: p. 175

14. A client and her husband used in vitro fertilization to become pregnant. The unused sperm
was frozen so the couple could have more children later. The husband is killed while in
combat, and the client journals her choices and the possible ramifications. She comes to the
fertility clinic after looking at the situation from many perspectives and after considering
many alternatives. She asks that the sperm be destroyed because her husband’s faith
prohibited remarrying, and allowing another person to use the sperm would conflict with her
late husband’s beliefs. The nurse realizes that:
a. the client is in the second step of ethical decision making and that the client’s value
system is influencing her choices of alternative actions.
b. a logical line of reasoning has led to validation of the decision to destroy the
husband’s sperm.
c. the client has not been able to navigate the complicated issues inherent in this
situation.
d. a rational decision was reached that was based on reflection and on the value
systems of the wife and the husband.
ANS: D
Correct: After completing all steps in the situation assessment procedure, the client is now
ready to justify her selection. In this phase, the person will specify reasons for the action, will
clearly present the ethical basis for these reasons, will understand the shortcomings of the
justification, and will anticipate objections to the justification.
Incorrect:
a. The second step of ethical decision making is identification of hidden issues.
b. Validation of the decision considers many factors and requires analysis of all possible
alternatives.
c. No situational decision can be made unless an individual begins with the first step of
actually identifying and stating the actual issue.

DIF: Analysis REF: p. 176

15. A client is in extreme pain after he was involved in a motor vehicle accident, and morphine
has been ordered every hour for pain. The nurse injects saline into the client’s IV line and
takes the morphine for herself. The nurse is violating which principle of ethics?
a. Autonomy
b. Utilitarianism
c. Beneficence
d. Dilemmas
ANS: C
Correct: Beneficence is providing benefit to others by promoting their good. In general terms,
to be beneficent is to promote goodness, kindness, and charity. By taking the client’s pain
medication and substituting saline, the nurse did harm, not good, for this client.
Incorrect:
a. Autonomy is the principle of respect for the individual person; the nurse does not respect
someone that he or she is inflicting harm upon.
b. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest
possible balance of good consequences or to the least possible balance of bad consequences.
Because the client’s pain medication was taken from him, the consequences were all bad.
d. Dilemmas are not included as a principle of ethics.
 DIF: Application REF: p. 175

16. The Health Care Reform Act provides insurance for all U.S. citizens and legal residents
presenting far reaching ethical considerations related to diverse individual patient health care
beliefs for those delivering nursing care. Nurses must consider their civil rights under the
Rights of conscience and how new health care agendas such as the Patient Protection and
Affordable Care Act (PPACA) could affect their practice in situations that may conflict with
their own belief system. Today’s practicing nurse must:
a. remember it is one’s professional duty to render patient-centered care—even when
it is in direct conflict with the nurse’s own beliefs—or be held liable for
withholding treatment.
b. consider whether the right to act according to one’s inner beliefs will continue to
be permissible when federal health insurance becomes fully enacted.
c. discuss with the patient and family different options in hopes they will accept the
nurse’s health care beliefs.
d. suggest to the hospital administration that they not accept federal funding to
prevent controversial health practices.
ANS: B
Correct: With federal funding, many controversial health care services will be covered and
provided as part of patient care when desired by the patient; therefore, whether a nurse has
autonomy to refuse to provide care may not be as clear even when one might request another
patient.
Incorrect:
a. A nurse must analyze his/her health beliefs to ensure the best care can be rendered without
prejudice and under the Right of Conscience (nurses’ civil right allowing them to act
according to their conscience).
c. It is not the role of the nurse to attempt to persuade patients to accept another set of health
care beliefs.
d. Federal health insurance will cover many patients, and refusing funding, even if possible,
would place the hospital in financial difficulty.

DIF: Application REF: p. 173

17. A nurse is assigned to a unit where 95% of all patients required total care. Most days the
assistive personnel are able to complete their assignments and provide high-quality care. A
patient returning from a procedure was somehow “skipped” when daily baths were performed
and requests that her care now be provided. The nurse discovers the bed is rumpled and damp.
The RN joins with some other staff to bathe the patient, change the bed, and help make the
patient comfortable. These staff members are demonstrating:
a. altruism.
b. veracity.
c. autonomy.
d. whistle blowing.
ANS: A
Correct: Altruism is concern for the welfare of others, including willingness to help others
when they are unable to get their assignments completed to ensure that the patient receives
high-quality care.
Incorrect:
 b. Veracity is truth telling, in this situation the staff provided care demonstrating altruism and
there was no concern that the truth was spoken.
c. Autonomy is self-determination: the patient was demonstrating autonomy by asking for
care, the staff was demonstrating altruism by providing requested care.
d. The staff did not report unsafe or inappropriate, harmful care.

DIF: Application REF: p. 173; Table 9-1

18. In which case does the nurse act as “whistle blower”?

a. One staff member on the unit covers for another nurse, who leaves the premises to
purchase illegal substances and signals her friend when she must return.
b. The nurse reports that another nurse is taking medications out of stock medicine
for her/himself.
c. A nurse informs respiratory therapy that a patient is now due a treatment.
d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure
all care was rendered properly.
ANS: B
Correct: Whistle blowing is the reporting of acts or situations that violate the principle of
beneficence such as a chemical impairment, negligence, abusiveness, incompetence, or
cruelty.
Incorrect:
a. The nurse is serving as an ally rather than reporting the violation.
c. Informing another department that a treatment is due is not considered “whistle blowing.”
d. Accountability of delegation requires the RN to ensure all assignments were completed
effectively.

DIF: Application REF: p. 181

MULTIPLE RESPONSE

1. Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience
from formal nursing school classes, clinical experiences, and the ethical issues they encounter
in their clinical practice. The ideal outcomes of these ongoing experiences with cultural
decision making include: (Select all that apply.)
a. increased trustworthiness.
b. enhanced ability to take into consideration many aspects of ethical situations.
c. confidence to make decisions based on experience and ethical intelligence.
d. improved clinical decision making and advocacy for patient autonomy.
e. authority to make ethical decisions independently that meet personal moral beliefs.
ANS: A, B, C, D
Correct:
a. The desired outcomes of ethics acculturation across the years are integrity, personal growth,
practical wisdom, and effective problem solving on behalf of patients and their families
(Weaver et al, 2008). These are the qualities that are characteristic of an ethically sensitive
and morally mature person. Trustworthiness is a characteristic of integrity.
b. The ability to take into consideration many aspects of ethical situations is due in part to
personal growth and practical wisdom.
Test Bank for Contemporary Nursing, 6th Edition, By Barbara Cherry, Susan R. Jacob,

c. The confidence to make ethically sensitive decisions comes from experience founded on
personal growth and personal wisdom.
d. The ability to be the patient’s advocate in ethical decision making is one test of cultural
acculturation.
Incorrect:
e. Ethical decisions are often the produce of professionals who come together to consider right
and wrong choices that affect society or patients as a whole rather than an independent
decision based on the nurse’s personal moral beliefs.

DIF: Analysis REF: p. 173

COMPLETION

1. Practicing nurses participate in employer-sponsored professional development classes that

provide case studies related to ethical situations and decision making. Ethical considerations
are debated among teams, and an expert helps the class arrive at the “best practices.” The
nurses are experiencing ethics ______________.

ANS:
acculturation.
Ethics acculturation is the didactic and experiential process of developing ethical reasoning
abilities as a part of ongoing professional education.

DIF: Application REF: p. 167

OTHER

1. When healthy, a patient had requested that all life-sustaining measures be implemented. Now
the patient has Alzheimer’s and had a deterioration in health that severely limits quality of
life. The patient’s only child is petitioning that the parent not be placed on life support again
and be given only palliative care. The nurse assessing this ethical situation following the
procedure would place the steps in what order? (Place in order of the Situation Assessment
Procedure). Put a comma and space between each answer choice (for example: a, b, c, d).
a. Discuss with the ethics committee possible alternatives that would be
acceptable to the family while considering the patient’s wishes.
b. After the family presents two alternatives, work with the committee and
family to agree on one alternative.
c. Provide rationale for the selection made.
d. Carefully assess the situation to identify the ethical issue and concerns.

ANS:
d, a, b, c
The steps to the Situation Assessment Procedure are as follows:
1. Identify the ethical issues and problems.
2. Identify and analyze available alternatives for action.
3. Select one alternative.
4. Justify the selection.

DIF: Application REF: p. 176

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