NUSS 500 - Part2

schools studied had a disproportionate number of students who reported
sleeplessness, nervousness, nightmares, and guilt. These were attributed to various

factors, the most significant of which was a very strict principal, who voiced open
disapproval of students she felt were underachieving their enormous academic
potential. Parents were very accepting of this behavior, echoing it in their
interactions with the students. (Atchison, Topeka, & Santa Fe, 2009).
c. As compared with other high schools, Atchison, Topeka, and Santa Fe (2009)
reported a higher incidence of distress manifestations, such as nightmares and
nervousness, in a strictly college-prep school with an extremely disapproving
principal, who verbally berated students for less-than-expected academic
performance.
d. High schools with disapproving authority figures have a higher incidence of
somatization (see Atchison et al, 2009).
ANS: C
Rather than using direct quotes from an author, the writer of the literature review should
paraphrase the author’s ideas. Use of the author’s exact words represents plagiarism.
Eliminating the quotation marks, and citing an entire paragraph, with the authors’ names at
the end, also constitutes plagiarism. Paraphrasing involves expressing the ideas clearly and in
one’s own words. The meanings of these sources are then connected to the proposed study.
DIF: Cognitive Level: Application REF: Page 111
MULTIPLE RESPONSE
1. Which of the following might a researcher include in a review of the literature concerning
acupuncture and conscious sedation for major surgical procedures? (Select all that apply.)
a. A research article from the Journal of Acupuncture comparing the use of
acupuncture with general anesthesia
b. Bryson’s Human Physiology textbook
c. A research synthesis on alternatives to general anesthesia compiled by the Agency
for Health Policy and Research
d. An article in National Enquirer on the dangers of major surgery
e. A master’s thesis on the use of acupuncture during closed reduction of radial-ulnar
fractures
f. A Wikipedia article on how acupuncture works
g. A monograph written by a physician in a third world country who used
acupuncture to control pain during surgical procedures
ANS: A, B, C, E, G
“The literature” consists of all written sources relevant to the selected topic. The literature
includes newspapers, monographs, encyclopedias, conference papers, scientific journals,
textbooks, other books, theses, dissertations, and clinical journals. Websites and reports
developed by government agencies and professional organizations are also included. Online
encyclopedias to which anyone can contribute, such as Wikipedia, are not considered
scholarly sources.
DIF: Cognitive Level: Analysis REF: Page 97
2. A student’s first draft of her thesis contains the following:

Evidence to the contrary was provided in several studies of efficacy but never examined in
a context of “the adolescent at sea with the ghost of his losses” (Reynolds, 2011).
The student’s reference list contains the following citation for this work:
Reynold, A. R. (2010). Never underestimate depression. Journal of Applied Psychology.
What is wrong with it? (Select all that apply.)
a. The reference list should re-state the quotation.
b. The reference is incomplete, lacking volume number and page numbers.
c. The years of the citation differ.
d. The author’s name is spelled differently in the citation and in the reference list.
e. No page number is provided for the direct quotation.
ANS: B, C, D, E
Sources that will be cited in a paper or recorded in a reference list should be cross-checked
two or three times to prevent errors. Questions that will identify common errors are displayed
in Box 6-1. To prevent these errors, the author checks all the citations within the text of the
literature review and each citation in his or her reference list, to assure agreement and
completeness.
3. In which of the following methods does substantive review of the literature take place after
data analysis? (Select all that apply.)
a. Grounded theory
b. Historicism
c. Phenomenology
d. Ethnography
e. Quantitative descriptive
ANS: A, C
In qualitative research, the purpose and timing of the literature review depends on the type of
study to be conducted. Some phenomenologists believe the literature should not be reviewed
until after the data have been collected and analyzed so that the literature will not interfere
with the researcher’s ability to suspend what is known and approach the topic with openness.
In development of a grounded theory study, a minimal review of relevant studies provides the
beginning point of the inquiry, but this review is only a means of making the researcher aware
of what studies have been conducted. This information, however, is not used to direct the
collection of data or interpretation of the findings in a grounded theory study. During the data
analysis stage, a core variable is identified and the researcher theoretically samples the
literature for extant theories that may assist in explaining and extending the emerging theory.
In historical research, the initial review of the literature helps the researcher define the study
questions and make decisions about relevant sources. The data collection is actually an intense
review of published and unpublished documents that the researcher has found. The purposes
for reviewing the literature for ethnographic studies and for exploratory descriptive qualitative
research are more similar to the literature review for quantitative research. The researcher
develops a general understanding of the concepts to be examined related to the selected
culture or topic. The literature review also provides a background for conducting the study
and interpreting the findings. The review of literature in quantitative research directs the
development and implementation of a study. The focus of the major literature review at the
beginning of the research process is to identify a gap in what is known.
DIF: Cognitive Level: Synthesis REF: Page 98
4. Which of the following are purposes of the literature review in quantitative research
concerning patient compliant with alternating leg pressure stockings (ALPs)? (Select all that
apply.)
a. It gives the researcher an overview of anecdotal reports about how it feels to the
patient to wear ALPs.
b. It allows the researcher to use the data from previous research on ALPs to add to
his or her database.
c. It allows the researcher to construct theory about compliance with ALPs.
d. It gives the researcher something with which to compare his or her findings on
compliance with ALPs.
e. It allows the researcher to discover previous research in the area of ALPs, so as to
identify what is not known (the research gap).
ANS: D, E
The review of literature in quantitative research directs the development and implementation
of a study. The focus of the major literature review at the beginning of the research process is
to identify a gap in what is known. The study is designed to add knowledge in the area of the
identified gap. After a thorough review of the literature, the researcher identifies a specific gap
in knowledge. After the data have been analyzed and the findings described, the researcher
will return to the literature in the generalization phase of the research report to integrate
knowledge from the literature with new knowledge obtained from the study. The purpose of
the literature review is similar for the different types of quantitative studies (descriptive,
correlational, quasi-experimental, and experimental).
5. In phenomenology, often the review of the literature is conducted after data analysis is
complete. What is the reason for this? (Select all that apply.)
a. The data analysis phase of phenomenology includes a literature review.
b. Phenomenology is data-free, and analyses are based only on the interpretation of
the researcher.
c. Some phenomenologists do believe that one can “bracket” what is known, in order
to perform an unbiased analysis, but it seems pointless to absorb information just
to then put it aside, so literature review is usually postponed.
d. Some phenomenologists don’t believe that one can “bracket” what is known, in
order to perform an unbiased analysis of the data, so they try to minimize what
they read about the topic of the study until data analysis is complete.
e. The review of the literature provides an objective cross-check for the researcher’s
interpretation.
ANS: C, D
In qualitative research, the purpose and timing of the literature review depends on the type of
study to be conducted. Some phenomenologists believe the literature should not be reviewed
until after the data have been collected and analyzed so that the literature will not interfere
with the researcher’s ability to suspend what is known and approach the topic with openness.

6. It is appropriate to conduct a review of the literature in which of the following circumstances?
(Select all that apply.)
a. An ethnographic study is planned.
b. A nurse is interested in conducting research on patients who “sundown.”
c. One requirement for a graduate course paper is a written literature review.
d. A hospital is attempting to develop a policy on bathing frequency for elders.
e. The hospital attorney is preparing a brief relative to a fall suffered by a patient.
ANS: A, B, C, D
For most course papers, instructors expect students to review published sources related to the
paper’s topic. Evidence-based practice guidelines are developed through the synthesis of the
literature on the clinical problem. The purpose of the literature review designed to examine
the strength of the evidence is to identify all studies that provide evidence of a particular
intervention, to critically appraise the quality of each study, and to synthesize all of the studies
providing evidence of the effectiveness of a particular intervention. The purposes for
reviewing the literature for ethnographic studies and for exploratory descriptive qualitative
research are more similar to the literature review for quantitative research. The researcher
develops a general understanding of the concepts to be examined related to the selected
culture or topic. The literature review also provides a background for conducting the study
and interpreting the findings. The focus of the major literature review at the beginning of the
research process is to identify a gap in what is known.
7. The review of literature in quantitative research directs everything from the first ideas about
the study variables through recommendations based upon the study’s conclusions. Which of
the following are outputs of the literature review in quantitative research? (Select all that
apply.)
a. Development of conceptual definitions of concepts
b. Determining the statistical power of the sample
c. Determination of how many subjects will drop out of the study
d. Description of what studies have been performed, so as to provide initial direction
for the study method
e. Interpretation of the study findings, in comparison with previous research
ANS: A, D, E
In quantitative studies, information obtained from the review of literature influences the
development of several steps in the research process (Table 6-1), which include, among other
items: developing conceptual and operational definitions, defining the purpose of the study,
establishing the research gap, synthesizing previous research in the area, selecting a research
design, and finally interpreting the study, in light of previous research.
8. Why would a reputable researcher use a secondary source instead of a primary one? (Select all
that apply.)
a. The primary publication is written in a language not currently spoken.
b. The primary source person will not consent to be interviewed, but a person who
knows the story secondhand will consent.
c. The primary publication is so steeped in jargon that it is very difficult to decipher.
d. The researcher has limited time and cannot squander it searching for primary
sources.
e. The primary publication describes only the beginnings of a theory, and a later
publication presents it in entirety.
f. There have never been any primary sources in this area.
g. The primary publication is no longer in print, and there are no extant copies.
ANS: A, B, C, E, G
The published literature contains primary and secondary sources. A primary source is written
by the person who originated, or is responsible for generating, the ideas published. A research
publication published by the person or people who conducted the research is a primary source.
A theoretical book or paper written by the theorist who developed the theory or conceptual
content is a primary source. A secondary source summarizes or quotes content from primary
sources. Thus, authors of secondary sources paraphrase the works of researchers and theorists.
The problem with a secondary source is that the author has interpreted the works of someone
else, and this interpretation is influenced by that author’s perception and bias. Authors have
sometimes spread errors and misinterpretations by using secondary sources rather than
primary sources. One should use mostly primary sources to write literature reviews.
Secondary sources are used when primary sources cannot be located or utilized, or if a
secondary source contains creative ideas or a unique organization of information not found in
a primary source.
MULTIPLE CHOICE
1. Which of the following is the research objective?

a. To answer the research question
b. To determine the strength of the statistical relationship among the variables
c. To determine whether homeless children seem to have longer length of hospital
stay, poorer verbal skills, and more fear of separation from their parents than do
other children
d. To measure length of stay, verbal skills, and fear of separation from parents in
homeless children admitted to the hospital
ANS: C
Research objectives are clear, concise, declarative statements that are expressed in the present
tense. For clarity, an objective usually focuses on one or two variables (or concepts) and
indicates whether the variables are to be identified or described. Objectives can also identify
relationships or associations among variables, determine differences between groups or
compare groups on selected variables, and predict a dependent variable based on selected
independent variables.
2. What is the research question?

a. Length of hospital stay, verbal skills, and fear of separation from parents have no
relationship to children’s homelessness.
b. Does children’s homelessness affect length of hospital stay, verbal skills, and fear
of separation from parents?
c. Was homelessness related to length of hospital stay, verbal skills, and fear of
separation from parents in this study?
d. Is homelessness in children related to length of hospital stay, verbal skills, and fear
of separation from parents?
ANS: D
A research question is a concise, interrogative statement that is worded in the present tense
and includes one or more variables (or concepts). The research questions focus on (1) the
description of the variable(s), (2) a determination of differences between two or more groups
regarding selected variables, (3) an examination of relationships among variables (relational),
and (4) the use of independent variables to predict a dependent variable. In this case (3), the
examination of relationships among variables, would be the focus of the research question,
since cause is not a focus of study.
3. What is the research hypothesis?

a. Longer length of hospital stay, worse verbal skills, and fear of separation from
parents are caused by children’s homelessness.
b. Homelessness in children is related to length of hospital stay, verbal skills, and fear
of separation from parents.
c. There is no relationship between children’s homelessness and length of hospital
stay, verbal skills, and fear of separation from parents.
d. If a child is homeless, that child is likely to have poor verbal skills, more difficulty
separating from parents, and a longer hospital stay.
ANS: B
A hypothesis is a formal statement of the expected relationship or relationships between two
or more variables in a specified population. The hypothesis translates the problem and
purpose into a clear explanation or prediction of the expected results or outcomes of the study.
A hypothesis (1) specifies the variables the researcher will manipulate or measure, (2)
identifies the population the researcher will examine, (3) indicates the type of research, and
(4) directs the conduct of the study. Hypotheses are described using the terms in the following
four categories: (1) associative versus causal, (2) simple versus complex, (3) directional
versus nondirectional, and (4) null versus research.
4. A researcher identifies three variables and formulates a hypothesis that links them. That
hypothesis is testable. What does it mean that the hypothesis is testable?
a. All the variables in the hypothesis are measurable.
b. The hypothesis must be replaced by a research question.
c. The value of the hypothesis is low.
d. The hypothesis is causational.
ANS: A
Hypotheses identify different types of relationships and numbers of variables. A well-
formulated hypothesis clearly identifies the relationship between the variables. A hypothesis’s
value is ultimately derived from whether it can be tested in the real world. A testable
hypothesis is one that contains variables that can be measured or manipulated in the world.
5. A stimulus or activity that is measured to examine the effect created by the independent
variable best describes a(n) _____ variable.
a. Independent
b. Demographic
c. Extraneous
d. Dependent
ANS: D
In quantitative research, the independent variable (intervention, treatment, or experimental
variable) is manipulated or varied by the researcher to cause an effect on the dependent
variable. The dependent variable (response or outcome variable) is measured to examine the
effect created by the independent variable. An independent variable is a stimulus or activity
that is manipulated or varied by the researcher to create an effect on the dependent variable. A
dependent variable is the response behavior or outcome that the researcher wants to predict or
explain. Extraneous variables exist in all studies and can affect the measurement of study
variables and the relationships among them. Extraneous variables are of primary concern in
quantitative studies, because they can obscure one’s understanding of the relational or causal
dynamics within the studies. Demographic variables are attributes of the subjects that are
measured during the study and used to describe the sample.
DIF: Cognitive Level: Comprehension REF: Page 145
6. The intervention that the researcher manipulates is the _____ variable.

a. Independent
b. Demographic
c. Extraneous
d. Dependent
ANS: A
In quantitative research, the independent variable (intervention, treatment, or experimental
variable) is manipulated or varied by the researcher to cause an effect on the dependent
variable. The dependent variable (response or outcome variable) is measured to examine the
effect created by the independent variable. An independent variable is a stimulus or activity
that is manipulated or varied by the researcher to create an effect on the dependent variable. A
dependent variable is the response behavior or outcome that the researcher wants to predict or
explain. Extraneous variables exist in all studies and can affect the measurement of study
variables and the relationships among them. Extraneous variables are of primary concern in
quantitative studies, because they can obscure one’s understanding of the relational or causal
dynamics within the studies. The extraneous variables that are not recognized until the study
is in process or are recognized before the study is initiated but cannot be controlled are
referred to as confounding variables. Demographic variables are attributes of the subjects that
are measured during the study and used to describe the sample.
7. It is important for the researcher to identify extraneous variables so that

a. All of the extraneous variables can be manipulated by the researcher.
b. The findings can be explained as clearly and truthfully as possible.
c. The research results are not critiqued unfairly.
d. The extraneous variables have no influence on the dependent variable.
ANS: B
Extraneous variables exist in all studies and can affect the measurement of study variables and
the relationships among them. Extraneous variables are of primary concern in quantitative
studies, because they can obscure one’s understanding of the relational or causal dynamics
within the studies. Extraneous variables are classified as (1) recognized or unrecognized and
(2) controlled or uncontrolled. The extraneous variables that are not recognized until the study
is in process or are recognized before the study is initiated but cannot be controlled are
referred to as confounding variables. Sometimes these variables can be measured during the
study and controlled statistically during analysis. In other cases, it is not possible to measure a
confounding variable, and the variable thus hinders the interpretation of findings. Such
extraneous variables must be identified as limitations or areas of study weakness in the
discussion section of a research report.
8. Simple descriptive statistics may be used to depict the sample characteristics, reflecting
demographic variable values, in which kind of research?
a. Quantitative research only
b. Qualitative research only
c. Both quantitative and qualitative research
d. Only when data has been extracted from an electronic database
ANS: C
Demographic variables are attributes of the subjects that are measured during the study and
used to describe the sample. Demographic variables are presented as the sample
characteristics, using simple descriptive statistics such as frequency and percentage, in both
quantitative and qualitative research.
9. In the following hypothesis, what is the independent variable?

Patients with recurrent bowel obstruction due to Crohn’s disease who are assigned to be
treated in an emergency room complain less frequently of pain and require less pain
medication than those patients admitted, in the usual fashion, and treated on a medical floor.
a. Bowel obstruction due to Crohn’s disease
b. Place treated
c. Number of complaints of pain
d. Number of doses of pain medication
ANS: B
An independent variable is a stimulus or activity that is manipulated or varied by the
researcher to create an effect on the dependent variable. The independent variable is also
called an intervention, treatment, or experimental variable. In this example, place treated
(emergency room versus medical floor) is the independent variable.
10. In the following purpose statement, what kind of variable is number of days absent from
class?
The purpose of this study was to examine the effects of a generous weekly allowance and
twice-weekly text messages from parents on number of days absent from class, in freshman
college students.
a. Demographic variable
b. Independent variable
c. Extraneous variable
d. Dependent variable
ANS: D
A dependent variable is the response behavior, or outcome that the researcher wants to predict
or explain. In this example, number of days absent from class is the dependent variable. An
independent variable is a stimulus or activity that is manipulated or varied by the researcher to
create an effect on the dependent variable. The independent variable is also called an
intervention, treatment, or experimental variable. Demographic variables are attributes of the
subjects that are measured during the study and used to describe the sample. Extraneous
variables exist in all studies and can affect the measurement of study variables and the
relationships among them.
11. The following statement is an example of which of the following?

There is no measurable difference in incidence of incarceration for adolescent children
whose mothers work outside the home in comparison with those whose mothers do not work
outside the home.
a. Null hypothesis
b. Confounding variable
c. Research objective
d. Research question
ANS: A
or more variables in a specified population. The null hypothesis, also referred to as a statistical
hypothesis, is used for statistical testing and interpretation of statistical outcomes. The null
hypothesis can be simple or complex and associative or causal. The null hypothesis states that
there is no relationship between two or more variables. Extraneous variables exist in all
studies and can affect the measurement of study variables and the relationships among them.
The extraneous variables that are not recognized until the study is in process, or that are
recognized before the study is initiated but cannot be controlled, are referred to as
confounding variables. Research objectives are clear, concise, declarative statements that are
expressed in the present tense, focus on one or two variables (or concepts), and indicate
whether the variables are to be identified or described. A research question is a concise,
interrogative statement that is worded in the present tense and includes one or more variables
(or concepts).
12. In the following hypothesis, what is the dependent variable?

There is no measurable difference in incidence of acne in 15-year-olds who are placed on a
chocolate-free diet.
a. Fifteen-year-olds
b. No chocolate in the diet
c. Chocolate in the diet
d. Acne
ANS: D
A dependent variable is the response behavior or outcome that the researcher wants to predict
or explain. An independent variable is a stimulus or activity that is manipulated or varied by
the researcher to create an effect on the dependent variable. In this example, acne is the
dependent variable and removal of chocolate from the diet is the independent variable.
13. What is the relationship between a conceptual definition and an operational definition?
a. The conceptual definition provides information; the operational definition provides
none.
b. The conceptual definition is concrete, and the operational definition is abstract.
c. They are the same, in most instances.
d. The operational definition allows the researcher to create a measurable variable
from a concept; the conceptual definition does not.
ANS: D
Operationalizing a variable or a concept involves developing conceptual and operational
definitions. A conceptual definition provides the theoretical meaning of a concept or variable.
The conceptual definition provides a basis for formulating an operational definition. An
operational definition is derived from a set of procedures and progressive acts that a
researcher performs either to manipulate an independent variable or to measure the existence
or degree of existence of the dependent variable.
14. In the following research question, what is the independent variable?

Can diabetics on oral antiglycemic medications achieve better control of blood sugar, as
measured by Hgb A1C, if they are taught to meditate and do this on a daily basis?
a. Oral antiglycemic medications
b. Hgb A1C
c. Meditation
d. Blood sugar
ANS: C
called an intervention, treatment, or experimental variable. In this example, nausea and
vomiting are dependent variables and guided imagery and relaxation techniques are
independent variables.
MULTIPLE RESPONSE
1. Which of the following are the research variables in this study? (Select all that apply.)
a. Patient age
b. Verbal skills
c. Homelessness
d. Parental presence
e. Fear of separation from parents
f. Whether or not a child is homeless
g. Length of hospital stay
ANS: B, E, G
Research variables or concepts are the qualities, properties, or characteristics that are
measured in qualitative studies and selected quantitative studies. Concrete concepts, such as
temperature, weight, and blood pressure, are referred to as variables in a study; abstract
concepts, such as creativity, empathy, and social support, are sometimes referred to as
research concepts.
2. Which of the following could be a dependent variable in an experimental study? (Select all
that apply.)
a. Medication A
b. The number of times the gerbil rings the bell
c. Quality of life
d. The number of times the subject is instructed in how to use the experimental
equipment
e. Vomiting
ANS: B, C, E
the researcher to create an effect on the dependent variable.
3. Which of the following could be an independent variable in an experimental study? (Select all
that apply.)
a. Quality of life
b. The percentage of moisture in the inspired air the subject breathes
c. The researcher’s preference for quantitative versus qualitative methodologies
d. Wearing a hat with a large brim
e. Seizure activity during the experiment
ANS: B, D
called an intervention, treatment, or experimental variable. A dependent variable is the
response behavior, or outcome that the researcher wants to predict or explain.
4. Which of the following are operational definitions? (Select all that apply.)
a. Length of smoking cessation is the subject’s statement of how long it has been
since the subject last smoked tobacco.
b. Pain is whatever the patient says it is, whenever the patient says it is (Margo
McCaffrey).
c. Imagination is the ability to see what will be, not what is.
d. Startle is the distance the research subject moves when a puppet tarantula is
dropped into his field of view, in front of a computer screen.
e. Nausea is the number the subject provides, on a 0- to 10-point numerical scale, in
response to being asked how nauseated the subject is.
ANS: A, D, E
An operational definition is derived from a set of procedures and progressive acts that a
researcher performs either to manipulate an independent variable or to measure the existence
or degree of existence of the dependent variable.
5. Which of the following could be a research question? (Select all that apply.)
a. What does postoperative vomiting feel like, to research subjects?
b. How is hypnosis related to smoking cessation?
c. In an English course, how do grading, praise, practice, submitting papers for
publication, and writing skills interact?
d. What are the differences between clients with pre-op orientation and those without,
in terms of procedural anxiety?
e. How does the researcher define loneliness?
ANS: A, B, C, D
Research questions meet the following criteria: (1) the identification and/or description of the
variable(s), (2) a determination of differences between two or more groups regarding selected
variables, (3) an examination of relationships among variables (relational), and (4) the use of
independent variables to predict a dependent variable.
6. Martha wants to know what happens when she fries bacon in a frying pan, versus
microwaving it: does the bacon end up moister and more flavorful when fried, or when
microwaved? What are the dependent variables? (Select all that apply.)
a. Frying bacon
b. Microwaving bacon
c. Consistent cooking temperature
d. Variable cooking temperature
e. Moistness of bacon
f. Kitchen burns
g. Flavor of bacon
ANS: E, G
the researcher to create an effect on the dependent variable. In this example, whether the
bacon ends up moister and more flavorful is the dependent variable and method of cooking is
the independent variable.

7. Ralph is an experimental psychologist. He studies rat behavior. He runs rats through a maze,
under different scent conditions. At the end of the maze is cheese. Sometimes the maze is lit,
and sometimes it is dark. During each run, the rates are subjected to different scents (cat
pheromone, the smell of cheddar cheese, tiger pheromone, the smell of rat feces) at crucial
decision-points in the maze. Ralph measures the time it takes the rats to finish the maze.
Which of the following could be considered independent variables in this study? (Select all
that apply.)
a. The rats
b. Light versus dark
c. Ralph
d. The amount of time the rats take to finish the maze
e. The scents
f. The cheese at the end of the maze
g. Rat behavior
ANS: B, E
called an intervention, treatment, or experimental variable. In this example, how long in
seconds it takes the rats to run through the maze is the dependent variables and different
scents are independent variables; light versus dark are the two experimental conditions, and
these could also affect the outcome, so they could also be considered independent variables.
8. What type of hypothesis is the following? (Select all that apply.)

Increased intake of dietary fiber in elders and increased fluid intake are associated with
fewer episodes of diverticulitis?
a. Simple hypothesis
b. Complex hypothesis
c. Causal hypothesis
d. Associative hypothesis
e. Nondirectional hypothesis
f. Directional hypothesis
ANS: B, D, F
or more variables in a specified population. A simple hypothesis predicts the relationship
(associative or causal) between two variables. A complex hypothesis predicts the relationship
(associative or causal) among three or more variables. The relationships identified in
hypotheses are associative or causal. An associative relationship identifies variables that
occur or exist together in the real world. Causal relationships identify a cause-and-effect
interaction between two or more variables. A nondirectional hypothesis states that a
relationship exists but does not predict the nature of the relationship. A directional hypothesis
states the nature or direction of the relationship between two or more variables.

Taking lessons to learn how to play bridge, and weekly practice in playing bridge, have an
effect on beginning bridge players’ win-loss ratio.
ANS: B, C, E
Having one’s house and yard professionally sprayed yearly by an extermination service has
an effect on infestations of common garden ants.
ANS: A, C, E
Providing early written feedback to undergraduate nursing students in the clinical setting
increases the incidence of desired behaviors of safe medication administration, work
efficiency, accurate charting, and competent time management.
ANS: A, C, F
Number of hours spent daily playing video games is negatively related to student
achievement in high school history class.
ANS: A, D, F
The number of children in the home is associated with noise level in that home, and with
parental stress.
ANS: B, D, E
The number of minutes a 16-year-old girl spends applying her makeup in the morning is
related to her perceived personal attractiveness.
ANS: A, D, E
Decreasing the time allotted for weekly in-class pop quizzes increases student anxiety and
decreases student grades.
ANS: B, C, F
MULTIPLE CHOICE
1. A research study offers elderly men who have, in the past, been prison inmates $1,500 for
participation in an all-day workshop at which they agree to be hypnotized and tell stories of
incarceration, which are later published. The research participants are allowed to listen to the
tapes of what they say under hypnosis and to withdraw permission to use any part of the
information. Why is this scenario a violation of self-determination?
a. Allowing participants to withdraw permission to use part of the research
information violates the study integrity and represents deception.
b. It is an example of coercion.
c. Prisoners are a vulnerable population and should not be used as research subjects.
d. What is said under hypnosis may not be true.
ANS: B
The right to self-determination is based on the ethical principle of respect for persons. This
principle holds that because humans are capable of self-determination, or controlling their
own destiny, they should be treated as autonomous agents who have the freedom to conduct
their lives as they choose without external controls. A subject’s right to self-determination can
be violated through the use of (1) coercion, (2) covert data collection, and (3) deception.
Coercion occurs when an overt threat of harm or excessive reward is intentionally presented
by one person to another to obtain his or her compliance. In the example, offering elderly men
$1,500 for one day could be considered offering an excessive reward: therefore, it is an act of
coercion violating the human right to self-determination.
2. A researcher working for Google collects data on fair treatment in the workplace. He attempts
to attach one of the raw data forms to a message to himself, so that he can finish the data
analysis at home that evening, but accidentally sends it to another employee who had provided
data for the study. The two employees, coincidentally, have an identical opinion about fair
treatment in the workplace. This best describes an example of a violation of which of the
following human rights?
a. Confidentiality
b. Fair treatment
c. Protection from harm
d. None of these—no ethical violation occurred, because the two subjects share a
point of view.
ANS: A
Confidentiality is the researcher’s management of private information shared by a subject that
must not be shared with others without the authorization of the subject. In the example,
sending one research subject the raw data of a different subject is a direct breach of
confidentiality. A breach in confidentiality can occur when a researcher, by accident or direct
action, allows an unauthorized person to gain access to raw study data. The right to fair
treatment is based on the ethical principle of justice. This principle holds that each person
should be treated fairly and should receive what he or she is due or owed. The right to
protection from discomfort and harm is based on the ethical principle of beneficence, which
holds that one should do good and, above all, do no harm.
3. In a study of outpatients experiencing panic attacks, a researcher was working in a busy clinic
waiting room and left his computer to consent a new study participant. A transcription of a
patient interview was displayed, and at the end of the transcription was the patient’s medical
record number and a list of medications currently taken. The researcher had not closed down
the screen, and when he returned to his computer, he found an adult patient playing a video
game on the computer. This best describes an example of a violation of which of the
a. Protection from the harm of exposure
b. Security
c. Confidentiality
d. Privacy
ANS: D
Privacy is an individual’s right to determine the time, extent, and general circumstances under
which personal information will be shared with or withheld from others. This information
consists of one’s attitudes, beliefs, behaviors, opinions, and records. The Privacy Act of 1974
provided the initial protection of an individual’s privacy. Because of this act, data collection
methods were to be scrutinized to protect subjects’ privacy, and data cannot be gathered from
subjects without their knowledge. Individuals also have the right to access their records and to
prevent access by others. The intent of this act was to prevent the invasion of privacy that
occurs when private information is shared without an individual’s knowledge or against his or
her will. Invading an individual’s privacy might cause loss of dignity, friendships, or
employment or create feelings of anxiety, guilt, embarrassment, or shame. The HIPAA
Privacy Rule expanded the protection of an individual’s privacy, specifically his or her
protected individually identifiable health information, and described the ways in which
covered entities can use or disclose this information. De-identifying health data involves
removing 18 elements that could be used to identify an individual. An important one on this
list is the individual’s medical record number. In the example, the researcher’s use of an
actual patient identification number on a transcription risks the human right to privacy; a code
number should have been used instead.
4. Ellen is a participant in a research study. She will receive either the customary medication to
treat her metastatic colon cancer or a new medication that has shown better results in animal
studies and one small human study. This is _____ research.
a. Coercive
b. Correlational
c. Therapeutic
d. Dangerous
ANS: C
Therapeutic research gives the patient an opportunity to receive an experimental treatment that
might have beneficial results. Nontherapeutic research is conducted to generate knowledge for
a discipline, and the results from the study might benefit future patients but will probably not
benefit those acting as research subjects. The Declaration of Helsinki differentiated
therapeutic research from nontherapeutic research. Neither descriptive nor correlational
research involves treatment or manipulation of a variable. There is no evidence of coercion.
5. A graduate student receives a mailed survey asking her to participate in research about
unpleasant experiences in graduate school. She is asked to return the survey, and the
instructions say, “Return of this instrument implies consent.” Why does this constitute
consent?
a. Studies like this are exempt from institutional review board oversight, so consent is
not required.
b. Not returning the survey constitutes refusal, and subjects may indeed refuse by not
completing the survey. The opposite is equally true.
c. The study is anonymous, so there is no risk of disclosure.
d. Only interventional research requires consent.
ANS: B
The requirements for written consent may be waived in research that “presents no more than
minimal risk of harm to subjects and involves no procedures for which written consent is
normally required outside of the research context.” For example, if questionnaires are used to
collect relatively harmless data, a signed consent form from the subjects would not be
required. The subject’s completion of the questionnaire may serve as consent. The top of the
questionnaire might contain a statement such as “Your completion of this questionnaire
indicates your consent to participate in this study.”
6. Both a subject in an experimental group who receives an experimental treatment and a subject
in a control group who receives a control treatment are considered to be subjects in
therapeutic research. Why is this?
a. A patient in an experimental research study who elects to be a member of the
experimental group knows he or she will be receiving the experimental treatment.
b. Each patient who is consented to be a research subject in an experimental study in
which the treatment has potentially beneficial results has the potential to receive a
therapeutic intervention.
c. The research is designed to measure the effect of the therapeutic treatment as
compared with the usual therapeutic treatment; hence, this is therapeutic research.
d. Each subject is blind to treatment.
ANS: C
might have beneficial results. In experimental research this means only that the subject is
recruited into the study and randomly assigned to either a treatment or control group, not that
the subject receives the experimental treatment.
DIF: Cognitive Level: Evaluation REF: Page 160
7. In what way could the researchers in the Willowbrook study have designed their research on
the hepatitis virus so that it was ethically acceptable?
a. The researchers could have given each participant a chance to assent.
b. The researchers could have performed their study on persons who were capable of
full assent.
c. The researchers could have made the study available at many institutions for the
mentally retarded.
d. The researchers could have performed descriptive research on persons already
infected with hepatitis.
ANS: D
From the mid-1950s to the early 1970s, research on hepatitis was conducted by Dr. Krugman
at Willowbrook, an institution for the mentally retarded. The subjects, all children, were
deliberately infected with the hepatitis virus. During the 20-year study, Willowbrook closed
its doors to new inmates because of overcrowded conditions. However, the research ward
continued to admit new inmates. To gain their child’s admission to the institution, the parents
were forced to give permission for the child to be a subject in the study. Because, the principal
of beneficence requires the researcher to do good and “above all, do no harm,” the only way
to study a virus that clearly harms people is non-interventionally: through descriptive or
correlational research.
8. The right an individual has to be told that he is a potential participant in a research study and
may decide not to be so best defines which of the following human rights?
a. Beneficence
b. Justice
c. Privacy
d. Self-determination
ANS: D
The right to self-determination holds that because humans are capable of self-determination,
or controlling their own destiny, they should be treated as autonomous agents who have the
freedom to conduct their lives as they choose without external controls. Privacy is an
individual’s right to determine the time, extent, and general circumstances under which
personal information will be shared with or withheld from others. Justice holds that each
person should be treated fairly and should receive what he or she is due or owed. The right to
9. The right an individual has to receive treatment even if he decides not to participate in the
research best defines which of the following human rights?
a. Beneficence
b. Justice
c. Privacy
d. Respect
ANS: B
The right to fair treatment is based on the ethical principle of justice. Privacy is the right an
individual has to determine the time, extent, and general circumstances under which personal
information will be shared or withheld from others. Such information consists of one’s
attitudes, beliefs, behaviors, opinions, and records. The right to protection from discomfort
and harm is based on the ethical principle of beneficence, which holds that one should do
good and, above all, do no harm. The right to self-determination is based on the ethical
principle of respect for persons.
10. To take positive action to prevent any harm to the research subjects best defines which of the
following principles?
a. Beneficence
b. Justice
c. Privacy
d. Respect
ANS: A
The right to protection from discomfort and harm is based on the ethical principle of
beneficence, which holds that one should do good and, above all, do no harm. This includes
positive actions taken to prevent harm to research subjects. Privacy is the right an individual
has to determine the time, extent, and general circumstances under which personal
attitudes, beliefs, behaviors, opinions, and records. The right to fair treatment is based on the
ethical principle of justice. The right to self-determination is based on the ethical principle of
respect for persons.
11. An institutional review board (IRB) ensures that (1) the rights and welfare of the individuals
involved were protected, (2) the appropriate methods were used to secure informed consent,
and (3) the potential benefits of the investigation were greater than the risks. Which of the
following is an example of how an IRB determines the level of potential risk?
a. It requires the researcher to provide a list of potential benefits to the clients, as well
as the results of a pilot study verifying this.
b. It compels the researcher to disclose his consenting process.
c. It provides for a supervisor from the IRB to be present for all data collection.
d. It reviews the researcher’s description of the study’s potential risks and compares
them with everyday risk.
ANS: D
The functions and operations of an IRB involve the review of research at three different
levels: (1) exempt from review, (2) expedited review, and (3) complete review. The level of
the review required for each study is decided by the IRB chairperson and/or committee, not by
the researcher, based on information provided by the researcher. Studies are usually exempt
from review if they pose no apparent risks for the research subjects. Studies that have some
risks, which are viewed as minimal, are expedited in the review process.
12. A researcher who is also a university professor is performing a multi-site study in which on-
site interviews are conducted with nurses in five hospitals in a major city. Each hospital has an
institutional review board (IRB). From how many IRBs or committees must the researcher
obtain permission to conduct the study?
a. Six: each of the five hospitals, and the university
b. One: only the university
c. Five: only the hospitals
d. None: educational research is exempt from review
ANS: A
Universities and healthcare agencies have IRBs that function in a similar way to review
research following federal regulations. If both a university and a hospital, or if more than one
hospital, should be involved in a research study, both IRBs must give permission for the study
to be conducted. This poses significant expenditure of time for such research.
13. What specific area of ethics does HIPAA address?

a. Privacy
b. Justice
c. Coercion to participate in a research study
d. Informed consent
ANS: A
The Health Insurance Portability and Accountability Act (HIPAA) was implemented in 2003
to protect an individual’s health information. The U.S. DHHS developed regulations titled the
Standards for Privacy of Individually Identifiable Health Information, and compliance with
these regulations is known as the Privacy Rule.
14. A researcher is applying for renewal of a large federal grant, without which his very
promising research on panic disorder cannot continue. He is completing renewal forms, which
include a synopsis of his results to date. If he excludes two of the subjects with very severe
panic disorder, and three with mental health disorders of another kind, the results are
statistically significant. He writes the report and does not mention the five subjects he
excluded. This is an instance of which of the following?
a. Beneficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: C
Fabrication in research is the making up of results and recording or reporting them.
Falsification of research is manipulating research materials, equipment, or processes, or
changing or omitting data or results such that the research is not accurately represented in the
research record. Plagiarism is the appropriation of another person’s ideas, processes, results,
or words without giving appropriate credit, including those obtained through confidential
review of others’ research proposals and manuscripts. The principle of beneficence requires
the researcher to do good and “above all, do no harm.”
15. A researcher is applying for a grant renewal on the subject of a promising new treatment for
liver cancer. His research group has used the treatment for 13 subjects. The results—9
responded and 4 did not—are not statistically significant. However, if the researcher entered
each patient as three different people and reported the results as 27 responded and 12 did not,
the results would be statistically significant. If he chose to do this, what would it represent?
a. Beneficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: B
16. A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs
but, on her advisor’s recommendation, decides to use it as a theoretical framework for her
thesis. The student goes to the library and accesses an old master’s thesis that also uses the
theory and copies three pages, word for word. She uses the other student’s reference to
Maslow’s work. This is an example of which of the following?
a. Nonmaleficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: D
Plagiarism is the appropriation of another person’s ideas, processes, results, or words without
giving appropriate credit, including those obtained through confidential review of others’
research proposals and manuscripts. Fabrication in research is the making up of results and
recording or reporting them. Falsification of research is manipulating research materials,
equipment, or processes, or changing or omitting data or results such that the research is not
accurately represented in the research record. The principle of beneficence requires the
researcher to do good and “above all, do no harm.”
thesis. The student goes online and finds a Wikipedia page and copies the description of
Maslow’s theory verbatim, putting a citation at the end of the paragraph but not using
quotation marks. This is an example of which of the following?
a. Nonmaleficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: D
18. A researcher receives permission to use the information in a hospital data set, without patient
identifiers. What level of subject consent is required?
a. Partial: the subjects must all be notified that their data is being re-used.
b. None.
c. Partial: the subjects must all be notified if the results are published.
d. Full: all subjects must be contacted and must agree to have their data used.
ANS: B
Covered entities (healthcare provider, health plan, and healthcare clearinghouse) may use and
disclose a limited data set to a researcher for a study without an individual subject’s
authorization or an IRB waiver.
19. A researcher is applying for institutional review board (IRB) approval, and the form specifies
that the researcher indicate the probable level of risk. The research creates situations in which
the RN research subjects are placed in unusual code-like situations in which they do not know
what action to take, and actors play the parts of other healthcare providers. The RN subjects
are then asked to describe their feelings and their levels of confidence as they go through 15
scenarios. What level of risk does this study pose?
a. No anticipated effects
b. Temporary discomfort
c. Unusual discomfort
d. Risk of permanent harm
ANS: B
Studies that cause temporary discomfort are described as minimal-risk studies, in which the
discomfort encountered is similar to what the subject would experience in his or her daily life
and ceases with the termination of the study. Many nursing studies require the subjects to
complete questionnaires or participate in interviews, which usually involve minimal risk. The
physical discomforts might be fatigue, headache, or muscle tension. The emotional and social
risks might entail the anxiety or embarrassment associated with responding to certain
questions. The economic risks might consist of the time spent participating in the study or
travel costs to the study site. Participation in many nursing studies is considered a mere
inconvenience for the subject, with no foreseeable risks of harm. Most clinical nursing studies
examining the impact of a treatment involve minimal risk.
20. Dr. Adamson is conducting research on a new and promising chemotherapy treatment for
breast cancer that improves survival and decreases adverse symptoms. Sixty subjects will be
recruited; of these, thirty will be assigned to the experimental group, receiving the new
treatment, and thirty to the control group, receiving the usual chemotherapy. His wife, newly
diagnosed with breast cancer, is randomly assigned to the treatment group; he removes her
from the treatment group and places her in the experimental group. What ethical violation has
occurred?
a. Mrs. Adamson has a right to self-determination: her husband has decided her
group assignment for her.
b. Mrs. Adamson’s husband has no right to know about her breast cancer: this is a
violation of confidentiality.
c. Mrs. Adamson shouldn’t be a member of the study: it’s a conflict of interest.
d. Mrs. Adamson has no right to be included in the experimental group: it unfairly
excludes someone else from this special benefit.
ANS: D
A concern with subject selection that is related to justice is that some researchers select certain
people as subjects because they like them and want them to receive the specific benefits of a
study. Other researchers have been swayed by power or money to make certain individuals
subjects so that they can receive potentially beneficial treatments. It is especially important in
research not to show preference in assigning subjects. That is the benefit of random
assignment: it is fair.
21. From an ethical point of view, what is the point of determining that a potential research
subject is incompetent?
a. An incompetent subject must receive more extensive explanation before
consenting to participate in research.
b. According to HIPAA, a different level of records security must ensue.
c. Inclusion of the subject necessitates a different consenting process.
d. The researcher has a responsibility to exclude all incompetent persons from
research participation.
ANS: C
Some persons have diminished autonomy or are vulnerable and less advantaged because of
legal or mental incompetence, terminal illness, or confinement to an institution. These persons
require additional protection of their right to self-determination, because they have a
decreased ability, or an inability, to give informed consent. In addition, these persons are
vulnerable to coercion and deception.
22. How would a professor who wants to have his students provide data for a research study go
about achieving this without involving coercion?
a. Mention that participation provides extra points.
b. Have a research assistant consent all subjects and collect all data.
c. Offer extra points to the whole class if 50% of them act as subjects.
d. Open the study to all students on campus and provide a nonacademic incentive.
ANS: D
A subject’s right to self-determination can be violated through the use of (1) coercion, (2)
covert data collection, and (3) deception. Coercion occurs when one person intentionally
presents another with an overt threat of harm or the lure of excessive reward to obtain
compliance. Sometimes students feel forced to participate in research to protect their grades or
prevent negative relationships with the faculty conducting the research. They are being
coerced.
MULTIPLE RESPONSE
1. Why are research ethics essential? (Select all that apply.)

a. Research subjects must be protected from accidental disclosure of information.
b. Institutional review boards exist to protect patient rights.
c. Researcher misconduct may result in dissemination of potentially harmful results.
d. Results published in professional journals represent a clear violation of privacy.
e. Research subjects must be protected from deliberate violation of their rights.
ANS: A, C, E
Ethical research is essential to generate sound knowledge for practice. The ethical conduct of
research has been a focus since the 1940s because of the mistreatment of human subjects in
selected studies. Human rights are claims and demands that have been justified in the eyes of
an individual or by the consensus of a group of individuals. Having rights is necessary for the
self-respect, dignity, and health of an individual. The human rights that require protection in
research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair
treatment, and (5) protection from discomfort and harm. Although institutional review boards
exist to protect patient rights, this is not a reason that research ethics are essential. Results
published in professional journals do not represent a violation of privacy if the researcher has
attended to ethical mandates.
2. Why are vulnerable populations considered vulnerable and to what are they vulnerable?
a. Physical harm because of a preexistent mental or physical condition
b. The possibility of being assigned to the experimental group
c. Unethical researchers
d. Coercion
e. Diminished autonomy because of an impaired ability to consent
ANS: A, D, E
vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable
groups of individuals, including pregnant women, human fetuses, neonates, children, mentally
incompetent persons, and prisoners, who require additional protection in the conduct of
research. Neonates are extremely vulnerable and require extra protection to determine their
involvement in research. Some hospitalized patients are survivors of trauma (such as auto
accidents, gunshot wounds, or physical and sexual abuse) who are very vulnerable and who
often have decreased decision-making capacities. Sometimes students feel forced to
participate in research to protect their grades or prevent negative relationships with the faculty
conducting the research. Other subjects are coerced to participate in studies because they
believe that they cannot refuse the excessive rewards offered, such as large sums of money,
specialized health care, special privileges, and jobs.
3. Which one of the following are considered vulnerable populations from an ethical point of
view? (Select all that apply.)
a. Students
b. Persons with osteoporosis who are subject to hip fracture
c. Persons who are depressed
d. Prisoners
e. Persons who have recently suffered loss of a spouse
ANS: A, D
research. Sometimes students feel forced to participate in research to protect their grades or
prevent negative relationships with the faculty conducting the research.
4. A nurse plans to interview prisoners as part of her master’s thesis on treatment of health
problems in correctional institutions. What special measures must she take before she studies
these potential subjects? (Select all that apply.)
a. Justify to an institutional review board why she must use prisoners as subjects.
b. Devise a consent process that provides for a conservator’s signature.
c. Destroy all of her records.
d. Devise interview questions that avoid any mention of prisons or prisoners.
e. Bracket her previous beliefs about prisoners.
f. Assure that the consent process involves no coercion.
ANS: A, F
The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant
women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who
require additional protection in the conduct of research. Researchers need to justify their use
of subjects with diminished autonomy in a study, and the need for justification increases as
the subjects’ risk and vulnerability. Subjects with diminished autonomy may be subject to
coercion.
5. A researcher conducts a mixed-methods study on exercise as a modality of controlling

hyperglycemia. The study has both quantitative results, describing the amount that glucose
falls with various amounts of exercise, and qualitative results, describing participants’ mood
and sense of well-being with different kinds of exercise. The researcher decides to publish an
article based on the quantitative findings immediately but wait to publish the qualitative
results later. What are the reasons that this would not be an instance of researcher misconduct?
a. The data from the quantitative part of the study are reported completely and
honestly.
b. The journal does not accept qualitative research.
c. Both “arms” of the study are freestanding.
d. Nobody will know that a qualitative study was performed.
e. No denial of the full scope of data collection is made.
ANS: A, C, E
Research misconduct is defined as “the fabrication, falsification, or plagiarism in processing,
performing, or reviewing research, or in reporting research results. It does not include honest
error or differences in opinion.” Fabrication in research is the making up of results and
accurately represented in the research record. The data from this study were neither fabricated
nor falsified; it is the researcher’s decision when to disseminate research results.
6. Which of the following represent a breach in confidentiality? (Select all that apply.)
a. The teenaged son of a researcher reads some of the raw interview data on the
researcher’s computer.
b. The researcher accidentally includes the real names of one participant’s husband
and two daughters in the finished article, instead of changing these to pseudonyms.
c. A researcher presents her findings at a research conference.
d. A tape of a research interview is misplaced in the researcher’s home and is never
found.
e. The researcher mentions to a colleague that all of the participants in a recent
research project on anger were divorced women.
ANS: A, B, D
A breach of confidentiality can occur when a researcher, by accident or direct action, allows
an unauthorized person to gain access to the study raw data. Confidentiality can also be
breached in the reporting or publication of a study when a subject’s identity is accidentally
revealed, violating the subject’s right to anonymity. Breaches of confidentiality can harm
subjects psychologically and socially, as well as destroy the trust they had in the researchers.
Breaches of confidentiality can be especially harmful to a research participant if they involve
(1) religious preferences; (2) sexual practices; (3) employment; (4) racial prejudices; (5) drug
use; (6) child abuse; and (7) personal attributes, such as intelligence, honesty, and courage.
7. An improvement in research ethics could prevent some or all of which of the following?
a. Breaches of anonymity
b. Researchers’ failures to report their funding sources in publications
c. Minimal risk to research participants
d. Unauthorized data collection
e. Patients’ inability to understand complex research designs
ANS: A, B, D
treatment, and (5) protection from discomfort and harm. Although Institutional Review
Boards exist to protect patient rights, this is not a reason that research ethics are essential.
Results published in professional journals do not represent a violation of privacy, if the
researcher has attended to ethical mandates.
8. In order for consent to be voluntary, which must occur? (Select all that apply.)
a. The subject must sign a consent form.
b. The subject cannot be mentally incompetent.
c. The subject cannot be shamed, forced, or cajoled into participation.
d. The subject cannot be paid (remunerated), because this would be coercive.
e. The researcher must confirm that the person signing the consent form truly
understands what the research will involve.
ANS: C, E
Voluntary consent means that the prospective subject has decided to take part in a study of his
or her own volition without coercion or any unique influence. Voluntary consent is obtained
after the prospective subject has been given essential information about the study and has
shown comprehension of this information. In some studies, the consent form may be replaced
by oral consent or the consent form may be used but the subject’s signature is waived. A
person who is mentally incompetent or incapacitated may be a research subject, but his or her
legal representative must consent for participation. If an individual is judged incompetent and
incapable of consent, the researcher must seek approval from the prospective subject and his
or her legally authorized representative. It is the researcher’s responsibility to confirm that the
person signing the consent form truly understands what the research entails. Sometimes
nursing studies have included a small financial reward of $10 to $30 or support for
transportation to increase participation, but this would not be considered coercive.
9. Which of these statements concerning guidelines for consenting children for research
participation are true? (Select all that apply.)
a. No infant or child may be used in research if he or she refuses treatment.
b. Emancipated minors may consent for themselves.
c. Coercion is wrong, but begging a child to participate is acceptable.
d. An 11-year-old should be asked to assent for research participation.
e. If infants and children participate in research, they should sign a consent form.
f. Infants cannot refuse to participate in research if their parents consent.
ANS: B, D, F
The unique vulnerability of children makes the decision to include them as research subjects
particularly important. To safeguard their interests and protect them from harm, special ethical
and regulatory considerations have been put in place for research involving children.
However, the laws defining the minor status of a child are statutory and vary from state to
state. Often a child’s competency to consent is governed by age, with incompetence being
nonrefutable up to age 7 years. Thus, a child younger than 7 years is not believed to be mature
enough to assent or consent to research. A child 7 years or older with normal cognitive
development can provide assent or dissent to participation in a study, and the process for
obtaining the assent should be included in the research proposal. To obtain informed consent,
federal regulations require both the assent of the children (when capable) and the permission
of their parents or guardians. An infant is not capable of speech or of understanding the
purpose of a research study.
10. The Tuskegee study was ethically objectionable because informed consent was flawed, an
available treatment was not provided, and deception was practiced. If informed consent had
been properly administered and research subjects informed of the availability of penicillin
when it became available, why would this still represent an ethically objectionable study?
a. The researcher has an obligation to actively do good for the research subjects;
merely informing them of the availability of penicillin would not have been
sufficient to meet this obligation.
b. It took place in one state of the Union and so had limited generalizability.
c. Some of the research subjects were illiterate and could not provide consent.
d. There was no need for the study to be performed in the first place, since enough
was known about syphilis at the time.
e. Since African American men in Alabama were in an inferior social position, they
constituted an underrepresented and potentially vulnerable population; every effort
should have been made to include participants from other ethnic groups.
ANS: A, E
In 1932, the U.S. Public Health Service (U.S. PHS) initiated a study of syphilis in black men
in the small rural town of Tuskegee, Alabama. The study, which continued for 40 years, was
conducted to determine the natural course of syphilis in the adult black male. The research
subjects were organized into two groups: one group consisted of 400 men who had untreated
syphilis and the other consisted of a control group of 200 men without syphilis. Many of the
subjects who consented to participate in the study were not informed about the purpose and
procedures of the research. Some individuals were unaware that they were subjects in a study.
The subjects were examined periodically but were not treated for syphilis, even after penicillin
was determined to be an effective treatment for the disease in the 1940s. There was
insufficient knowledge about the natural course of syphilis at the time the study was begun.
Consent of illiterate subjects does not prohibit consent. Single-site research is not considered
ethically objectionable per se.
11. A researcher obtains consent from a person with a recent traumatic brain injury (TBI) to
observe the person and test her at intervals, using cognitive survey instruments. The person
has not yet regained the ability to speak, and can understand and obey only simple commands.
She nods yes, and shakes her head for no. The subject’s husband, who has the authority to
consent for his wife because he has legal power of attorney for health care, is consented for
the study, and the patient is asked to assent.. Does this fulfill the requirements for consenting
someone with diminished capabilities? Why or why not? (Select all that apply.)
a. Yes, it does.
b. No, it does not.
c. The subject should have been told the purpose of the study over and over again,
and the tests the researcher planned to administer, until the subject nodded that she
understood. Her husband should not make this decision for her.
d. The researcher must obtain consent from both the legal representative and the
subject.
e. The researcher need not obtain assent for research involving persons with
decreased ability or total inability to give informed consent. The subject will
probably not remember any of this later, anyhow.
f. The subject should have been asked to consent, and the husband to assent. That is
the proper procedure.
g. The prospective subject can understand only simple commands but, because of her
TBI, she is not competent to consent.
h. The subject is asked to assent in case she has an opinion about this and might
understand the purpose of the study. Eliciting her cooperation is wise in either
case.
ANS: A, G, H
legal or mental incompetence, terminal illness, or confinement to an institution (Fry et al.,
2011). These persons require additional protection of their right to self-determination, because
they have a decreased ability, or an inability, to give informed consent. In addition, these
persons are vulnerable to coercion and deception. Neonates and children (minors), the
mentally impaired, and unconscious patients are legally or mentally incompetent to give
informed consent. They should, however, be asked to assent, since their cooperation is
essential for high-quality data collection. If an individual is judged incompetent and incapable
of consent, the researcher must seek approval from the prospective subject and his or her
legally authorized representative.
12. In the Jewish Chronic Disease Hospital Study, 22 patients were injected—unknowingly—with
a suspension containing live cancer cells that had been generated from human cancer tissue.
What ethical principles apply here? (Select all that apply.)
a. Beneficence
b. Self-determination
c. Anonymity
d. Confidentiality
e. Fair treatment
ANS: A, B, E
A highly publicized example of unethical research was a study conducted at the Jewish
Chronic Disease Hospital in the 1960s. Its purpose was to determine the patients’ rejection
responses to live cancer cells. Twenty-two patients were injected with a suspension containing
live cancer cells that had been generated from human cancer tissue. An extensive investigation
of this study revealed the patients were not informed that they were taking part in research or
that the injections they received were live cancer cells. In addition, the Jewish Chronic
Disease Hospital Institutional Review Board never reviewed the study; even the physicians
caring for the patients were unaware that the study was being conducted. In addition, the
principle of beneficence requires the researcher to do good and “above all, do no harm.”
13. Monica is a nurse researcher. She completes her paperwork for an institutional review board
(IRB). Her application for approval is returned to her, with comments as to how it should be
revised and resubmitted. Which of the following comments are within the scope of the IRB?
a. “You have failed to provide a copy of your survey. Please do so.”
b. “Your study protocol does not provide information on potential risks to anonymity.
Please indicate this in Section 1g.”
c. “Because of inexperience in this area, the IRB invites you to meet with us as one
of the reviewers of this protocol.”
d. “We can only provide provisional approval of your study.”
e. “You have not included information about the risk-to-benefit ratio of this research.
Please do so.”
ANS: A, B, E
An institutional review board (IRB) is a committee that reviews research to ensure that the
investigator is conducting the research ethically. Universities, hospital corporations, and many
managed care centers have IRBs to promote the conduct of ethical research and protect the
rights of prospective subjects at these institutions. Each IRB has at least five members of
various backgrounds (cultural, economic, educational, gender, racial) to promote a complete,
scholarly, and fair review of research that is commonly conducted in an institution. If an
institution regularly reviews studies with vulnerable subjects, such as children, neonates,
pregnant women, prisoners, and mentally disabled persons, the IRB should include one or
more members with knowledge about and experience in working with these individuals. The
members must have sufficient experience and expertise to review a variety of studies,
including quantitative, outcomes, intervention, and qualitative research (Munhall, 2012b). The
IRB members must not have a conflicting interest related to a study conducted in an
institution. Any member having a conflict of interest with a research project being reviewed
must excuse himself or herself from the review process, except to provide information
requested by the IRB. In reviewing the research, the reviewers may exercise all of the
authorities of the IRB such as require revision of a study protocol or study documents and
disapproval of the research. The IRB reviews research in progress at least yearly.
14. Which of the following statements are true? (Select all that apply.)
a. HIPAA regulations were formulated to address ethical treatment of research
subjects.
b. If electronic medical records had not been invented, HIPAA would not have been
necessary.
c. Data held by health insurance companies sparked the emergence of HIPAA.
d. Ethics and HIPAA regulations overlap in the area of justice.
e. Ethics and HIPAA regulations overlap in the area of anonymity.
ANS: B, C, E
One of the more recent regulations, the Health Insurance Portability and Accountability Act
(HIPAA), was enacted in 2003 to protect the privacy of an individual’s health information and
was necessitated by the electronic storage and exchange of health information. The principle
of justice holds that human subjects should be treated fairly. Anonymity exists if the subject’s
identity cannot be linked, even by the researcher, with his or her individual responses.
15. Research articles may be considered fraudulent in which of the following instances? (Select
all that apply.)
a. The person who designed the study and performed all of the research is not
mentioned as an author.
b. The authors hired someone other than themselves to collect, analyze, and interpret
the data.
c. Graduate students collected the data but did not analyze it.
d. A statistician was hired to perform all of the statistical tests.
e. Both quantitative and qualitative results were reported in the same article.
f. The authors used another researcher’s raw data without permission.
ANS: A, B, F
Editors of journals have a major role in monitoring and preventing research misconduct in the
published literature. Friedman identified criteria for classifying a publication as fraudulent,
questionable, or valid. According to these criteria, research articles were classified as
“fraudulent if there was documentation or testimony from coauthors that the publication did
not reflect what had actually been done.” Articles were questionable if no coauthor could
produce the original data or if no coauthor had personally observed or performed each phase
of the research or participation. A research article was considered valid “if some coauthor had
personally performed or participated in each aspect of the research and publication.”
DIF: Cognitive Level: Evaluation REF:
MULTIPLE CHOICE
1. A research study offers elderly men who have, in the past, been prison inmates $1,500 for
participation in an all-day workshop at which they agree to be hypnotized and tell stories of
incarceration, which are later published. The research participants are allowed to listen to the
tapes of what they say under hypnosis and to withdraw permission to use any part of the
information. Why is this scenario a violation of self-determination?
a. Allowing participants to withdraw permission to use part of the research
information violates the study integrity and represents deception.
b. It is an example of coercion.
c. Prisoners are a vulnerable population and should not be used as research subjects.
d. What is said under hypnosis may not be true.
ANS: B
The right to self-determination is based on the ethical principle of respect for persons. This
principle holds that because humans are capable of self-determination, or controlling their
own destiny, they should be treated as autonomous agents who have the freedom to conduct
their lives as they choose without external controls. A subject’s right to self-determination can
be violated through the use of (1) coercion, (2) covert data collection, and (3) deception.
Coercion occurs when an overt threat of harm or excessive reward is intentionally presented
by one person to another to obtain his or her compliance. In the example, offering elderly men
$1,500 for one day could be considered offering an excessive reward: therefore, it is an act of
coercion violating the human right to self-determination.
2. A researcher working for Google collects data on fair treatment in the workplace. He attempts
to attach one of the raw data forms to a message to himself, so that he can finish the data
analysis at home that evening, but accidentally sends it to another employee who had provided
data for the study. The two employees, coincidentally, have an identical opinion about fair
treatment in the workplace. This best describes an example of a violation of which of the
a. Confidentiality
b. Fair treatment
c. Protection from harm
d. None of these—no ethical violation occurred, because the two subjects share a
point of view.
ANS: A
Confidentiality is the researcher’s management of private information shared by a subject that
must not be shared with others without the authorization of the subject. In the example,
sending one research subject the raw data of a different subject is a direct breach of
confidentiality. A breach in confidentiality can occur when a researcher, by accident or direct
action, allows an unauthorized person to gain access to raw study data. The right to fair
treatment is based on the ethical principle of justice. This principle holds that each person
should be treated fairly and should receive what he or she is due or owed. The right to
3. In a study of outpatients experiencing panic attacks, a researcher was working in a busy clinic
waiting room and left his computer to consent a new study participant. A transcription of a
patient interview was displayed, and at the end of the transcription was the patient’s medical
record number and a list of medications currently taken. The researcher had not closed down
the screen, and when he returned to his computer, he found an adult patient playing a video
game on the computer. This best describes an example of a violation of which of the
a. Protection from the harm of exposure
b. Security
c. Confidentiality
d. Privacy
ANS: D
Privacy is an individual’s right to determine the time, extent, and general circumstances under
which personal information will be shared with or withheld from others. This information
consists of one’s attitudes, beliefs, behaviors, opinions, and records. The Privacy Act of 1974
provided the initial protection of an individual’s privacy. Because of this act, data collection
methods were to be scrutinized to protect subjects’ privacy, and data cannot be gathered from
subjects without their knowledge. Individuals also have the right to access their records and to
prevent access by others. The intent of this act was to prevent the invasion of privacy that
occurs when private information is shared without an individual’s knowledge or against his or
her will. Invading an individual’s privacy might cause loss of dignity, friendships, or
employment or create feelings of anxiety, guilt, embarrassment, or shame. The HIPAA
Privacy Rule expanded the protection of an individual’s privacy, specifically his or her
protected individually identifiable health information, and described the ways in which
covered entities can use or disclose this information. De-identifying health data involves
removing 18 elements that could be used to identify an individual. An important one on this
list is the individual’s medical record number. In the example, the researcher’s use of an
actual patient identification number on a transcription risks the human right to privacy; a code
number should have been used instead.
4. Ellen is a participant in a research study. She will receive either the customary medication to
treat her metastatic colon cancer or a new medication that has shown better results in animal
studies and one small human study. This is _____ research.
a. Coercive
b. Correlational
c. Therapeutic
d. Dangerous
ANS: C
might have beneficial results. Nontherapeutic research is conducted to generate knowledge for
a discipline, and the results from the study might benefit future patients but will probably not
benefit those acting as research subjects. The Declaration of Helsinki differentiated
therapeutic research from nontherapeutic research. Neither descriptive nor correlational
research involves treatment or manipulation of a variable. There is no evidence of coercion.
5. A graduate student receives a mailed survey asking her to participate in research about
unpleasant experiences in graduate school. She is asked to return the survey, and the
instructions say, “Return of this instrument implies consent.” Why does this constitute
consent?
a. Studies like this are exempt from institutional review board oversight, so consent is
not required.
b. Not returning the survey constitutes refusal, and subjects may indeed refuse by not
completing the survey. The opposite is equally true.
c. The study is anonymous, so there is no risk of disclosure.
d. Only interventional research requires consent.
ANS: B
The requirements for written consent may be waived in research that “presents no more than
minimal risk of harm to subjects and involves no procedures for which written consent is
normally required outside of the research context.” For example, if questionnaires are used to
collect relatively harmless data, a signed consent form from the subjects would not be
required. The subject’s completion of the questionnaire may serve as consent. The top of the
questionnaire might contain a statement such as “Your completion of this questionnaire
indicates your consent to participate in this study.”
6. Both a subject in an experimental group who receives an experimental treatment and a subject
in a control group who receives a control treatment are considered to be subjects in
therapeutic research. Why is this?
a. A patient in an experimental research study who elects to be a member of the
experimental group knows he or she will be receiving the experimental treatment.
b. Each patient who is consented to be a research subject in an experimental study in
which the treatment has potentially beneficial results has the potential to receive a
therapeutic intervention.
c. The research is designed to measure the effect of the therapeutic treatment as
compared with the usual therapeutic treatment; hence, this is therapeutic research.
d. Each subject is blind to treatment.
ANS: C
might have beneficial results. In experimental research this means only that the subject is
recruited into the study and randomly assigned to either a treatment or control group, not that
the subject receives the experimental treatment.
7. In what way could the researchers in the Willowbrook study have designed their research on
the hepatitis virus so that it was ethically acceptable?
a. The researchers could have given each participant a chance to assent.
b. The researchers could have performed their study on persons who were capable of
full assent.
c. The researchers could have made the study available at many institutions for the
mentally retarded.
d. The researchers could have performed descriptive research on persons already
infected with hepatitis.
ANS: D
From the mid-1950s to the early 1970s, research on hepatitis was conducted by Dr. Krugman
at Willowbrook, an institution for the mentally retarded. The subjects, all children, were
deliberately infected with the hepatitis virus. During the 20-year study, Willowbrook closed
its doors to new inmates because of overcrowded conditions. However, the research ward
continued to admit new inmates. To gain their child’s admission to the institution, the parents
were forced to give permission for the child to be a subject in the study. Because, the principal
of beneficence requires the researcher to do good and “above all, do no harm,” the only way
to study a virus that clearly harms people is non-interventionally: through descriptive or
correlational research.
8. The right an individual has to be told that he is a potential participant in a research study and
may decide not to be so best defines which of the following human rights?
a. Beneficence
b. Justice
c. Privacy
d. Self-determination
ANS: D
The right to self-determination holds that because humans are capable of self-determination,
or controlling their own destiny, they should be treated as autonomous agents who have the
freedom to conduct their lives as they choose without external controls. Privacy is an
individual’s right to determine the time, extent, and general circumstances under which
personal information will be shared with or withheld from others. Justice holds that each
person should be treated fairly and should receive what he or she is due or owed. The right to
9. The right an individual has to receive treatment even if he decides not to participate in the
research best defines which of the following human rights?
a. Beneficence
b. Justice
c. Privacy
d. Respect
ANS: B
The right to fair treatment is based on the ethical principle of justice. Privacy is the right an
individual has to determine the time, extent, and general circumstances under which personal
attitudes, beliefs, behaviors, opinions, and records. The right to protection from discomfort
and harm is based on the ethical principle of beneficence, which holds that one should do
good and, above all, do no harm. The right to self-determination is based on the ethical
principle of respect for persons.
10. To take positive action to prevent any harm to the research subjects best defines which of the
following principles?
a. Beneficence
b. Justice
c. Privacy
d. Respect
ANS: A
The right to protection from discomfort and harm is based on the ethical principle of
beneficence, which holds that one should do good and, above all, do no harm. This includes
positive actions taken to prevent harm to research subjects. Privacy is the right an individual
has to determine the time, extent, and general circumstances under which personal
attitudes, beliefs, behaviors, opinions, and records. The right to fair treatment is based on the
ethical principle of justice. The right to self-determination is based on the ethical principle of
respect for persons.
11. An institutional review board (IRB) ensures that (1) the rights and welfare of the individuals
involved were protected, (2) the appropriate methods were used to secure informed consent,
and (3) the potential benefits of the investigation were greater than the risks. Which of the
following is an example of how an IRB determines the level of potential risk?
a. It requires the researcher to provide a list of potential benefits to the clients, as well
as the results of a pilot study verifying this.
b. It compels the researcher to disclose his consenting process.
c. It provides for a supervisor from the IRB to be present for all data collection.
d. It reviews the researcher’s description of the study’s potential risks and compares
them with everyday risk.
ANS: D
The functions and operations of an IRB involve the review of research at three different
levels: (1) exempt from review, (2) expedited review, and (3) complete review. The level of
the review required for each study is decided by the IRB chairperson and/or committee, not by
the researcher, based on information provided by the researcher. Studies are usually exempt
from review if they pose no apparent risks for the research subjects. Studies that have some
risks, which are viewed as minimal, are expedited in the review process.
12. A researcher who is also a university professor is performing a multi-site study in which on-
site interviews are conducted with nurses in five hospitals in a major city. Each hospital has an
institutional review board (IRB). From how many IRBs or committees must the researcher
obtain permission to conduct the study?
a. Six: each of the five hospitals, and the university
b. One: only the university
c. Five: only the hospitals
d. None: educational research is exempt from review
ANS: A
Universities and healthcare agencies have IRBs that function in a similar way to review
research following federal regulations. If both a university and a hospital, or if more than one
hospital, should be involved in a research study, both IRBs must give permission for the study
to be conducted. This poses significant expenditure of time for such research.
13. What specific area of ethics does HIPAA address?

a. Privacy
b. Justice
c. Coercion to participate in a research study
d. Informed consent
ANS: A
The Health Insurance Portability and Accountability Act (HIPAA) was implemented in 2003
to protect an individual’s health information. The U.S. DHHS developed regulations titled the
Standards for Privacy of Individually Identifiable Health Information, and compliance with
these regulations is known as the Privacy Rule.
14. A researcher is applying for renewal of a large federal grant, without which his very
promising research on panic disorder cannot continue. He is completing renewal forms, which
include a synopsis of his results to date. If he excludes two of the subjects with very severe
panic disorder, and three with mental health disorders of another kind, the results are
statistically significant. He writes the report and does not mention the five subjects he
excluded. This is an instance of which of the following?
a. Beneficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: C
15. A researcher is applying for a grant renewal on the subject of a promising new treatment for
liver cancer. His research group has used the treatment for 13 subjects. The results—9
responded and 4 did not—are not statistically significant. However, if the researcher entered
each patient as three different people and reported the results as 27 responded and 12 did not,
the results would be statistically significant. If he chose to do this, what would it represent?
a. Beneficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: B
thesis. The student goes to the library and accesses an old master’s thesis that also uses the
theory and copies three pages, word for word. She uses the other student’s reference to
Maslow’s work. This is an example of which of the following?
a. Nonmaleficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: D
thesis. The student goes online and finds a Wikipedia page and copies the description of
Maslow’s theory verbatim, putting a citation at the end of the paragraph but not using
quotation marks. This is an example of which of the following?
a. Nonmaleficence
b. Fabrication
c. Falsification
d. Plagiarism
ANS: D
18. A researcher receives permission to use the information in a hospital data set, without patient
identifiers. What level of subject consent is required?
a. Partial: the subjects must all be notified that their data is being re-used.
b. None.
c. Partial: the subjects must all be notified if the results are published.
d. Full: all subjects must be contacted and must agree to have their data used.
ANS: B
Covered entities (healthcare provider, health plan, and healthcare clearinghouse) may use and
disclose a limited data set to a researcher for a study without an individual subject’s
authorization or an IRB waiver.
19. A researcher is applying for institutional review board (IRB) approval, and the form specifies
that the researcher indicate the probable level of risk. The research creates situations in which
the RN research subjects are placed in unusual code-like situations in which they do not know
what action to take, and actors play the parts of other healthcare providers. The RN subjects
are then asked to describe their feelings and their levels of confidence as they go through 15
scenarios. What level of risk does this study pose?
a. No anticipated effects
b. Temporary discomfort
c. Unusual discomfort
d. Risk of permanent harm
ANS: B
Studies that cause temporary discomfort are described as minimal-risk studies, in which the
discomfort encountered is similar to what the subject would experience in his or her daily life
and ceases with the termination of the study. Many nursing studies require the subjects to
complete questionnaires or participate in interviews, which usually involve minimal risk. The
physical discomforts might be fatigue, headache, or muscle tension. The emotional and social
risks might entail the anxiety or embarrassment associated with responding to certain
questions. The economic risks might consist of the time spent participating in the study or
travel costs to the study site. Participation in many nursing studies is considered a mere
inconvenience for the subject, with no foreseeable risks of harm. Most clinical nursing studies
examining the impact of a treatment involve minimal risk.
20. Dr. Adamson is conducting research on a new and promising chemotherapy treatment for
breast cancer that improves survival and decreases adverse symptoms. Sixty subjects will be
recruited; of these, thirty will be assigned to the experimental group, receiving the new
treatment, and thirty to the control group, receiving the usual chemotherapy. His wife, newly
diagnosed with breast cancer, is randomly assigned to the treatment group; he removes her
from the treatment group and places her in the experimental group. What ethical violation has
occurred?
a. Mrs. Adamson has a right to self-determination: her husband has decided her
group assignment for her.
b. Mrs. Adamson’s husband has no right to know about her breast cancer: this is a
violation of confidentiality.
c. Mrs. Adamson shouldn’t be a member of the study: it’s a conflict of interest.
d. Mrs. Adamson has no right to be included in the experimental group: it unfairly
excludes someone else from this special benefit.
ANS: D
A concern with subject selection that is related to justice is that some researchers select certain
people as subjects because they like them and want them to receive the specific benefits of a
study. Other researchers have been swayed by power or money to make certain individuals
subjects so that they can receive potentially beneficial treatments. It is especially important in
research not to show preference in assigning subjects. That is the benefit of random
assignment: it is fair.
21. From an ethical point of view, what is the point of determining that a potential research
subject is incompetent?
a. An incompetent subject must receive more extensive explanation before
consenting to participate in research.
b. According to HIPAA, a different level of records security must ensue.
c. Inclusion of the subject necessitates a different consenting process.
d. The researcher has a responsibility to exclude all incompetent persons from
research participation.
ANS: C
vulnerable to coercion and deception.
22. How would a professor who wants to have his students provide data for a research study go
about achieving this without involving coercion?
a. Mention that participation provides extra points.
b. Have a research assistant consent all subjects and collect all data.
c. Offer extra points to the whole class if 50% of them act as subjects.
d. Open the study to all students on campus and provide a nonacademic incentive.
ANS: D
A subject’s right to self-determination can be violated through the use of (1) coercion, (2)
covert data collection, and (3) deception. Coercion occurs when one person intentionally
presents another with an overt threat of harm or the lure of excessive reward to obtain
compliance. Sometimes students feel forced to participate in research to protect their grades or
prevent negative relationships with the faculty conducting the research. They are being
coerced.
MULTIPLE RESPONSE
1. Why are research ethics essential? (Select all that apply.)

a. Research subjects must be protected from accidental disclosure of information.
b. Institutional review boards exist to protect patient rights.
c. Researcher misconduct may result in dissemination of potentially harmful results.
d. Results published in professional journals represent a clear violation of privacy.
e. Research subjects must be protected from deliberate violation of their rights.
ANS: A, C, E
treatment, and (5) protection from discomfort and harm. Although institutional review boards
exist to protect patient rights, this is not a reason that research ethics are essential. Results
published in professional journals do not represent a violation of privacy if the researcher has
attended to ethical mandates.
2. Why are vulnerable populations considered vulnerable and to what are they vulnerable?
a. Physical harm because of a preexistent mental or physical condition
b. The possibility of being assigned to the experimental group
c. Unethical researchers
d. Coercion
e. Diminished autonomy because of an impaired ability to consent
ANS: A, D, E
research. Neonates are extremely vulnerable and require extra protection to determine their
involvement in research. Some hospitalized patients are survivors of trauma (such as auto
accidents, gunshot wounds, or physical and sexual abuse) who are very vulnerable and who
often have decreased decision-making capacities. Sometimes students feel forced to
participate in research to protect their grades or prevent negative relationships with the faculty
conducting the research. Other subjects are coerced to participate in studies because they
believe that they cannot refuse the excessive rewards offered, such as large sums of money,
specialized health care, special privileges, and jobs.
3. Which one of the following are considered vulnerable populations from an ethical point of
view? (Select all that apply.)
a. Students
b. Persons with osteoporosis who are subject to hip fracture
c. Persons who are depressed
d. Prisoners
e. Persons who have recently suffered loss of a spouse
ANS: A, D
research. Sometimes students feel forced to participate in research to protect their grades or
prevent negative relationships with the faculty conducting the research.
4. A nurse plans to interview prisoners as part of her master’s thesis on treatment of health
problems in correctional institutions. What special measures must she take before she studies
these potential subjects? (Select all that apply.)
a. Justify to an institutional review board why she must use prisoners as subjects.
b. Devise a consent process that provides for a conservator’s signature.
c. Destroy all of her records.
d. Devise interview questions that avoid any mention of prisons or prisoners.
e. Bracket her previous beliefs about prisoners.
f. Assure that the consent process involves no coercion.
ANS: A, F
The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant
women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who
require additional protection in the conduct of research. Researchers need to justify their use
of subjects with diminished autonomy in a study, and the need for justification increases as
the subjects’ risk and vulnerability. Subjects with diminished autonomy may be subject to
coercion.
5. A researcher conducts a mixed-methods study on exercise as a modality of controlling

hyperglycemia. The study has both quantitative results, describing the amount that glucose
falls with various amounts of exercise, and qualitative results, describing participants’ mood
and sense of well-being with different kinds of exercise. The researcher decides to publish an
article based on the quantitative findings immediately but wait to publish the qualitative
results later. What are the reasons that this would not be an instance of researcher misconduct?
a. The data from the quantitative part of the study are reported completely and
honestly.
b. The journal does not accept qualitative research.
c. Both “arms” of the study are freestanding.
d. Nobody will know that a qualitative study was performed.
e. No denial of the full scope of data collection is made.
ANS: A, C, E
Research misconduct is defined as “the fabrication, falsification, or plagiarism in processing,
performing, or reviewing research, or in reporting research results. It does not include honest
error or differences in opinion.” Fabrication in research is the making up of results and
accurately represented in the research record. The data from this study were neither fabricated
nor falsified; it is the researcher’s decision when to disseminate research results.
6. Which of the following represent a breach in confidentiality? (Select all that apply.)
a. The teenaged son of a researcher reads some of the raw interview data on the
researcher’s computer.
b. The researcher accidentally includes the real names of one participant’s husband
and two daughters in the finished article, instead of changing these to pseudonyms.
c. A researcher presents her findings at a research conference.
d. A tape of a research interview is misplaced in the researcher’s home and is never
found.
e. The researcher mentions to a colleague that all of the participants in a recent
research project on anger were divorced women.
ANS: A, B, D
A breach of confidentiality can occur when a researcher, by accident or direct action, allows
an unauthorized person to gain access to the study raw data. Confidentiality can also be
breached in the reporting or publication of a study when a subject’s identity is accidentally
revealed, violating the subject’s right to anonymity. Breaches of confidentiality can harm
subjects psychologically and socially, as well as destroy the trust they had in the researchers.
Breaches of confidentiality can be especially harmful to a research participant if they involve
(1) religious preferences; (2) sexual practices; (3) employment; (4) racial prejudices; (5) drug
use; (6) child abuse; and (7) personal attributes, such as intelligence, honesty, and courage.
7. An improvement in research ethics could prevent some or all of which of the following?
a. Breaches of anonymity
b. Researchers’ failures to report their funding sources in publications
c. Minimal risk to research participants
d. Unauthorized data collection
e. Patients’ inability to understand complex research designs
ANS: A, B, D
treatment, and (5) protection from discomfort and harm. Although Institutional Review
Boards exist to protect patient rights, this is not a reason that research ethics are essential.
Results published in professional journals do not represent a violation of privacy, if the
researcher has attended to ethical mandates.
8. In order for consent to be voluntary, which must occur? (Select all that apply.)
a. The subject must sign a consent form.
b. The subject cannot be mentally incompetent.
c. The subject cannot be shamed, forced, or cajoled into participation.
d. The subject cannot be paid (remunerated), because this would be coercive.
e. The researcher must confirm that the person signing the consent form truly
understands what the research will involve.
ANS: C, E
Voluntary consent means that the prospective subject has decided to take part in a study of his
or her own volition without coercion or any unique influence. Voluntary consent is obtained
after the prospective subject has been given essential information about the study and has
shown comprehension of this information. In some studies, the consent form may be replaced
by oral consent or the consent form may be used but the subject’s signature is waived. A
person who is mentally incompetent or incapacitated may be a research subject, but his or her
legal representative must consent for participation. If an individual is judged incompetent and
incapable of consent, the researcher must seek approval from the prospective subject and his
or her legally authorized representative. It is the researcher’s responsibility to confirm that the
person signing the consent form truly understands what the research entails. Sometimes
nursing studies have included a small financial reward of $10 to $30 or support for
transportation to increase participation, but this would not be considered coercive.
9. Which of these statements concerning guidelines for consenting children for research
participation are true? (Select all that apply.)
a. No infant or child may be used in research if he or she refuses treatment.
b. Emancipated minors may consent for themselves.
c. Coercion is wrong, but begging a child to participate is acceptable.
d. An 11-year-old should be asked to assent for research participation.
e. If infants and children participate in research, they should sign a consent form.
f. Infants cannot refuse to participate in research if their parents consent.
ANS: B, D, F
The unique vulnerability of children makes the decision to include them as research subjects
particularly important. To safeguard their interests and protect them from harm, special ethical
and regulatory considerations have been put in place for research involving children.
However, the laws defining the minor status of a child are statutory and vary from state to
state. Often a child’s competency to consent is governed by age, with incompetence being
nonrefutable up to age 7 years. Thus, a child younger than 7 years is not believed to be mature
enough to assent or consent to research. A child 7 years or older with normal cognitive
development can provide assent or dissent to participation in a study, and the process for
obtaining the assent should be included in the research proposal. To obtain informed consent,
federal regulations require both the assent of the children (when capable) and the permission
of their parents or guardians. An infant is not capable of speech or of understanding the
purpose of a research study.
10. The Tuskegee study was ethically objectionable because informed consent was flawed, an
available treatment was not provided, and deception was practiced. If informed consent had
been properly administered and research subjects informed of the availability of penicillin
when it became available, why would this still represent an ethically objectionable study?
a. The researcher has an obligation to actively do good for the research subjects;
merely informing them of the availability of penicillin would not have been
sufficient to meet this obligation.
b. It took place in one state of the Union and so had limited generalizability.
c. Some of the research subjects were illiterate and could not provide consent.
d. There was no need for the study to be performed in the first place, since enough
was known about syphilis at the time.
e. Since African American men in Alabama were in an inferior social position, they
constituted an underrepresented and potentially vulnerable population; every effort
should have been made to include participants from other ethnic groups.
ANS: A, E
In 1932, the U.S. Public Health Service (U.S. PHS) initiated a study of syphilis in black men
in the small rural town of Tuskegee, Alabama. The study, which continued for 40 years, was
conducted to determine the natural course of syphilis in the adult black male. The research
subjects were organized into two groups: one group consisted of 400 men who had untreated
syphilis and the other consisted of a control group of 200 men without syphilis. Many of the
subjects who consented to participate in the study were not informed about the purpose and
procedures of the research. Some individuals were unaware that they were subjects in a study.
The subjects were examined periodically but were not treated for syphilis, even after penicillin
was determined to be an effective treatment for the disease in the 1940s. There was
insufficient knowledge about the natural course of syphilis at the time the study was begun.
Consent of illiterate subjects does not prohibit consent. Single-site research is not considered
ethically objectionable per se.
11. A researcher obtains consent from a person with a recent traumatic brain injury (TBI) to
observe the person and test her at intervals, using cognitive survey instruments. The person
has not yet regained the ability to speak, and can understand and obey only simple commands.
She nods yes, and shakes her head for no. The subject’s husband, who has the authority to
consent for his wife because he has legal power of attorney for health care, is consented for
the study, and the patient is asked to assent.. Does this fulfill the requirements for consenting
someone with diminished capabilities? Why or why not? (Select all that apply.)
a. Yes, it does.
b. No, it does not.
c. The subject should have been told the purpose of the study over and over again,
and the tests the researcher planned to administer, until the subject nodded that she
understood. Her husband should not make this decision for her.
d. The researcher must obtain consent from both the legal representative and the
subject.
e. The researcher need not obtain assent for research involving persons with
decreased ability or total inability to give informed consent. The subject will
probably not remember any of this later, anyhow.
f. The subject should have been asked to consent, and the husband to assent. That is
the proper procedure.
g. The prospective subject can understand only simple commands but, because of her
TBI, she is not competent to consent.
h. The subject is asked to assent in case she has an opinion about this and might
understand the purpose of the study. Eliciting her cooperation is wise in either
case.
ANS: A, G, H
legal or mental incompetence, terminal illness, or confinement to an institution (Fry et al.,
2011). These persons require additional protection of their right to self-determination, because
they have a decreased ability, or an inability, to give informed consent. In addition, these
persons are vulnerable to coercion and deception. Neonates and children (minors), the
mentally impaired, and unconscious patients are legally or mentally incompetent to give
informed consent. They should, however, be asked to assent, since their cooperation is
essential for high-quality data collection. If an individual is judged incompetent and incapable
of consent, the researcher must seek approval from the prospective subject and his or her
legally authorized representative.
12. In the Jewish Chronic Disease Hospital Study, 22 patients were injected—unknowingly—with
a suspension containing live cancer cells that had been generated from human cancer tissue.
What ethical principles apply here? (Select all that apply.)
a. Beneficence
b. Self-determination
c. Anonymity
d. Confidentiality
e. Fair treatment
ANS: A, B, E
A highly publicized example of unethical research was a study conducted at the Jewish
Chronic Disease Hospital in the 1960s. Its purpose was to determine the patients’ rejection
responses to live cancer cells. Twenty-two patients were injected with a suspension containing
live cancer cells that had been generated from human cancer tissue. An extensive investigation
of this study revealed the patients were not informed that they were taking part in research or
that the injections they received were live cancer cells. In addition, the Jewish Chronic
Disease Hospital Institutional Review Board never reviewed the study; even the physicians
caring for the patients were unaware that the study was being conducted. In addition, the
principle of beneficence requires the researcher to do good and “above all, do no harm.”
13. Monica is a nurse researcher. She completes her paperwork for an institutional review board
(IRB). Her application for approval is returned to her, with comments as to how it should be
revised and resubmitted. Which of the following comments are within the scope of the IRB?
a. “You have failed to provide a copy of your survey. Please do so.”
b. “Your study protocol does not provide information on potential risks to anonymity.
Please indicate this in Section 1g.”
c. “Because of inexperience in this area, the IRB invites you to meet with us as one
of the reviewers of this protocol.”
d. “We can only provide provisional approval of your study.”
e. “You have not included information about the risk-to-benefit ratio of this research.
Please do so.”
ANS: A, B, E
An institutional review board (IRB) is a committee that reviews research to ensure that the
investigator is conducting the research ethically. Universities, hospital corporations, and many
managed care centers have IRBs to promote the conduct of ethical research and protect the
rights of prospective subjects at these institutions. Each IRB has at least five members of
various backgrounds (cultural, economic, educational, gender, racial) to promote a complete,
scholarly, and fair review of research that is commonly conducted in an institution. If an
institution regularly reviews studies with vulnerable subjects, such as children, neonates,
pregnant women, prisoners, and mentally disabled persons, the IRB should include one or
more members with knowledge about and experience in working with these individuals. The
members must have sufficient experience and expertise to review a variety of studies,
including quantitative, outcomes, intervention, and qualitative research (Munhall, 2012b). The
IRB members must not have a conflicting interest related to a study conducted in an
institution. Any member having a conflict of interest with a research project being reviewed
must excuse himself or herself from the review process, except to provide information
requested by the IRB. In reviewing the research, the reviewers may exercise all of the
authorities of the IRB such as require revision of a study protocol or study documents and
disapproval of the research. The IRB reviews research in progress at least yearly.
14. Which of the following statements are true? (Select all that apply.)
a. HIPAA regulations were formulated to address ethical treatment of research
subjects.
b. If electronic medical records had not been invented, HIPAA would not have been
necessary.
c. Data held by health insurance companies sparked the emergence of HIPAA.
d. Ethics and HIPAA regulations overlap in the area of justice.
e. Ethics and HIPAA regulations overlap in the area of anonymity.
ANS: B, C, E
One of the more recent regulations, the Health Insurance Portability and Accountability Act
(HIPAA), was enacted in 2003 to protect the privacy of an individual’s health information and
was necessitated by the electronic storage and exchange of health information. The principle
of justice holds that human subjects should be treated fairly. Anonymity exists if the subject’s
identity cannot be linked, even by the researcher, with his or her individual responses.
15. Research articles may be considered fraudulent in which of the following instances? (Select
all that apply.)
a. The person who designed the study and performed all of the research is not
mentioned as an author.
b. The authors hired someone other than themselves to collect, analyze, and interpret
the data.
c. Graduate students collected the data but did not analyze it.
d. A statistician was hired to perform all of the statistical tests.
e. Both quantitative and qualitative results were reported in the same article.
f. The authors used another researcher’s raw data without permission.
ANS: A, B, F

NUSS 500 - Part2

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schools studied had a disproportionate number of students who reported

sleeplessness, nervousness, nightmares, and guilt. These were attributed to various

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2. A student’s first draft of her thesis contains the following:

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1. Which of the following is the research objective?

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2. What is the research question?

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3. What is the research hypothesis?

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6. The intervention that the researcher manipulates is the _____ variable.

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7. It is important for the researcher to identify extraneous variables so that

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9. In the following hypothesis, what is the independent variable?

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11. The following statement is an example of which of the following?

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12. In the following hypothesis, what is the dependent variable?

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14. In the following research question, what is the independent variable?

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8. What type of hypothesis is the following? (Select all that apply.)

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9. What type of hypothesis is the following? (Select all that apply.)

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13. What specific area of ethics does HIPAA address?