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17. 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 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
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.”

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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.

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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.

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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.

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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.

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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.

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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.

DIF: Cognitive Level: Synthesis REF: Page 159

2. Why are vulnerable populations considered vulnerable and to what are they vulnerable?
(Select all that apply.)
 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
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. 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.

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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
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. 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. Sometimes students feel forced to participate in research to protect their grades or
prevent negative relationships with the faculty conducting the research.

DIF: Cognitive Level: Analysis REF: Page 165

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.

DIF: Cognitive Level: Analysis REF: Page 165

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?
(Select all that apply.)
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
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 data from this study were neither fabricated
nor falsified; it is the researcher’s decision when to disseminate research results.

DIF: Cognitive Level: Evaluation REF: Page 188

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.