Ethics

Question 1

1. Which of the following statements is true?

a. Decision-making capacity can be determined only by a psychiatrist.
b. A diagnosis of dementia precludes competent decision making.
c. Lack of decision-making capacity should not be presumed if the patient goes against medical advice.
d. Expression of a choice is sufficient to indicate decision-making capacity.

Answer 1

c. Lack of decision-making capacity should not be presumed if the patient goes against medical advice.

Question 2

2. Which of the following statements concerning advance directives is true?

a. The Supreme Court has established a standard advance directive form.
b. The living will is used to appoint a healthcare agent to make medical decisions if an individual loses decision-making capacity.
c. A DNR order is not equivalent to a do-not-treat order.
d. Periods of acute illness are the most appropriate times to begin discussions with patients about advance directives.

Answer 2

c. A DNR order is not equivalent to a do-not-treat order.

Question 3

3. The following are components of the open disclosure of medical error, except:

a. An apology to the injured patient.
b. An explanation of the error in lay language.
c. A best guess as to why the error occurred.
d. An assurance that a full investigation will take place.

Answer 3

c. A best guess as to why the error occurred.

Question 4

4. Mrs. Gloth is an 84-year-old woman whom you are admitting to the nursing home. Her son takes you aside and tells you that she has metastatic ovarian cancer but has not been told the diagnosis. He asks that you not tell her, because she would “lose all hope and die.” Which of the following is an appropriate response?

a. Tell the son that you are going to immediately inform the patient of her diagnosis.
b. Tell the son that he can count on you to respect his wishes.
c. Suggest that you discuss this further after getting to know the patient and family a little better.
d. Find out from the son what the family has been telling her about her health, so you will maintain a consistent story.

Answer 4

c. Suggest that you discuss this further after getting to know the patient and family a little better.

Question 5

5. Dr. Smith is obtaining informed consent from Mr. Jones to perform a colonoscopy, because the patient had blood in his stool and Dr. Smith is concerned that this might indicate the presence of carcinoma of the colon. Mr. Jones is able to recite back to Dr. Smith what a colonoscopy is, how it is done, and that a colonoscopy is performed to look for cancer. He then tells Dr. Smith that he is refusing the procedure; he knows he does not have cancer because he has not experienced any bleeding. Of the following required elements for Mr. Jones’s decision-making capacity, which is impaired?

a. Understanding
b. Appreciation
c. Ability to express a choice

Answer 5

b. Appreciation

Question 6

6. George Hall is a 91-year-old man visiting his physician to receive the results of a recent computed tomography scan of his abdomen. He is cognitively intact and still works 2 days a week. He is accompanied by his daughter Eleanor. She takes the doctor aside before the appointment and says, “Please do not tell my father any bad news. It would just kill him.” If the physician were to agree, which ethical principles might this violate?

a. Paternalism
b. Autonomy
c. Authenticity
d. None of the above
e. Answers a, b, and c

Answer 6

b. Autonomy

Question 7

7. Lenore White is an 80-year-old woman who smokes two packs of cigarettes per day. She is hospitalized for pneumonia because she has presenting symptoms of cough and fever. On her second day of hospitalization, she asks the nurse to please wheel her outside so she can smoke a cigarette. The nurse feels uncomfortable agreeing to this and speaks to her clinical nurse manager. What two ethical principles are in conflict?
   a. Beneficence and community
   b. Nonmaleficence and justice
   c. Autonomy and justice
   d. Autonomy and nonmaleficence

Answer 7

d. Autonomy and nonmaleficence

Question 8

8. Ms. Greta Thornberg is an 88-year-old woman admitted to the hospital with a diagnosis of squamous cell carcinoma of the lung with metastases to liver. She has signed a POLST indicating that she would like no limitation on life-sustaining measures, including resuscitation, artificial feeding, antibiotics, and hydration. On the second day of her stay, she sustains a stroke, resulting in global aphasia and hemiparesis. As her clinician, in addition to instituting appropriate medical management, you contact her healthcare agent and:

a. Inform her healthcare agent of the POLST and notify her that it cannot be changed.
b. Inform her healthcare agent of the POLST and notify her that the change of condition requires that the POLST be reviewed.
c. Ask her healthcare agent to locate her Last Will and Testament.
d. Since she has a signed POLST, there is no reason to contact the healthcare agent.

Answer 8

b. Inform her healthcare agent of the POLST and notify her that the change of condition requires that the POLST be reviewed.

Question 9

Nonmaleficence

Answer 9

You’ve likely already heard of this ethical principle, which is to do no harm. Nursing nonmaleficence echoes exactly that. Nurses have a critical responsibility to prevent further harm from coming to all their patients. Each nurse must take action to prevent harm.
Nonmaleficence in nursing is essential to safe, effective patient care that is delivered to the best of a nurse’s ability.

Question 10

Autonomy

Answer 10

The autonomy ethical principle requires each nurse be able to perform their duties using their own knowledge and professional judgement appropriate for each unique patient interaction. To uphold a code of ethics in nursing, nurses must act only within their scope of practice, yet continue to provide full, high-quality care. Autonomy is an essential part of all aspects of nursing practice, helping nurses make appropriate decisions based on critical thinking. The autonomy ethical principle goes hand in hand with accountability.

Question 11

Beneficence

Answer 11

Beneficence in nursing can be defined as the charity and kindness nurses offer to other people, which is demonstrated by their actions in the medical setting. Beneficence means that nurses perform actions intended to benefit others; they act with the patient’s best interests in mind. In
order to act with beneficence in nursing, each nurse must approach each patient as a unique individual with their own life circumstances, opinions, and experiences. Beneficence also means that nurses must put aside their own personal feelings to provide care to the best of their abilities.