Chapter 03: Critical Thinking, Ethical Decision Making, and the
Nursing Process Hinkle: Brunner & Suddarth's Textbook of Medical-
Surgical Nursing, 13th Edition
MULTIPLE CHOICE
1. A nurse has been offered a position on an obstetric unit and has learned that the
unit offers therapeutic abortions, a procedure which contradicts the nurse's
personal beliefs. What is the nurse's ethical obligation to these patients?
A) The nurse should adhere to professional standards of practice and
offer service to these patients.
B) The nurse should make the choice to decline this position and
pursue a different nursing role.
C) The nurse should decline to care for the patients considering abortion.
D) The nurse should express alternatives to women considering terminating their
pregnancy.
ANS: B
To avoid facing ethical dilemmas, nurses can follow certain strategies. For
example, when applying for a job, a nurse should ask questions regarding the
patient population. If a nurse is uncomfortable with a particular situation, then
not accepting the position would be the best option. The nurse is only required
by law (and practice standards) to provide care to the patients the clinic accepts;
the nurse may not discriminate between patients and the nurse expressing his or
her own opinion and providing another option is inappropriate.
2. A terminally ill patient you are caring for is complaining of pain. The physician
has ordered a large dose of intravenous opioids by continuous infusion. You
know that one of the adverse effects of this medicine is respiratory depression.
When you assess your patient's respiratory status, you find that the rate has
decreased from 16 breaths per minute to 10 breaths per minute. What action
should you take?
A) Decrease the rate of IV infusion.
, B) Stimulate the patient in order to increase respiratory rate.
C) Report the decreased respiratory rate to the physician.
D) Allow the patient to rest comfortably.
ANS: C
End-of life issues that often involve ethical dilemmas include pain control, do
not resuscitate orders, life-support measures, and administration of food and
fluids. The risk of respiratory depression is not the intent of the action of pain
control. Respiratory depression should not be used as an excuse to withhold
pain medication for a terminally ill patient. The patient's respiratory status
should be carefully monitored and any changes should be reported to the
physician.
3. An adult patient has requested a do not resuscitate (DNR) order in light of his
recent diagnosis with late stage pancreatic cancer. The patient's son and
daughter-in-law are strongly opposed to the patient's request. What is the
primary responsibility of the nurse in this situation?
A) Perform a slow code until a decision is made.
B) Honor the request of the patient.
C) Contact a social worker or mediator to intervene.
D) Temporarily withhold nursing care until the physician talks to the family.
ANS: B
The nurse must honor the patient's wishes and continue to provide required
nursing care. Discussing the matter with the physician may lead to further
communication with the family, during which the family may reconsider their
decision. It is not normally appropriate for the nurse to seek the assistance of a
social worker or mediator. A slow code is considered unethical.
, 4. An elderly patient is admitted to your unit with a diagnosis of community-
acquired pneumonia. During admission the patient states, I have a living will.
What implication of this should the nurse recognize?
A) This document is always honored, regardless of circumstances.
B) This document specifies the patient's wishes before hospitalization.
C) This document that is binding for the duration of the patient's life.
D) This document has been drawn up by the patient's family to determine DNR status.
ANS: B
A living will is one type of advance directive. In most situations, living wills
are limited to situations in which the patient's medical condition is deemed
terminal. The other answers are incorrect because living wills are not always
honored, they are not binding for the duration of the patient's life, and they are
not drawn up by the patient's family.
5. A nurse has been providing ethical care for many years and is aware of the need
to maintain the ethical principle of nonmaleficence. Which of the following
actions would be considered a contradiction of this principle?
A) Discussing a DNR order with a terminally ill patient
B) Assisting a semi-independent patient with ADLs
C) Refusing to administer pain medication as ordered
D) Providing more care for one patient than for another
ANS: C
The duty not to inflict as well as prevent and remove harm is termed
nonmaleficence. Discussing a DNR order with a terminally ill patient and
assisting a patient with ADLs would not be considered contradictions to the
nurse's duty of nonmaleficence. Some patients justifiably require more care than
others.
6. You have just taken report for your shift and you are doing your initial
assessment of your patients. One of your patients asks you if an error has been
Nursing Process Hinkle: Brunner & Suddarth's Textbook of Medical-
Surgical Nursing, 13th Edition
MULTIPLE CHOICE
1. A nurse has been offered a position on an obstetric unit and has learned that the
unit offers therapeutic abortions, a procedure which contradicts the nurse's
personal beliefs. What is the nurse's ethical obligation to these patients?
A) The nurse should adhere to professional standards of practice and
offer service to these patients.
B) The nurse should make the choice to decline this position and
pursue a different nursing role.
C) The nurse should decline to care for the patients considering abortion.
D) The nurse should express alternatives to women considering terminating their
pregnancy.
ANS: B
To avoid facing ethical dilemmas, nurses can follow certain strategies. For
example, when applying for a job, a nurse should ask questions regarding the
patient population. If a nurse is uncomfortable with a particular situation, then
not accepting the position would be the best option. The nurse is only required
by law (and practice standards) to provide care to the patients the clinic accepts;
the nurse may not discriminate between patients and the nurse expressing his or
her own opinion and providing another option is inappropriate.
2. A terminally ill patient you are caring for is complaining of pain. The physician
has ordered a large dose of intravenous opioids by continuous infusion. You
know that one of the adverse effects of this medicine is respiratory depression.
When you assess your patient's respiratory status, you find that the rate has
decreased from 16 breaths per minute to 10 breaths per minute. What action
should you take?
A) Decrease the rate of IV infusion.
, B) Stimulate the patient in order to increase respiratory rate.
C) Report the decreased respiratory rate to the physician.
D) Allow the patient to rest comfortably.
ANS: C
End-of life issues that often involve ethical dilemmas include pain control, do
not resuscitate orders, life-support measures, and administration of food and
fluids. The risk of respiratory depression is not the intent of the action of pain
control. Respiratory depression should not be used as an excuse to withhold
pain medication for a terminally ill patient. The patient's respiratory status
should be carefully monitored and any changes should be reported to the
physician.
3. An adult patient has requested a do not resuscitate (DNR) order in light of his
recent diagnosis with late stage pancreatic cancer. The patient's son and
daughter-in-law are strongly opposed to the patient's request. What is the
primary responsibility of the nurse in this situation?
A) Perform a slow code until a decision is made.
B) Honor the request of the patient.
C) Contact a social worker or mediator to intervene.
D) Temporarily withhold nursing care until the physician talks to the family.
ANS: B
The nurse must honor the patient's wishes and continue to provide required
nursing care. Discussing the matter with the physician may lead to further
communication with the family, during which the family may reconsider their
decision. It is not normally appropriate for the nurse to seek the assistance of a
social worker or mediator. A slow code is considered unethical.
, 4. An elderly patient is admitted to your unit with a diagnosis of community-
acquired pneumonia. During admission the patient states, I have a living will.
What implication of this should the nurse recognize?
A) This document is always honored, regardless of circumstances.
B) This document specifies the patient's wishes before hospitalization.
C) This document that is binding for the duration of the patient's life.
D) This document has been drawn up by the patient's family to determine DNR status.
ANS: B
A living will is one type of advance directive. In most situations, living wills
are limited to situations in which the patient's medical condition is deemed
terminal. The other answers are incorrect because living wills are not always
honored, they are not binding for the duration of the patient's life, and they are
not drawn up by the patient's family.
5. A nurse has been providing ethical care for many years and is aware of the need
to maintain the ethical principle of nonmaleficence. Which of the following
actions would be considered a contradiction of this principle?
A) Discussing a DNR order with a terminally ill patient
B) Assisting a semi-independent patient with ADLs
C) Refusing to administer pain medication as ordered
D) Providing more care for one patient than for another
ANS: C
The duty not to inflict as well as prevent and remove harm is termed
nonmaleficence. Discussing a DNR order with a terminally ill patient and
assisting a patient with ADLs would not be considered contradictions to the
nurse's duty of nonmaleficence. Some patients justifiably require more care than
others.
6. You have just taken report for your shift and you are doing your initial
assessment of your patients. One of your patients asks you if an error has been
