NSG 4067: LEGAL AND ETHICAL CONCERNS
1. A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance
directives in the chart. Which of the following questions will best prepare the nurse to begin a
dialogue with this client about advance directives?
A) "With whom do you talk to about your health care decisions?"
B) "I see that you have no advanced directives on your chart, could you tell me about that?"
C) "Is there someone we should call to join us while we discuss your care?"
D) "Tell me about your living arrangements; do you live alone or with others?"
Ans: A
Feedback:
Nurses need to identify patterns of culturally influenced decision making in order to ask
questions and obtain relevant information from clients of different cultures. Why there are no
advance directives on the chart is not the place to start to open the conversation. Whether or not
she lives with someone, inviting family to join reflects an emphasis on family caregiving
consistent with the Hispanic culture.
2. A nurse discusses advance medical directives with a group of older adults at the senior
citizens' center. Which of the following statements made by a member of the group indicates a
need for further teaching about medical directives?
A) "Advance directives address the person's right to refuse medical treatment."
B) "It is helpful to see an attorney before completing a durable power of attorney."
C) "Advance directives provide legal assurances that a person's preferences will be
considered."
D) "A durable power of attorney cannot be initiated before a person is incapacitated."
Ans: D
Feedback:
Medical directives focus on the right to refuse treatment and address the person's desires for
medical treatment in certain circumstances. The durable power of attorney for health care must
be initiated when the person is competent, but it takes effect only when the person is
incapacitated. Medical directives cannot guarantee that a medical intervention will be completed,
but they give assurances that the person's preferences will be considered.
3. An 87-year-old woman has a history of depression and hypothyroidism. She was recently
diagnosed as having breast cancer. Her daughter tells her health care provider that her mother
cannot participate in decision making about her care because she is too old. Which of the
following statements is true about decision-making capacity?
, A) Determination of decision-making capacity is based on the older adult's diagnosis and
chronologic age.
B) The older adult has decision-making capacity if she understands most of the risks and
benefits of medical treatment.
C) The older adult needs to understand the issues involved in decision making and
communicate about them.
D) Decision-making capacity of older adults is always determined by a mental health judge.
Ans: C
Feedback:
Decision making should not be determined by the diagnosis or the age of the older adult. The
older adult needs to understand all of the risks and benefits of medical treatment. Decision-
making capacity is determined by the health care practitioner or by the interdisciplinary team
assigned to the client.
4. An older woman of Filipino heritage has been having rectal bleeding for several months. Her
physician has told the woman and her daughters that she has advanced colon cancer. Her
daughters want to obtain hospice services but the client is reluctant and does not want to discuss
what she feels is "beyond her control." Which of the following concerns is this client most likely
experiencing?
A) Entrenched optimism in health care providers
B) Individual autonomy regarding end of life
C) Impaired cognition secondary to cancer
D) Cultural taboo to discuss death
Ans: D
Feedback:
Some members of the Filipino culture believe in fatalism and resist any discussion about or
planning for events beyond one's control such as illness or death, because it is viewed as
tempting fate and will likely bring the potential event into reality.
5. A nurse manager of a nursing care facility reviews potential health and safety interventions
and outcomes with the nursing staff. Which of the following interventions places emphasis on
quality of life with the best possible health and safety outcomes?
A) Telling the resident about his or her schedule for the day
B) Allowing the resident with a history of falls to walk with the help of an assistant
C) Discouraging the resident who states they are tired from participating in activities
D) Advising the resident not to attend church because the resident is not Catholic
Ans: B
1. A 76-year-old Hispanic woman has been admitted to the hospital. There are no advance
directives in the chart. Which of the following questions will best prepare the nurse to begin a
dialogue with this client about advance directives?
A) "With whom do you talk to about your health care decisions?"
B) "I see that you have no advanced directives on your chart, could you tell me about that?"
C) "Is there someone we should call to join us while we discuss your care?"
D) "Tell me about your living arrangements; do you live alone or with others?"
Ans: A
Feedback:
Nurses need to identify patterns of culturally influenced decision making in order to ask
questions and obtain relevant information from clients of different cultures. Why there are no
advance directives on the chart is not the place to start to open the conversation. Whether or not
she lives with someone, inviting family to join reflects an emphasis on family caregiving
consistent with the Hispanic culture.
2. A nurse discusses advance medical directives with a group of older adults at the senior
citizens' center. Which of the following statements made by a member of the group indicates a
need for further teaching about medical directives?
A) "Advance directives address the person's right to refuse medical treatment."
B) "It is helpful to see an attorney before completing a durable power of attorney."
C) "Advance directives provide legal assurances that a person's preferences will be
considered."
D) "A durable power of attorney cannot be initiated before a person is incapacitated."
Ans: D
Feedback:
Medical directives focus on the right to refuse treatment and address the person's desires for
medical treatment in certain circumstances. The durable power of attorney for health care must
be initiated when the person is competent, but it takes effect only when the person is
incapacitated. Medical directives cannot guarantee that a medical intervention will be completed,
but they give assurances that the person's preferences will be considered.
3. An 87-year-old woman has a history of depression and hypothyroidism. She was recently
diagnosed as having breast cancer. Her daughter tells her health care provider that her mother
cannot participate in decision making about her care because she is too old. Which of the
following statements is true about decision-making capacity?
, A) Determination of decision-making capacity is based on the older adult's diagnosis and
chronologic age.
B) The older adult has decision-making capacity if she understands most of the risks and
benefits of medical treatment.
C) The older adult needs to understand the issues involved in decision making and
communicate about them.
D) Decision-making capacity of older adults is always determined by a mental health judge.
Ans: C
Feedback:
Decision making should not be determined by the diagnosis or the age of the older adult. The
older adult needs to understand all of the risks and benefits of medical treatment. Decision-
making capacity is determined by the health care practitioner or by the interdisciplinary team
assigned to the client.
4. An older woman of Filipino heritage has been having rectal bleeding for several months. Her
physician has told the woman and her daughters that she has advanced colon cancer. Her
daughters want to obtain hospice services but the client is reluctant and does not want to discuss
what she feels is "beyond her control." Which of the following concerns is this client most likely
experiencing?
A) Entrenched optimism in health care providers
B) Individual autonomy regarding end of life
C) Impaired cognition secondary to cancer
D) Cultural taboo to discuss death
Ans: D
Feedback:
Some members of the Filipino culture believe in fatalism and resist any discussion about or
planning for events beyond one's control such as illness or death, because it is viewed as
tempting fate and will likely bring the potential event into reality.
5. A nurse manager of a nursing care facility reviews potential health and safety interventions
and outcomes with the nursing staff. Which of the following interventions places emphasis on
quality of life with the best possible health and safety outcomes?
A) Telling the resident about his or her schedule for the day
B) Allowing the resident with a history of falls to walk with the help of an assistant
C) Discouraging the resident who states they are tired from participating in activities
D) Advising the resident not to attend church because the resident is not Catholic
Ans: B
