COMMUNITY HEALTH FINAL TEST BANK QUESTIONS AND RATIONALE

1. When and by whom was nursing’s first code of ethics written? a. 1893, by Lystra Gretter b. 1950, by the ANA House of Delegates c. 1953, by the International Council of Nurses (ICN) d. 2001, by the ANA House of Delegates ANS: A The Nightingale Pledge, considered nursing’s first code of ethics, was written by Lystra Gretter in 1893. DIF: Cognitive Level: Remember (Knowledge) REF: p. 53 2. A nurse didn’t know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn’t seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse’s actions? a. Appropriate, because the supervisor is responsible for the nurse’s choices b. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn’t considered c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices ANS: C Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. DIF: Cognitive Level: Apply (Application) REF: p. 54 3. Which of the following is the first and most crucial step in the ethical decision-making process? a. Assess the context or environment in which the decision must be made. b. Consider the various ethical principles or theories. c. Identify the ethical concerns. d. Make a decision and act on it. ANS: C The first step in the ethical decision-making framework is to carefully identify the ethical issue or dilemma. DIF: Cognitive Level: Understand (Comprehension) REF: p. 54 4. A nurse is asked to meet with a family who recently emigrated from Botswana (Africa). After the clinical doctor tells the husband the wife’s diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse’s most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family’s current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family’s well-being ANS: D Any of the actions might be taken. However, the United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family’s cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures the family, rather than the individual, is the unit of primary concern. DIF: Cognitive Level: Analyze (Analysis) REF: p. 54 5. The nurse learns that a family has decided not to accept medical intervention for a health care problem because paying for the care would drastically reduce the family’s resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. c. Talk to the media to see whether a campaign to raise funds for the family can be created. d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious. ANS: A As Callahan described, although the nurse may attempt moral persuasion to change the family’s values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family’s values. DIF: Cognitive Level: Apply (Application) REF: p. 54 6. Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It is a wife’s responsibility to care for an ill husband.” Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism ANS: C The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. DIF: Cognitive Level: Apply (Application) REF: p. 55 7. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “The whole family is being affected and will fall apart if they don’t focus on their family’s needs first before anything else.” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism ANS: D By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. DIF: Cognitive Level: Apply (Application) REF: p. 55 8. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “But it doesn’t have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn’t that be fair?” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism ANS: C The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). DIF: Cognitive Level: Apply (Application) REF: p. 56 9. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It’s not up to us; it’s the family’s decision. They know what is best for them.” Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism ANS: C The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values and goals. Therefore, the nurse is using principlism— that is, basic principles are the basis of the nurse’s actions. DIF: Cognitive Level: Apply (Application) REF: p. 56 10. Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principles ANS: D In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle.