Question 1

The nurse learns that a family has declined an elective 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?

Accepted Answer

According to Callahan,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.Because there is no immediate or grievous harm,it is not in the best interest of the nurse to interfere with the family's decision.Thus,the other answers are not an appropriate action for the nurse to take.

Question 2

How are ethics and public policies similar?

Accepted Answer

An important goal of both policy and ethics is to achieve the public good,and both are involved in good citizenship.Ethics involves the application of specific principles when making decisions.There is nothing that supports that ethics and public policies are better achieved by those in high political office.

Question 3

Which of the following is considered the most important goal in nursing today?

Accepted Answer

Since the mid-1980s,nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing practice.Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationship between the patient and the care provider.The primary goal of nursing is not to adapt to technological advances,distinguish nursing from medical care,or seek evidence based outcomes; rather,the goal of nursing is to implement caring which has been the moral ideal of nursing for many years.

Question 4

Which of the following is generally considered to be nursing's first code of ethics?

Accepted Answer

The Nightingale Pledge is generally considered to be nursing's first code of ethics.After the Nightingale Pledge,the Code for Professional Nurses was formally adopted by the ANA House of Delegates in 1950.It was amended and revised five more times,until,in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements.The Principles of the Ethical Practice of Public Health was approved in 2002.

Question 5

A man entered the emergency department bleeding profusely and screaming,"I've got to see a doctor right now! I've got a right to see a doctor! I'm hurt.You have to take care of me!" Which of the following premises would ethically justify such a demand for immediate attention?

Accepted Answer

The ethical theory of egalitarianism suggests that everyone is entitled to equal rights,equal treatment,and an equal share of the goods of society-and that the government's role is to ensure this happens,at least on a basic level.Therefore,the man has a right to emergency care.Hospital funding and use of tax payer money does not demonstrate the use of an ethical principle.Saving an individual's life may or may not improve society.There is not an ethical principle that states that the man has a property right to his own body.

Question 6

A new nurse states to a nursing colleague,"But why do I have to be involved in politics? I just want to be the very best clinical nurse I can." Which of the following would be the best response from the nursing colleague?

Accepted Answer

To be a good clinical nurse,the nurse needs resources and supportive policies that can be obtained only through political action to ensure those very resources and policies.Many clients are members of vulnerable groups who have often previously lacked access to quality care at an affordable cost.The American Nurses Association Code of Ethics for Nurses emphasizes political action as the mechanism to effect social justice and reform regarding homelessness,violence,and stigmatization.Nurses need to be involved in the political process in more ways than only being a dues paying member to the American Nurses Association.Clinical practice is not the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse.Nurses must make a conscious effort to be involved in political action.

Question 7

The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient.Which of the following approaches should the nurse use in personally deciding what is right?

Accepted Answer

One of the rules in deontological decision making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly.In the same way,principlism suggests the nurse examine the context and make the decision that can be morally justified within that context.In order to apply the deontological ethics decision process the nurse must first determine the moral rules that serve as standards by which individuals can perform their moral obligations,examine their own personal motives,and then determine wheter the proposed actions can be generalized.Doing whatever will not get the nurse in trouble,whatever is suppported by an ethical expert,or whatever the nurse supervisor feels comfortable with is not an appropriate way to make an ethical decision.

Question 8

Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care?

Accepted Answer

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.Upholding ethical principles should be the first consideration before obeying legal mandates or doing what is best for the community or family.

Question 9

Which of the following is the first and most crucial step in a generic ethical decision-making process?

Accepted Answer

The first step in the ethical decision-making framework is to identify the ethical issue or dilemma.After the first step of identifying the ethical concern,the following steps are: (2)place the ethical issue or dilemma within a meaningful context,(3)obtain all relevant facts,(4)reformulate ethical issues or dilemmas,if needed,(5)consider appropriate approaches to action or options,(6)make the decision and take action,and (7)evaluate the decision and action.

Question 10

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?

Accepted Answer

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).Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community.The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

Question 11

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?

Accepted Answer

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.Principlism relies on these ethical principles to guide decision making.Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community.The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

Question 12

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?

Accepted Answer

The nurse is focusing on duty,which is a deontological approach based on the moral obligation to engage in certain actions.The nurse is focusing on duty,which is a deontological approach based on the moral obligation to engage in certain actions.

Question 13

How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions?

Accepted Answer

The end products of appropriate advocacy are decreased morbidity and mortality.In other words,if advocacy has been effective,public health problems will be decreased.Efffectiveness can not be assessed accurately by asking community leaders for their opinions,reassessing the community,or surveying community members regarding their perception; data must be collected to determine results.

Question 14

A physician refuses to order pain medication for a drug addict who has been severely injured in a car accident.When reminded by nurses that pain medication has not been ordered,the physician merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs.Which of the following ethical theories is the physician using (or misusing)?

Accepted Answer

Virtue ethics emphasizes practical reasoning applied to character development.Although such action by a care provider is paternalistic and unethical on many grounds,the physician may truly be concerned with enabling the injured addict to learn from his experience and possibly develop into a drug-free person.Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community.When decisions are based on outcomes or consequences it is known as consequentialism.The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

Question 15

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?

Accepted Answer

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.The supervisor is not responsible for the nurse's choices,the nurse must maintain responsibility for his/her own decisions.The nurse should have access to the same resources as the supervisor and should have similar knowledge as the supervisor.

Question 16

A nurse is asked to meet with a family who recently immigrated from Botswana (Africa).After the physician 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?

Accepted Answer

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.Setting up a surgical appointment immediately would not be an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has cancer.Assessing the family's current living situation would not be the first concern of the nurse; the first concern should focus on the family's well-being.After assessing the family's well-being,the next action of the nurse may be to educate the family about the treatment and prognosis of breast cancer.

Question 17

With which of the following ethical approaches are Gilligan and Noddings associated?

Accepted Answer

Gilligan and Noddings are associated with the approach known as the feminine ethic,which focuses on the morality of responsibility in relationships that emphasize connection and caring as a moral imperative.Distributive justice (fair distribution of the benefits and burdens of society),principlism (relying on ethical principles for decision making),and virtue ethics (seeking to enable persons to flourish as human beings)were not developed by Gilligan and Noddings.

Question 18

From an ethical standpoint,what is the problem with the belief that everyone should receive his or her fair share,that life should always be fair,and that everyone should make his or her own decisions?

Accepted Answer

All principles of justice focus on the individual,which ignores the needs of society as a whole.The rights of an individual may conflict with the rights of the community as a whole.It is recognized that distribution should be based on what needs and deserves there is considerable disagreement that exists when considering what these terms mean in the context of fairness.

Question 19

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?

Accepted Answer

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.Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community.The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

Question 20

Which of the following would confirm that the nurse's advocacy has been truly successful or effective?

Accepted Answer

Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community live to reduce death and disability and improve quality of life in the community.Only when systematic social changes are made to improve quality of life can advocacy be considered truly effective.Systematic change encompasses the complete role of the nurse as an advocate.Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations may have different views than the nurse.Advocacy goes beyond only working with legislators to allocate resources.Serving those who are disenfranchised is only one part of the advocacy role.

Quiz 4: Ethics in Public and Community Health Nursing Practice