BIOETHICS IN NURSING PRACTICE SET 1 (Answer Key with Rationale)

Prepared By: Robbie Liabres, RN

1. C. The most appropriate nursing intervention is to discuss with the family
possible organ donation since brain-death criteria is already met. The
decision to withdraw life support is not within the scope of nursing practice.
There is no need for sedation because the patient is brain dead. Although
talking to staff members about their feeling is also necessary, it isnt the first
action to take.
2. B. Nurse Warren has spoken to his colleague about the issue properly but the
nurses behavior hasnt change. Therefore, the next step is to address the
issue to the manager. It is inappropriate to talk to other staff members about
the issue because they dont have the authority to bring the colleagues
practice to compliance. A nurse should never point out to a patient that a
staff is not meeting the standards.
3. D. Nurse Jenny should file an incident report. Calling the hospitals lawyer is
not the job of Nurse Jenny. Taking no action is not an appropriate action.
Documenting that she has given one capsule instead of two violates the
virtue of veracity and the principle of non-maleficence.
4. A. A nurse who suspects another nurse of impaired practice has a duty to
report the colleague to the nursing supervisor. If Nurse Paulo fails to do that,
he may also face a disciplinary action. A nurse should not cover for an
impaired nurse or give him one more chance. This action places patients in
danger and prevent the impaired nurse from receiving help. The nurse should
report to the nurse supervisor but not to the security or the police.
5. B. Medical information about a patient can be disclosed only to the following;
the patient, whoever is in-charge of the patient, those who may be affected
by the patients health and to legitimate authorities or those who are directly
involved in the care of the patient.
6. A. Libelous statements in prints and pictures in the workplace are ethically
and legally prohibited. This should be addressed directly to the nursing
supervisor. Calling the security is unnecessary. Option B and D are not the
most appropriate actions to take.
7. B. An informed consent requires the physician to give enough information to
the patient and his significant others in order to make decisions properly
regarding the patients health. The patient needs to understand fully the
procedure that will be done. It is based on the patients wishes, not the
familys wishes, and the informed consent is not concerned about the
physicians competence.
8. C. A reasonable suspicion of abuse is created by the statements of the
mother. Healthcare providers are mandated by law to report suspected
abuse. The nurse needs not to witness the beating in actuality. Diverting the
attention of the mother is incorrect because it fails to deal with the legal
obligation to report reasonable suspicion of an abuse.

9. D. Nurse Ryan should refer the patient to a sex counselor or to other

professional. Making appropriate referrals is a valid part of planning the
patients care. The nurse doesnt normally provide sex counseling.
10.B. Referring the patient to a health care professional with knowledge of
community resources is the best intervention to ensure compliance of a
homeless patient. Educating the patient about his health may help, but the
basic necessities like shelter, food and clothing must be met first. Providing
formal education and attempting to contact family members are
inappropriate when caring for a homeless patient.
11.B. The disease of a patient need not be in public view like in door labels of
patients rooms. Plain label of reverse isolation or strict isolation is enough to
ensure safety of healthcare workers. Options A, C and D are but part of the
principle of confidentiality.
12.D. The family needs to understand what brain death is before talking about
organ donation. They need time to accept the death of their family member.
An environment conducive to discussing an emotional issue is needed.
Chapel is not the proper place where they would discuss their concerns. The
phrase life support system may give family false hope that the patient is
still alive. And the more the family members are present during discussion,
the more difficult it will be to discuss issues and attain unity in a decision.
13.D. It is the role and obligation of the physician to inform the patient. The
nurse is obligated to inform the physician that the patient is demanding
information. The nurse has an ethical obligation to be truthful, but the
physician has the obligation to inform the patient. Regardless of whether the
patient has the right to view her record, the patient is not in the position to
interpret the information found in the chart. Again, that is the role of the
physician.
14.D.
15.C.
16.D.
17.B.
18.C.
19.B.
20.A.
21.D.
22.C.
23.C.
24.B.
25.C.
26.C.
27.B.
28.B.
29.C.
30.C.
31.D.
32.D
33.B.

34.C. It is the legal obligation of the witness to verify that the signature took
place. It is the legal obligation of the attending physician, not the nurse, to
conduct the informed consent process. It is the attending physicians
obligation, not the nurse, to fully inform the patient. And it is not necessary to
obtain family consent.
35.C. It is the legal and ethical obligation of the nurse to report incidents such as
medication errors that exposes the patient to harm. Failing to check the
medication record to see if a drug had been given is a form of medication
error. Reporting the other nurse fails to discharge the legal and ethical
obligation to report any error. Actual harm to the client is not a prerequisite
for filing an incident report, and failure to report the incident does nothing to
prevent future incidents. It is not the legal and ethical obligation of the
physician to inform the nurse about the need to report a medication error.
36.A. Hospice care is for patients who are terminally ill and their families or
caregivers. Bereavement counseling is available even after the death of a
patient. Educated volunteers are also part of the interdisciplinary team. The
service is available at all times. There is usually an RN on call 24 hours a day.
37.D. Although all of the patients need social service and discharge assistance,
the patient who is newly diagnosed with diabetes is at greater risk of
complications from the condition and the potential for poor management.
Proper diet and safe medication administration would be difficult for a person
who is homeless. The other patients are not faced with the most immediate
risk.
38.B. The nurse is ethically and legally obliged to question orders that appear
incorrect in order to protect the patient from harm. The nurse should not
assume that the order is correct. The patient is not an appropriate source to
validate a medication order. The actions of the nurses on previous shifts do
not remove the obligation to question that order, unless there is a clear note
that the order has been questioned.
39.A. The patient with chest pain may be having a myocardial infarction (MI),
and immediate assessment and intervention are priorities. Although pain
management is important, pain is an expected manifestation from the
surgery. Hyperglycemia of 180 is not life threatening. Assessment and
intervention is necessary but not priorities compared with a patient with
chest pain. Further assessment of the patient with calf pain is necessary to
rule out a thrombophlebitis and the possibility of a future pulmonary
embolus.
40.D. The nurse is upholding the ethical obligation to tell the truth and to make
the patient aware that, ethically and legally, the nurse may be required by
law to report the information. That is not an accurate statement about the
code of ethics. Health of other people does not necessarily force the
disclosure of confidential information.
41.A. Healthcare professionals need to identify and come to terms with their own
feelings regarding interruption of pregnancy. Nurses whose religious or moral
beliefs do not support abortion have the right to refuse the assignment of

caring for patients undergoing this procedure. The nurse should inform the
employer of the beliefs before being assigned patients. The conflicts and
doubts of the nurse can be readily communicated to women who might
already be anxious and sensitive about the procedure. Nurses have the right
to refuse the assignment of caring for women undergoing abortion if their
religious or moral beliefs do not support abortion. The nurse may be
employed in an agency that performs abortions, but may work in another
section or unit.
42.B. These are likely signs of an acute myocardial infarction (MI), which is a
cardiovascular emergency requiring immediate attention. Acute MI is
potentially fatal if not treated immediately. Pain and swelling is a
musculoskeletal problem and not life threatening. A child who vomited once
since start of complaint does not take priority over a life-threatening cardiac
emergency. Loss of appetite and fatigue is not an immediate emergency,
43.D. Patients who are in panic need immediate assistance because their
behavior may result in harm to themselves or others. Identifying addiction is
more time consuming and not an easily solved problem. Depression would
develop over a longer period of time. Euphoria is defined as an exaggerated
feeling of well-being (mild elation). It is unlikely that a patient who is euphoric
would take priority over a patient who is panicking.
44.D. The only factually correct answer would provide information about
contraindications. Organ donors must be at least 18 years of age. Written
consent is required. Family member or legal guardian may authorize organ
donation in the absence of written documentation by donor.
45.D. Providing foods that are culturally acceptable to the extent possible is an
important principle of cultural sensitivity when planning nursing care. There is
no guarantee that food from any culture will decrease agitation. Specific
foods are not mentioned. Nutritional specifications are not included. In fact,
favorite foods may not be nutritionally sound. And even though serving
culturally required foods convey acceptance, it does not guarantee
cooperation with other treatments.
46.B. The physician may not be aware of the role that religious beliefs play in
making a decision about surgery. The nurse does not have the right to
encourage a specific treatment that is contrary to the patients wishes. The
patient has the right to make the decision. The family could be incorporated
when exploring all options to help the patient make an informed decision.
And presenting other options is the role of the physician. The role of the
nurse is to assess whether the patient is well informed, relay information
pertinent to the decision and confirm that a decision is voluntary.
47.C. In case of the unusual circumstances, a test of reasonableness is applied.
The nurse is expected to be flexible enough to prioritize care, and the
minimal level of acceptable care is patient safety. Providing customary or
ideal care to some patients and leaving others without care would not meet
the test of reasonableness. Refusing the assignment will expose the patients

to harm from abandonment. Care by family members does not obviate the
need for nursing care or attendance by the nurse.
48.C. The nurse has a moral and professional responsibility to advocate for
patients who experience decreased independence, loss of freedom of action
and interference with their ability to make autonomous choices. Coordinating
a meeting between the physician and family members may allow the patient
an opportunity to express his or her wishes and promote awareness of his or
her feelings, as well as influence future care decisions. All other options are
inappropriate.
49.D. The nurse is obligated to let the patient leave. Detaining him in any form is
a violation of the patients bill of rights.
50.D. When advance directives state that a patient does not want life-prolonging
interventions, nursing care focuses on providing emotional and spiritual
support and comfort measures. The patient still needs to be checked
regularly. The patient and the family should not feel as if they have been
abandoned. Providing mouth and skin care makes the patient more
comfortable. Turning the patient provides comfort and prevents potentially
painful complications such as pressure ulcers.
51.C. Nurses are always responsible for their actions. The hospital is liable for
negligent conduct of its employees within the scope of employment.
Consequently, both the nurse and the hospital are liable. Although the
mistake wasnt intentional, standard procedure wasnt followed.
52.A. Advance directives give a competent patient control over his situation and
a legal forum in which to express his wishes about his care. Discussion of
advance directives isnt outside the scope of nursing practice. The patients
bill of rights involves multiple patient rights and does not provide detailed
information about advance directives. Active euthanasia is illegal.
53.B. The nurses release of information to the patients employer without the
patients consent is a breach of confidentiality. The stigma associated with
psychiatric illness may affect the patients employment: therefore, it is better
to maintain confidentiality and refrain from disclosing any information,
including whether shes a patient in the hospital
54.B. if a patient requests for DAMA, the nurse should notify the physician
immediately. If the physician can not convince the patient to stay, the
physician will ask the patient to sign a DAMA form. This form releases the
hospital from legal responsibility. If the physician isnt available, the nurse
should obtain the patients signature on the DAMA form. A patient who
refuses to sign the form should not be detained; forced detention violates the
patients rights. After the patient leaves, the nurse should document the
incident thoroughly and notify the physician that the patient has left.
55.B. The first action would be to protect the child by removing her from the
room. Calling the security is necessary but only after ensuring the safety of
the child. Asking one of the family members to leave the room or reasoning
with them would be ineffective at this point and may even escalate the
situation.

56.C. By leaving the patient, the nurse is at fault for abandonment. The better
course of action is to turn on the call bell or elicit help on the way to the
patients room. Educating the patient about safety measures doesnt alleviate
the nurse from responsibility for ensuring patient safety. The nurse cant
restrain the patient without a physicians order and restraints wont ensure
the patients safety. Documenting that he left the patient doesnt excuse the
nurse from his responsibility for ensuring the patients safety.
57.D. Respiratory, cardiovascular and neurological assessments which are
physiological assessments are the priority assessment.
58.D. Although CATs should be approved by the physician and they may have
interactions with the treatment plan, the nurse should be therapeutic in
dealing with patients with life threatening conditions.
59.C.
60.D.
61.A.
62.D.
63.B.
64.B.
65.C.
66.B.
67.C.
68.C.
69.C.
70.A.
71.B.
72.D.
73.C.
74.A.
75.C.
76.D.
77.C.
78.C.
79.D.
80.D.
81.B.
82.D.
83.B.
84.B.
85.D.
86.C.
87.