Instant download and all chapter : Test Bank for Fundamentals of Canadian Nursing Concepts Process and Practice 3th Edition by Kozier CLICK HERE Chapter Values, Ethics, and Advocacy 1) Which of the following is true about a nursing code of ethics? A) A code of ethics provides answers for nursing care decisions B) It describes the ethical commitment and values of the profession C) It describes the competencies required for safe practice D) A code of ethics is the legislation that protects the public Answer: B Explanation: A) Incorrect A nursing code of ethics cannot provide answers to particular care decisions; it reflects the mandate of professional nursing and the elements that must be considered when making ethical practice decisions B) Correct A nursing code of ethics reflects the mandate of professional nursing and the elements that must be considered when making ethical practice decisions The CNA’s Code of Ethics for Registered Nurses (2008) indicates the values held by the profession C) Incorrect The competencies for safe practice are not described in a nursing code of ethics D) Incorrect A nursing code of ethics is not an act of legislation Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-4 2) When faced with a difficult decision, why is it important for the nurse to distinguish between ethics and law? A) Legal and moral actions have the same meaning B) An action must be both legal and moral C) An action can be legal but not moral D) A legal action offers the most benefit for the client Answer: C Explanation: A) Incorrect Laws reflect the moral values of a society, and they offer guidance in determining what is moral; however, an action can be legal but not moral B) Incorrect An action can be moral but illegal For example, if a child at home stops breathing, it is moral but not legal to exceed the speed limit when driving to the hospital C) Correct An action can be legal but not moral For example, an order for full resuscitation of a dying client is legal, but the nurse could question whether the act is moral D) Incorrect A court-appointed substitute decision maker or person with power of attorney can legally make decisions regarding a client’s care, but these decisions may not provide the most benefit to the client, emotionally or physically Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Critical Thinking Learning Outcome: 5-1 Copyright © 2014 Pearson Canada, Inc 3) Craig, a second year undergraduate nursing student, realizes that he had omitted a step while performing an abdominal assessment on his client Which action would indicate that he is engaging in reflective practice? A) Requesting that his clinical instructor re-assigns him to another client B) Completing and submitting a hospital critical incident form C) Documenting his perspective of the situation in his daily clinical journal D) Asking one of his peers to repeat the assessment on his behalf Answer: C Explanation: A) Incorrect Re-assigning Craig does not help him to learn from the error, nor does it promote reflective practice B) Incorrect This situation would not be considered a critical incident C) Correct Journal-writing, designed to document and reflect upon significant events, is a useful strategy to facilitate reflective practice in nursing Models to assist Registered Nurses in selfreflection are available in the various jurisdictions in Canada, to assist nurses in implementing strategies for continuing competency requirements One example of this is the What? So What? and Now What? model recommended by the Registered Nurses Association of Ontario (RNAO) D) Incorrect Having a peer repeat the assessment does not help Craig to learn from his error Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-5 4) Why may client advocacy be difficult for nurses? A) The patient navigator is the person responsible for client advocacy B) Being an advocate may create conflict with other team members C) Advocacy conflicts with the utilitarian values of nursing D) Nurses not have the appropriate education to be client advocates Answer: B Explanation: A) Incorrect Nurses fulfill an advocacy role for clients and/or families when they cannot so for themselves B) Correct Other health care providers, such as physicians, may resent the implication that clients need to be protected from them Physicians, too, consider themselves to be client advocates, as many other concerned professionals, such as social workers and physiotherapists The nurse has a moral obligation to the client but also an obligation to keep the health care team functioning cohesively C) Incorrect Utilitarianism is a form of teleological theory, which focuses on what action brings the most good to the client D) Incorrect Nurses are educated in how to advocate for clients Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-8 Copyright © 2014 Pearson Canada, Inc 5) Sheena, a nurse-manager, is on a committee considering funding for a community kitchen There is much controversy regarding a rural vs downtown location What moral theory would be useful to guide Sheena in her choice of location? A) Caring B) Deontology C) Fidelity D) Teleology Answer: D Explanation: A) Incorrect Relationships-based (caring) theories stress courage, generosity, commitment, and the need to nurture and maintain relationships B) Incorrect Deontological theories involve an emphasis on individual rights, duties and obligations They are also known as principle-based theories C) Incorrect Fidelity means to be faithful to agreements and promises D) Correct A consequence-based or teleological theory considers a moral act as one that brings the most good and the least harm to the greatest number of people This approach is often used in making decisions about the funding and delivery of health care Teleological theories focus on issues of fairness Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-6 6) What is the agreed-upon basis of nursing ethics? A) A commitment to others B) Reflective practice C) Professional competencies D) Justice theory Answer: A Explanation: A) Correct The commitment to others as reflected in an attitude of caring is the basis, if not the whole, of nursing ethics (Marck, 2000b) B) Incorrect Reflective practice refers to the ability to take information about experience, knowledge, or skills levels based on assessments, analyze this information, and determine how to act upon this information in the future (RNAO, 2009) C) Incorrect Professional competencies refer to the knowledge, skills, and judgment required for professional nursing practice D) Incorrect The concept of justice (not justice theory), refers to fairness Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-1 Copyright © 2014 Pearson Canada, Inc 7) Which of the following statements is true regarding nursing values? A) The CNA Code of Ethics ensures ethical practice B) Nursing values can influence the quality of care delivered C) Only selected caregiving situations have moral components D) Nursing values and beliefs mean the same thing Answer: B Explanation: A) Incorrect The code can only outline nurses’ ethical responsibilities and guide nurses in their reflection and decision-making It cannot ensure ethical practice B) Correct Nurses must consider how their values might affect the care they give to clients Certainly, every caregiving situation has moral components and will be affected by the values, beliefs, and attitudes of all those involved C) Incorrect Every caregiving situation has a moral component and will be affected by the values, beliefs, and attitudes of all those involved D) Incorrect Beliefs not necessarily involve values For example, the statement “If I study hard, I will get a good grade.” expresses a belief that does not involve a value By contrast, the statement “Good grades are really important to me, and I must study hard to obtain good grades.” involves both a value and a belief Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-6 8) Aggressive cancer therapy is planned for Mr Renaulds, 80 His nurse is stressed, wondering if the therapy will actually more harm than good because of the toxic chemicals used This nurse is struggling with which of the following principles? A) Autonomy B) Justice C) Beneficence D) Nonmaleficence Answer: D Explanation: A) Incorrect Autonomy refers to the right to make one’s own decisions B) Incorrect Justice is often referred to as fairness C) Incorrect Beneficence means “doing good.” In this case, the benefits are not known, making the harm more real D) Correct Nonmaleficence is duty to “do no harm.” Doing intentional harm is never acceptable in nursing Placing a client at risk of harm is what is depicted in this scenario, and it occurs as a known consequence of a nursing intervention or some other type of treatment It is unknown how much therapy will be of benefit to the client or whether it will actually more harm Aggressive cancer therapy is difficult to endure, and given the age of the client, this case is more suggestive of nonmaleficence than beneficence Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-6 Copyright © 2014 Pearson Canada, Inc 9) Latisha is a staff nurse who observes certain religious holidays Her manager tries to make sure that these accommodations can be met if possible The manager is practicing which of the following values? A) Integrity B) Social justice C) Autonomy D) Altruism Answer: D Explanation: A) Incorrect Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice B) Incorrect Social justice is upholding moral, legal, and humanistic principles C) Incorrect Autonomy is the right to self-determination D) Correct Altruism is a concern for the welfare and well-being of others A professional behaviour of this value involves demonstrating the understanding of the cultures, beliefs, and perspectives of others Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-1 10) Which of the following is true about the personal and professional values of nurses? A) Personal values are the same as professional values B) Utilitarianism is an important nursing value C) Values clarification is a nursing intervention D) Personal values are always held at a conscious level Answer: C Explanation: A) Incorrect When people can identify their values, they can retain or change them and thus act based on freely chosen, rather than unconscious, values B) Incorrect Utilitarianism, one form of consequentialist theory, views a good act as one that brings the most good and the least harm to the greatest number of people C) Correct When clients hold unclear or conflicting values that are detrimental to their health, the nurse should use values clarification as an intervention D) Incorrect Even though they may be unspoken and perhaps even unconsciously held, values underlie all moral dilemmas Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-2 Copyright © 2014 Pearson Canada, Inc 11) Mr Hakim, 56, has inoperable cancer and has decided not to have chemotherapy Although his nurse believes that everything possible should be done to preserve life, she supports his decision Which moral principle is being employed by the nurse? A) Respect for autonomy B) Nonmaleficence C) Beneficence D) Justice Answer: A Explanation: A) Correct In principle-based ethics, the principle of autonomy (respect for persons) states that individuals have the right to make choices about their own lives It also means showing respect for others and accepting them as unique individuals with personal histories that influence their decision making B) Incorrect Nonmaleficence is the duty to no harm C) Incorrect Beneficence is the obligation to good D) Incorrect Justice is sometimes referred to as fairness Type: MC CRNE Competency: Nurse-Client Partnership CRNE Taxonomy: Application Learning Outcome: 5-6 12) Which of the following is a characteristic of ethics rounds in a health care setting? A) Ethics rounds use only real client cases for discussion B) Nurses are not members of ethics committees, but can have input C) Ethics rounds incorporate traditional teaching approaches into discussions D) There is a strong focus on client clinical diagnosis and treatment Answer: C Explanation: A) Incorrect Both hypothetical and real cases are discussed B) Incorrect Nurses may be members of ethics committees C) Correct Traditional clinical teaching approaches are used in ethics rounds D) Incorrect The focus of ethics rounds is on ethical dimensions of care rather than clinical diagnosis and treatment Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-7 Copyright © 2014 Pearson Canada, Inc 13) What is the purpose of the mnemonic device LEARN? A) Providing a framework to establish ethics rounds B) Organizing acute care practice environments C) Acting as a framework for solving moral distress issues D) Enhancing collaboration in ethical decision making Answer: D Explanation: A) Incorrect The mnemonic device LEARN is not intended as a framework for rounds B) Incorrect The mnemonic device LEARN is not intended as a framework for organizing practice environments C) Incorrect The mnemonic device LEARN is not intended as a framework for solving moral distress issues D) Correct The mnemonic device LEARN can remind nurses to work toward collaboration in ethical decisions (Berlin & Fowkes, 1983): Listen to others Explain your perceptions Acknowledge and discuss differences Recommend alternatives Negotiate agreement Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-7 14) Mr Terrill, 71, has been admitted to hospital with a myocardial infarction and refuses to have any discussion about advanced directives The nurse should be aware of which moral principle affecting his decision? A) Veracity B) Autonomy C) Social justice D) Nonmaleficence Answer: B Explanation: A) Incorrect Veracity refers to telling the truth B) Correct Individuals have the right to make choices about their own lives Autonomy also means showing respect for others and accepting them as unique individuals with personal histories that influence their decision making C) Incorrect Social justice is upholding moral, legal, and humanistic principles This value is reflected in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality health care D) Incorrect Nonmaleficence is the duty to no harm Type: MC CRNE Competency: Nurse-Client Partnership CRNE Taxonomy: Application Learning Outcome: 5-2 Copyright © 2014 Pearson Canada, Inc 15) Mrs Occhino, 68, is ordered to follow a high-protein renal diet She tells the nurse that she will eat only food brought into the hospital by her family Which approach by the nurse would be most helpful at this time? A) Explain that this decision goes against doctor’s orders B) Offer to arrange for food substitutes that she likes C) Review the rationale for the diet prescribed for her D) Ask what led her to make this particular decision Answer: D Explanation: A) Incorrect Although true, this is negating the client’s views and can close off communication B) Incorrect Substituting food could be harmful, and perhaps not realistic, given the complexity of the diet ordered C) Incorrect Repeating the rationale for the diet is assuming the client does not understand the rationale; this may be interpreted as condescending D) Correct Values are enduring beliefs or attitudes about the worth of a person, an object, an idea, or an action Values influence decisions and actions, and are often taken for granted Type: MC CRNE Competency: Nurse-Client Partnership CRNE Taxonomy: Critical Thinking Learning Outcome: 5-2 16) Which of the following situations best illustrates values transmission? A) A child imitates his mother’s respectful actions toward older persons B) Police candidates attend a training lecture regarding law enforcement values C) New members of a non-profit organization are provided with a code of “right” actions D) A political leader delineates values to be taught to all school children Answer: A Explanation: A) Correct Values are learned through observation and experience As a result, they are heavily influenced by a person’s sociocultural environment – that is, by cultural, ethnic, and religious groups, and by family and peer groups B) Incorrect There is no evidence that values were transmitted just because the police candidates attended the lecture C) Incorrect Provision of a code of correct actions does not ensure that people will emulate those actions D) Incorrect Delineating one’s values to others does not ensure they will be transmitted and upheld by others Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-1 Copyright © 2014 Pearson Canada, Inc 17) Which of the following situations describes a breach of nursing ethics? A) A nurse takes her palliative client to a birthday party in the patient lounge B) During lunch in the hospital cafeteria, two nurses discuss a recent code situation on their unit C) Some health care agency nurses sign a petition demanding more pay for their work responsibilities D) An orthopedic nurse ambulates his postoperative client who is reluctant to get up Answer: B Explanation: A) Incorrect The nurse is caring holistically for the client, providing for social and emotional needs B) Correct According to the Canadian Nurses Association’s Code of Ethics for registered nurses, nurses recognize the importance of maintaining privacy and confidentiality and safeguard personal, family, and community information obtained in the context of a professional relationship C) Incorrect The nurses are not breaching ethics; it is simply an employees/employer issue D) Incorrect Although the patient is reluctant, the nurse is providing care in the best interests of the client’s recovery Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Critical Thinking Learning Outcome: 5-3 18) Which of the following is a known dimension of moral distress? A) A breach of policy B) Poor communication C) A violation of values D) An expected client death Answer: C Explanation: A) Incorrect Breaching policy is not a dimension of moral distress B) Incorrect Poor communication is not a dimension of moral distress C) Correct While nurses frequently have experiences that cause emotional distress, moral distress involves the added dimension that personal or professional values are being violated D) Incorrect An expected client death may be a dimension of emotional distress Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Knowledge Learning Outcome: 5-6 10 Copyright © 2014 Pearson Canada, Inc 19) Mrs Umlah, 33, has recently returned from major surgery The nurse enters her room with the intention of turning her in bed but decides against it because it would cause her great pain What is the principle being utilized by the nurse? A) Justice B) Beneficence C) Nonmaleficence D) Advocacy Answer: C Explanation: A) Incorrect Justice is often referred to as fairness In health care, justice issues arise most often in deciding how scarce resources should be used B) Incorrect Beneficence is the obligation to “do good.” C) Correct Nonmaleficence is the duty to no harm This can mean intentional harm, risk of harm, and unintentional harm In nursing, intentional harm is never acceptable However, nurses sometimes inflict harm during a nursing intervention that is intended to be helpful, such as turning a client in bed who has recently had surgery D) Incorrect The overall goal of a client advocate is to protect clients’ rights Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-1 20) Christopher, 4, is terminally ill, and his parents have decided to remove him from life support Which of the following demonstrates that the assigned nurse, Angela, practices the value of autonomy? A) Angela suggests that they reconsider their decision B) She privately disagrees, but shows respect for the family C) Social services receives a referral from Angela D) Angela asks to be re-assigned to a different client Answer: B Explanation: A) Incorrect The nurse must respect clients’ rights to make decisions about their health care B) Correct Autonomy is the right to self-determination, and professional practice reflects autonomy when the nurse respects clients’ rights to make decisions about their health care C) Incorrect Referring the parents to another service points to feelings of unease about the parents’ choice D) Incorrect Asking to be assigned to another client does not honour the right of patients and families to make decisions about health care Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-2 11 Copyright © 2014 Pearson Canada, Inc 21) A nurse mistakenly gave a morning breakfast tray to a client who was NPO Realizing his mistake, the nurse reported the error to the physician and client and documented the situation according to policy This nurse demonstrated which of the following? A) Altruism B) Social justice C) Integrity D) Human dignity Answer: C Explanation: A) Incorrect Altruism is a concern for the welfare and well-being of others B) Incorrect Social justice is upholding moral, legal, and humanistic principles C) Correct Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice By taking responsibility for the mistake, the nurse is demonstrating honesty with the physician as well as the client and provides accurate documentation of the action D) Incorrect Human dignity is respect for the worth and uniqueness of individuals and populations Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-4 22) A prenatal client, Ms Kempter, 32, admits to regularly drinking alcohol but states that she wants to have a healthy baby In addressing this risk factor, the nurse needs to recognize that Ms Kempter is struggling with which of the following? A) Values transmission B) Values clarification C) Morals D) Ethics Answer: B Explanation: A) Incorrect Values transmission means that values are learned through observation and experience and are influenced by sociocultural environment and traditions B) Correct Her behaviour indicates unclear values; she is ignoring advice against unhealthy behaviours, such as using alcohol during pregnancy C) Incorrect Morals refer to personal standards of what is right and wrong D) Incorrect Ethics refers to the practices or beliefs of a certain group Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-2 12 Copyright © 2014 Pearson Canada, Inc 23) Mrs Morgan, 29, is demanding more pain medication, even though the maximum amount ordered by the physician has been administrated to her Which of the following actions by the nurse demonstrates respect for Mrs Morgan’s autonomy? A) Calling the physician to request further orders for pain management B) Reassuring Mrs Morgan that she will get her next dose as soon as it is due C) Documenting on the chart that Mrs Morgan has a low pain tolerance D) Suspecting that Mrs Morgan is exhibiting is drug seeking behaviour Answer: A Explanation: A) Correct Honouring the principle of autonomy means that the nurse respects the client’s right to make decisions, treating others with consideration and not as impersonal sources of knowledge or training Believing the client continues to have pain would be an example of treating with consideration For whatever reason, this particular client is not responding to the medication ordered by the physician, and other medications or treatment should be initiated B) Incorrect The nurse is not showing regard for Mrs Morgan’s concerns about her pain, and is not therapeutic for the client C) Incorrect Although this may be true, it is judgmental and subjective D) Incorrect The nurse is being judgmental, as she has no assessment data to support this and is jumping to conclusions Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-8 13 Copyright © 2014 Pearson Canada, Inc 24) Mrs Lingar, 81, has chosen to discontinue hemodialysis but her family is not supportive of her decision Which of the following rationales supported by the nurse demonstrates an understanding of the theory of principles-based reasoning? A) Mrs Lingar is of sound mind and is capable of making her own decisions regarding her health care B) The family needs assistance and support to better cope with her decision C) Mrs Lingar’s health is so deteriorated that the treatment is prolonging, rather than saving, her life D) The client understands her decision and the advanced stage of her disease If she quits treatment, she will die Answer: A Explanation: A) Correct Principles-based theories stress individual rights, like autonomy Mrs Lingar has the ability to make the decision and it is her right to autonomy to that B) Incorrect Caring or relationship theories, stress courage, generosity, commitment, and the need to nurture and maintain relationships Caring theories promote the common good or the welfare of the group Trying to help the family understand the client’s decision is an example of a caring-based theory in practice C) Incorrect Consequence-based theories look at the outcomes of an action in judging whether that action is right or wrong Consequence theories are exemplified by the nurse looking at the outcomes of the client’s decision D) Incorrect Consequence-based theories look at the outcomes of an action in judging whether that action is right or wrong Consequence theories are exemplified by the nurse looking at the outcomes of the client’s decision Type: MC CRNE Competency: Changes in Health CRNE Taxonomy: Application Learning Outcome: 5-2 14 Copyright © 2014 Pearson Canada, Inc 25) A local hospital’s administration plans to incorporate a struggling private clinic into its existing infrastructure, although relocating the clinic may cause transportation difficulties for some clients The nurse should recognize that which of the following is useful in guiding such a decision? A) Teleological theory B) Deontological theory C) Utilitarianism D) Caring Answer: C Explanation: A) Incorrect Teleological theories look at the outcomes of an action and judge it to be right or wrong B) Incorrect Deontological theories, which are also principles based, emphasize individual rights, duties, and obligations In this situation, a number of people are involved with the clinic, not just one person C) Correct Utilitarianism views a good act as one that brings the most good and the least harm to the greatest number of people Continuing to provide a service, even though it needs to be relocated, is better than discontinuing something that clients continue to use D) Incorrect Caring theories stress courage, generosity, commitment, and the need to nurture and maintain relationships Type: MC CRNE Competency: Professional Practice CRNE Taxonomy: Application Learning Outcome: 5-7 26) Tyler, 4, has just been admitted to the pediatric unit and is crying and scared The nurse needs to initiate an IV and Tyler’s mother asks if the procedure will be painful for him How can the nurse practice veracity with her response? A) Admit that many children find it painful to have an IV initiated B) Reassure the parent that every care will be taken not to hurt her child C) Tell her that the procedure is quick and that it should not be too bad D) Reassure her that the procedure is very common so not to worry Answer: A Explanation: A) Correct Veracity refers to telling the truth Even though telling the truth may frighten the parent, starting an IV on a frightened, ill child is a difficult task Being honest with the parent will help the nurse gain trust and will outweigh any benefits that may be gained by downplaying the situation B) Incorrect Saying that the nurse will not hurt the child is simply not true A needle going into a vein is not a comfortable procedure C) Incorrect The nurse really cannot predict how bad it will be D) Incorrect Telling the parent that the procedure is common, or not to worry, is pointless Type: MC CRNE Competency: Nurse-Client Partnership CRNE Taxonomy: Critical Thinking Learning Outcome: 5-3 15 Copyright © 2014 Pearson Canada, Inc 27) Chimiko, 19, a home health care client receiving social assistance, tells the visiting nurse that she is taking nutritional supplements but, because of their cost, is diluting them so that she uses only one, not the prescribed three, cans per day How can the nurse advocate for this client? A) Help the client look for available community resources B) Tell the client that she needs to take the prescribed amount C) Report the client’s situation to her physician D) Weigh the client on a weekly basis to monitor weight gain or loss Answer: A Explanation: A) Correct Resource allocation and financial considerations are major issues in home health care Community resources may help this client to be able to afford the proper supplement at the correct dose or to provide assistance in other financial areas so the client has her treatment needs met B) Incorrect The client probably knows she should take the prescribed amount C) Incorrect Telling the physician will not help to solve the situation D) Incorrect Weighing the client merely assesses the need, which has already been established, and is something that’s probably being done anyway Type: MC CRNE Competency: Health and Wellness CRNE Taxonomy: Critical Thinking Learning Outcome: 5-8 28) Which process implemented for continuing competence includes the stages of awareness, analysis, and new perspective? A) Conflict resolution B) Scope of practice C) Communication techniques D) Reflective practice Answer: D