Test Bank For Canadian Fundamentals of Nursing Revised Reprint 4th edition by Potter Chapter MULTIPLE CHOICE The client states that she needs to exercise regularly, watch her weight, and reduce her fat intake What does this demonstrate about the client? a She believes she will have a heart attack b She values health promotion activities c She believes she will not become sick d She has unrealistic expectations for herself ANS: B A value is a strong personal belief It is an ideal that a person or group (such as nurses) strives to uphold An individual’s values reflect cultural, social influences, and personalneeds A belief is a conviction of the truth of something The client’s statement does not indicate that she has beliefs or fears about having a heart attack A belief is a conviction of the truth or reality of something The client does not state that she believes these health promotion activities will keep her from becoming sick These are not unrealistic expectations DIF: Comprehension REF: 90 Which of the following assists in protecting the client’s right to autonomy? a Answerability b Informed consent c Constrained moral agency d Maleficence ANS: B The goal of informed consent is to protect the client’s right to autonomy Answerability offers reasons and explanations for certain aspects of nursing practice If the nurse feels powerless to act for what he or she thinks is right, or believe the actions will not bring about change, the nurse will have difficulty being an effective advocate Maleficence refers to hurt or harm DIF: Application REF: 94 A secondary school teacher with advanced multiple sclerosis teaches from her wheelchair but insists on being treated the same as other colleagues Which of the following is the teacher demonstrating? a Preserving dignity b Choosing from alternatives c Considering all consequences 8-2 d Acting with a pattern of consistency ANS: A The teacher’s choice is preserving dignity, which is a value included in the CNA Code of Ethics She cherishes her choice of being treated like everyone else despite her medical condition and publicly affirms the choice by teaching from her wheelchair and insisting that she be treated the same as her colleagues At this point, the teacher is not choosing from alternatives She could have chosen to quit teaching, but she did not She has already made her choice The teacher is not demonstrating that she is considering all consequences She has already made her choice At this point, the teacher is not demonstrating that she is acting with a pattern of consistency She is not repeating a behaviour DIF: Application REF: 91 (Box 8-2) In which following instance does the nurse recognize that interventions for values clarification are beneficial for the client? a The client and nurse have different beliefs b The client is experiencing a values conflict c The nurse is unsure of the client’s values d The client has rejected normal values ANS: B Values clarification is the process of appraising one’s own personal values It is not a set of rules; nor does it suggest that certain values should be accepted by all people Values clarification can help nurses strengthen their ability to advocate for clients, as nurses are better able to accurately identify the personal values of clients Values clarification is not necessarily beneficial to the client when the client and nurse have differing beliefs Values clarification will not necessarily help the nurse who is unsure of the client’s values Values clarification interventions are for the benefit of the client and not for the nurse to gain awareness The values that an individual holds reflect cultural and social influences, relationships, and personal needs Values vary among people and develop and change over time Therefore, it may be inappropriate to state that a client has rejected “normal” values when different value systems exist among people What is considered normal for one person may not be so for another DIF: Comprehension REF: 91 A nurse is working with a client to try to clarify the client’s values in relation to his care Which of the following is an example of the type of response that the nurse should use in such a situation? a “Your questions were pretty blunt.” b “Tell me what you are thinking about.” c “I’ve felt that way before; I’d be upset, too.” d “You seem concerned about your tests Let me explain them.” 8-3 ANS: B Values clarification is the process of appraising one’s own personal values It involvesself-reflection that leads to greater self-awareness and personal insight Values clarification is a process of self-discovery, and the nurse can assist the client through it The character of the nurse’s response to a client can motivate the client to examine personal thoughts and actions When the nurse makes a clarifying response, it should be brief and nonjudgemental This response is a judgemental one The nurse should not influence the client with his or her own values, even if these values are similar to the client’s The statement You seem concerned about your tests Let me explain them is therapeutic in that it reflects the client’s feelings and offers information However, it does not encourage the client to examine his or her values DIF: Application REF: 91 Which one of the following is an example of ethical responsibility? a Delivery of competent care b Formation of interpersonal relationships c Application of the nursing process d Evaluation of new computerized technologies ANS: A Providing competent care is one of the values in the Code of Ethics that nurses have to uphold Formation of interpersonal relationships is not an ethical responsibility Application of the nursing process is not an ethical responsibility Evaluation of new computerized technologies is not an ethical responsibility DIF: Application REF: 91 (Box 8-2) A student nurse realizes that she has administered the wrong dose of medication to a client and immediately informs her clinical instructor of this error How is this student nurse best described as a professional? a Confident b Trustworthy c Compliant d Accountable ANS: D Accountability refers to the ability to answer for one’s own actions The goal is the prevention of injury to the client The student nurse who informs her instructor of her error is holding herself accountable for her action and aims to avoid causing any injury to the client Accountability is one of the seven values of the Code of Ethics central to nursing practice It would not be correct to describe the student nurse as confident (i.e., sure of oneself) professionally 8-4 It would not be correct to describe the student as trustworthy To be trustworthy, one should be worthy of trust or confidence and be reliable In this case, the student could not be relied on to administer medication correctly It would not be correct to describe this student nurse as compliant The student did not act in accordance with wishes, commands, or requirements DIF: Comprehension REF: 91 (Box 8-2) A client has just been informed by her physician that she has cancer The client says that she is not ready to discuss this with her family The nurse encourages the client to consider sharing the information with her family so that the family can support her through the decisions she will need to make regarding her care Which following principle must the nurse be careful not to breach? a Confidentiality b Fidelity c Veracity d Justice ANS: A The nurse should recognize the importance of privacy and confidentiality and safeguard the client’s personal, family, and community information obtained in the context of a professional relationship Fidelity refers to an agreement to keep promises Veracity, in general, means accuracy or conformity to truth In this situation, the nurse encourages the client to be truthful with her family Justice refers to fairness DIF: Comprehension REF: 91 (Box 8-2) The nurse is investigating the process for resolving an ethical problem Which of the following is the correct sequence for resolving ethical problems? a Examining one’s own values; evaluating; identifying the problem b Evaluating the outcomes; gathering data; considering actions c Gathering facts; verbalizing the problem; considering actions d Recognizing the dilemma; evaluating; gathering information ANS: C The correct sequence for resolving ethical problems is recognizing the dilemma, gathering facts, examining one’s own values, verbalizing the problem, considering actions, negotiating the outcome, and evaluating the action Examining one’s own values; evaluating; identifying the problem is not the correct sequence for resolving ethical problems Evaluating the outcomes; gathering data; considering actions is not the correct sequence for resolving ethical problems Recognizing the dilemma; evaluating; gathering information is not the correct sequence for resolving ethical problems DIF: Analysis REF: 95 8-5 10 A nurse is ambivalent about performing vigorous suctioning in a terminally ill client in a comatose state Which of the following is the appropriate statement by the nurse in regard to processing this ethical dilemma? a “I need to know the legalities of the living will of this client.” b “My spiritual beliefs mandate that I continue to provide all the interventions within my scope of practice.” c “I cannot figure out what’s right in this situation I need to collect more data.” d “I just feel that I should not suction this client.” ANS: C The first step in processing an ethical dilemma is determining whether the problem is an ethical one The nurse who cannot figure out what is right is stating a characteristic of an ethical dilemma, which is that the problem is perplexing The next step is to gather as much relevant information as possible The nurse who wants to know the legalities of the living will of a client is collecting some, but not all, data pertaining to the problem The statement “My spiritual beliefs mandate that I continue to provide all the interventions within my scope of practice.” describes the nurse’s own beliefs The nurse is describing the problem in terms of her feelings DIF: Application REF: 95 11 Which of the following statements best illustrates deontological ethical theory? a “I believe this disease was allowed to occur by a supreme being.” b “He has become a stronger individual through experiencing the loss of his father.” c “It would never be right for a person to stop cardiopulmonary resuscitation (CPR) efforts.” d “The chemotherapy did not cure this person, but it provided a better life for him.” ANS: C Deontology defines actions as right or wrong based on their “right-making characteristics, such as fidelity to promises, truthfulness, and justice” (Beauchamp & Childress, 2001) Deontology does not look to the consequences of actions to determine the rightness or wrongness of the actions Determining the wrongness of this statement may be based on fidelity to promises and beneficence The statement, “I believe this disease was allowed to occur by a supreme being” does not reflect deontological ethical theory It is based on feminist ethical theory because it reflects a relationship between disease and a supreme being The statement, “He has become a stronger individual through experiencing the loss of his father” does not best illustrate deontological ethical theory because it is citing a consequence It is based on utilitarian ethical theory The statement, “The chemotherapy did not cure this person, but it provided a better life for him” does not best illustrate deontological ethical theory because it is citing aconsequence It based on utilitarian ethical theory DIF: Application REF: 93 8-6 12 The nurse stops at an accident scene to provide emergency care to the victims Ethically, how would his or her actions best be labelled? a Respect for persons b Beneficence c Maleficence d Triage ANS: B Beneficence refers to positive actions to help others, as in providing emergency care at an accident scene Respect for persons has to with equal treatment of people irrespective of their social standing and so on Maleficence refers to causing harm or hurt to others Triage is the screening and classification of casualties to make optimal use of treatment resources and to maximize the survival and welfare of clients DIF: Comprehension REF: 94 13 Which of the following does an ethics committee in a health care facility do? a Interviews all persons involved in a case b Illustrates circumstances that demonstrate malpractice c Serves as a resource in specific situations involving ethical dilemmas d Examines similar previous instances for comparison of outcome decisions ANS: C Ethics committees serve as a resource to support the processing of ethical dilemmas Ethics committees serve several purposes: education, policy recommendation, and case consultation or review Although an ethics committee may gather detailed information, they not interview all persons involved in a case; rather, they offer consultations or case reviews Illustrating circumstances that demonstrate malpractice is not a purpose of an ethics committee Examining similar previous instances for comparison of outcome decisions may be part of data gathering to help process an ethical dilemma or for policy recommendation, but it is not the purpose of an ethics committee DIF: Knowledge REF: 95-96 14 A client who recently immigrated to Canada believes that she has been made to wait in the emergency department longer than the other individuals because she has not yet qualified for provincial health coverage Which one of the following ethical principles is involved in this particular situation? a Justice b Autonomy c Beneficence d Nonmaleficence ANS: A Test Bank Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd 8-7 Justice refers to fairness Allocation of resources and access to health care involve the ethical principle of justice The client without provincial health insurance should not have to wait longer to receive health care than those with coverage The duration of the wait should be determined by need alone Autonomy refers to a person’s independence Autonomy represents an agreement to respect another’s right to determine a course of action Beneficence refers to taking positive actions to help others Nonmaleficence refers to the avoidance of causing harm or hurt to others DIF: Application REF: 94 15 Which of the following is an example of a nurse’s use of the ethical principle of autonomy in a situation with a client? a Learning how to a procedure safely and effectively b Returning to speak to the client at a mutually agreed time c Preparing the client’s room for comfort and privacy d Supporting the client’s decision to refuse therapy ANS: D Following the ethical principle of autonomy, the nurse allows the client to make decisions regarding care and then supports that decision Learning how to a procedure safely and effectively demonstrates the nurse’s application of the ethical principle of responsibility Returning to speak to the client at a mutually agreed time demonstrates the ethical principle of fidelity Preparing the client’s room for comfort and privacy demonstrates the nurse’s application of the ethical principle of responsibility DIF: Comprehension REF: 93 16 The nurse always tries to apply ethical principles in her clinical practice Which following statement reflects the application of the ethical principle of confidentiality? a “I’m concerned that decreased funding may affect the outpatient program.” b “I’m going to make sure that the client understands the instructions.” c “I cannot share that information about the client with you.” d “I need to get more information about the client’s health history.” ANS: C The statement I cannot share that information about the client with you reflects the application of the ethical principle of confidentiality Client information is not to be shared with others without client consent The statement I’m concerned that decreased funding may affect the outpatient program reflects a concern regarding allocation of resources It is not a confidentiality issue The nurse who makes sure that a client fully understands instructions is being ethically responsible 8-8 The statement I need to get more information about the client’s health history reflects data gathering The information that is gathered is to be used for the purpose of providing competent health care and should not be shared with others without the specific consent of the client DIF: Application REF: 91 (Box 8-2) 17 A client has been diagnosed with malignant bone cancer, and treatment involves chemotherapy on an outpatient basis Over the course of the treatment, the client becomes very ill and is experiencing debilitating side effects from the therapy and a severe reduction in the quality of life Which of the following ethical principles is in question in this situation? a Veracity b Fidelity c Justice d Nonmaleficence ANS: D Nonmaleficence is the avoidance of harm or hurt The discomforts of treatment raise the following question: is the treatment benefiting the client, or are the side effects of the treatment worse than the disease itself? The health care professional should try to weigh the risks and benefits of a plan of care and strive to the least harm possible Veracity refers to truthfulness Truthfulness is not an issue in this situation Fidelity refers to agreement to keep promises Fidelity is not an issue in this situation Justice refers to fairness Justice is not an issue in this situation DIF: Analysis REF: 94 18 When obtaining client consent for a procedure, the nurse realizes that the client is consenting without full understanding of the procedure What should the nurse do? a Explain the procedure b Ask the client to sign the consent form c Notify the physician d Record the client’s questions on the consent form ANS: C In this situation, the physician needs to provide further clarification Informed consent is a decision based on accurate and complete information Obtaining client consent is not a nursing responsibility The nurse’s responsibility is only to explain the nature of the treatment or procedure so that to ensure that the client fully understands it Recording the client’s questions on the consent form is incorrect If the client has questions, the physician needs to provide further clarification before the client can consent DIF: Analysis REF: 98 8-9 19 The nurse observes another nurse dropping a frail older client during transfer The client does not seem to be injured, so the other nurse does not plan to report the incident What should the nurse do? a The nurse and the client’s physician should fill out the incident report b If the other nurse has not filled out the incident report, then the nurse should fill it out c The nurse should ask the client to fill out the incident report d Report the incident to the Canadian Nursing Association ANS: B Whistleblowing (i.e., reporting a colleague’s errors, incompetence, unsafe/negligent practice, or client abuse) is one of the most difficult things a nurse has to to ensure safe, compassionate, competent, and ethical care If the other nurse has not filled out the incident report, then the nurse should Filling out the incident report with the client’s physician is not an appropriate action Asking the client to fill out the incident report is not an appropriate action Reporting the incident to the Canadian Nursing Association is not an appropriate action DIF: Synthesis REF: 99 20 The nurse’s friend asks the nurse to access someone’s test results on the computer and let her know what they are, even though she is not the client receiving care on the nurse’s unit If the nurse agrees to it, which Code of Ethics value would he or she be violating? a Promoting and Respecting Informed Decision Making b Promoting Health and Well-Being c Maintaining Privacy and Confidentiality d Promoting Justice ANS: C The nurse should be aware of the importance of privacy and confidentiality and should safeguard personal, family, and community information obtained in the context of a professional relationship Promoting and respecting informed decision making is not a violation of informed decision making Promoting health and well-being is not a violation of promotion of the highest level of health and well-being Promoting justice is not a violation of human rights or fairness DIF: Analysis REF: 91 (Box 8-2)