Grohar-Murray TIF
Chapter 5: The Ethical Responsibility of the Nurse Leader
Learning Objective 1:
Understand basic concepts and principles related to ethics in nursing and health care.
1. The nurse is caring for a client with cancer pain. The client states, “I wish you would just give
me enough medication to make me stop breathing!” From the nurse’s perspective, of which
ethical principle is this situation most indicative?
1. Beneficence
2. Nonmaleficence
3. Justice
4. Autonomy
2. Which nurse’s statement most closely indicates paternalism?
1. “While I know you are scared, you need to consider all your options.”
2. “I must follow these orders and prepare you for surgery now.”
3. “The tests and blood work are completed, so the course of action is decided.”
4. “If you don’t understand why we are doing something, just ask questions.”
3. For the nurse providing care for a neonate, which are considered acts of beneficence? Select
all that apply.
1. Giving report to the nightshift nurse before leaving
2. Updating the rounding care provider on the client’s status
3. Making sure the infant’s diaper is changed frequently
4. Checking in with the mother “rooming in” just before discharge
5. Allowing the parents to stay at the bedside after visiting hours ended
Learning Objective 2:
Become familiar with the Code of Ethics for Nurses.
4. After an ethics refresher course, which nurse needs further instruction about the Code of
Ethics for Nurses? The one who states:
1. “The Code of Ethics does not specifically address ending a client’s life because
it’s legal in some states.”
2. “I understand now where we nurses get our responsibility for the client’s safety,
integrity, and dignity.”
3. “I believe the Code of Ethics specifically mentions delegation, professional
development, and collaboration with others.”
4. “The Code of Ethics is broken into two main sections with advancing
responsibilities as the nurse’s career advances.”
5. The nurse is on a mission trip in an underdeveloped country, and sees children stealing food
from the group’s supplies. Which interpretive statement is most applicable in this situation?
1. “The profession of nursing, as represented by associations and their
members, is responsible for articulating nursing values, for maintaining the
integrity of the profession and its practice, and for shaping social policy.”
2. “The nurse participates in the advancement of the profession through
contributions to practice, education, administration, and knowledge
development.”
3. “The nurse is responsible and accountable for individual nursing practice, and
determines the appropriate delegation of tasks consistent with the nurse’s
obligation to provide optimum patient care.”
4. “The nurse owes the same duties to self as to others, including the
responsibility to preserve integrity and safety, to maintain competence, and to
continue personal and professional growth.”
Learning Objective 3:
Know various challenges to ethical decision making in nursing practice.
6. The nurse is caring for a client of Chinese heritage who asks the nurse to assist in coining, or
gua sha. The nurse knows this practice can lead to angry, red marks wherever the technique is
used on the body, but knows the client believes the practice to be helpful. Which ethical
principles are in conflict in this situation?
1. Justice and nonmaleficence
2. Autonomy and paternalism
3. Autonomy and nonmaleficence
4. Justice and paternalism
7. While the nurse is caring for a child with multiple congenital abnormalities in the unit, the
parents ask that the child remain on life support. Knowing the child has no brain function, what
is the nurse’s best action?
1. The nurse should talk to the parents about organ donation.
2. All aspects of the situation should be considered before any action is made.
3. Continue to care for the child regardless of the situation.
4. Discuss the situation with the caretaking team.
8. Which situation will most likely result in an ethical problem because of short staffing on a
geriatric unit?
1. The nurses begin to spend a few minutes with assigned clients each shift in quiet
conversation.
2. Each nurse on the unit has an assigned client with whom they are to
discuss end-of-life decision making.
3. The clients on the unit are assigned days of the week on which they go to
exercise.
4. Most of the clients have family visiting on the weekends who ask the nurses
questions.
Learning Objective 4:
Know strategies for enhancing ethical decision making in nursing practice.
9. Which policy or procedure represents strategies that can help nurses make better ethical
decisions? Select all that apply.
1. The nurse manager requires education on ethics at least once annually.
2. After each end-of-life situation, the nurses have a meeting to discuss the ethical
implications.
3. The charge nurse assigns a different nurse to a premature baby every day.
4. Hospital administration starts an ethics committee to make decisions for the
nurses.
5. The nurses ask the nurse manager to allow them to discuss difficult situations.
10. Which is the most appropriate method a nurse can use to advocate for clients when ethical
decisions are made inappropriately?
1. The nurse discusses concerns with the nurse manager, who then calls together a
meeting of the ethics committee.
2. The nurse confronts the care provider to discuss the specifics of the issue and then
discusses with the team.
3. The nurse discusses concerns with the nurse manager, citing institutional policy
and client rights documents.
4. The nurse discusses concerns with the client and/or family to get them to confront
the care providing team.
11. The nurse manager suspects a nurse working on night shift of mishandling narcotics by
diverting medications prescribed for client’s pain. Which action if undertaken first will indicate
that the nurse manager needs further instruction in the appropriate steps to take when faced with
ethical concerns?
1. The nurse in question is confronted.
2. The rights of all involved are considered.
3. The client is medicated for pain as necessary.
4. The nurse in question is investigated.
12. A family is in crisis about the steps to take after a family member is critically ill. When an
ethics committee meets, who will be allowed to discuss the ethical dilemma? Select all that
apply.
1. The client’s appointed advocate
2. The client’s family
3. Other nurses on the unit
4. The nurse assigned to the client
5. The care provider
13. If an institution does not have an ethics committee, in what order should the organizational
steps be undertaken to form one?
1. The institution should decide who the members of the committee should be.
2. Members of the committee must write institutional policies about ethics.
3. The committee should set up a meeting schedule and a method to contact them.
4. Members should undergo significant ethics training.
5. The ethics committee should publish education materials on identifying ethical
issues.
Learning Objective 6:
Understand common ethical issues facing nurses in their various professional relationships.
14. After a care provider has explained a procedure to the client, the client seems confused.
Ethically, what is the nurse’s next action?
1. The nurse should sign the document witnessing the client’s signature.
2. The nurse should assess understanding, since the client appears confused.
3. The nurse should have the care provider come back and answer any questions the
client has.
4. The nurse needs to go over the procedure again, answering any questions
afterwards.
15. Ethically, what is the nurse’s best action when he believes a medication error has been made?
1. Immediately make the care provider aware of the error.
2. Attempt to correct the error to avoid any punitive actions.
3. Fill out the safety report, using it to report the error to the nurse manager.
4. Call the charge nurse to get advice as to the next action needed.