1. A nurse is caring for an alert and oriented client with end-stage breast cancer who has been unable to eat for 4 days due to intractable nausea. The nurse calls the health care provider (HCP) and obtains an order for an NG tube placement per the spouse’s request. When the nurse brings the equipment to the room, the client turns to the spouse and states “I just told you that I don’t want any tubes or feedings!” Using the ANA Code of Ethics for Nurses, place the nursing actions in sequential order (rank actions from first to last). All options must be used. o Apologize for not asking the client prior to calling the HCP. o Verify that the client understands the purpose of the NG tube. o Explore other options that would be acceptable to the client. o Educate the husband on the wife’s right to refusal of care. o Document the client’s wishes in the medical record. o Notify the HCP of the client’s wishes and decision.  The ANA Code of Ethics for Nurses directs that a nurse promote, advocate for, and strive to protect the health, safety, and rights of the patient. The client has the right to refusal and is able to make an informed decision. The nurse should first apologize, then make sure the client has enough information to make an informed decision, including exploring other options, then educate the husband about the wife’s right to refuse treatment. This should be followed by documentation of the client’s wishes and notification of the HCP. 2. A nursing student is initiating a relationship with an assigned client. After meeting and spending approximately 20 minutes talking with the client, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of clients to play volleyball. The student starts to go with them but then remembers the promise to meet with the client. The student decides to forgo volleyball and talk with the client. The student's decision reflects which ethical principle? o Autonomy o Veracity o Beneficence o Fidelity  Fidelity is faithfulness to obligations and duties. It is keeping promises. Fidelity is important in establishing trusting relationships. With autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Veracity is the duty to tell the truth. 3. Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports him or her in whatever decision he or she makes? o Parent surrogate o Advocate o Teacher o Caregiver  In the advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role. Emma Lodato 4. A nurse cultivates dispositions that enable practicing nursing in a manner in which he or she believes in. This nurse is displaying what essential element of ethical agency? o Ethical sensibility o Ethical character o Ethical valuing o Ethical responsiveness  Ethical character is the development or cultivation of virtues such as humility, courage, and integrity to name just a few. The development or cultivation of these virtues allows the nurse to practice in a manner in which the nurse believes in. 5. The nurse is preparing to give medications to a client with high blood pressure. The prescription indicates that the client is to have the combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate 40 mg by mouth twice daily. What is the appropriate nursing action? o Administer the drug as prescribed. o Contact the health care provider for clarification of the prescription. o Assume that the provider meant to prescribe propranolol. o Ask another nurse to verify the prescription.  Before administering the medication, the nurse should immediately contact the health care provider to verify the prescription; no one else can verify the prescription. The combination drug dextroamphetamine saccharate-amphetamine aspartate monohydrate-dextroamphetamine sulfate-amphetamine sulfate and the drug propranolol are medications that have look-alike and sound-alike properties, but are very different in indication and dosage. 6. Several times, family members have asked a nurse to share personal prescriptions when they were in need of pain medication or antibiotics. Which type of rules or standards should govern the nurse's moral decision? o civil law o common law o ethics o administrative law  Although all of the options may affect the decision, moral decisions are guided by ethics (moral principles and values that guide the behavior of honorable people). Ethical standards dictate the rightness or wrongness of human behavior. Laws are written rules for conduct and actions. They are binding for all citizens and ensure the protection of rights. 7. A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged? o Libel o Slander o Negligence o Malpractice  The nurse can be charged with slander, which is a verbal attack on a person's character. Libel pertains to damaging written statements read by others. Both libel and slander are considered defamation of character-an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. To be found guilty of slander or libel, the statement must be proved false. Negligence and malpractice pertain to actions which are committed or omitted, thereby causing physical harm to a client. 8. According to the Health Insurance Portability and Accountability Act (HIPAA) passed in 1996, clients: o can be punished for violating guidelines. o need to obtain legal representation to update their health records. Emma Lodato o have the right to copy their health records. o are required to obtain health record information through their insurance company.  HIPAA affords clients the right to see and copy their health records, update their health records, and get a list of disclosures that a health care institution has made for the purposes of treatment, payment, and health care operations. Clients have the right to request a restriction on certain uses or disclosures and choose how to receive this health information. HIPAA includes punishments for anyone caught violating client privacy, but these punishments are not directed at the client because HIPAA was implemented to protect the privacy of an individual's health information. 9. A nurse is providing care to a client with end-stage cancer. After weighing the alternatives, the client decides not to participate in a clinical trial offered and is requesting no further treatment. The nurse advocates for the client's decision based on the understanding that the client has the right to self-determination, interpreting the client's decision as reflecting which ethical principle? o Autonomy o Beneficence o Justice o Fidelity  When respecting autonomy, the nurse supports the client's right to make decisions with informed consent. When promoting the client's well-being, the nurse acts in the best interests of the client. Advocacy is linked to the belief that making choices about health is a fundamental human right that promotes the individual's dignity and well-being. Beneficence is reflected by doing good and promoting what will benefit the client. Justice involves treating each client fairly. Fidelity involves being faithful and keeping promises. 10. In some cases, the act of providing nursing care in unexpected situations is covered by the Good Samaritan laws. Which nursing action would most likely be covered by these laws? o Emergency care for a choking victim in a restaurant o Any emergency care given when consent is obtained o A negligent act performed in an emergency situation o Medical advice given to a neighbor regarding a child’s rash  Good Samaritan laws are designed to protect health practitioners when they give aid to people in emergency situations in which the practitioner is off duty, such as providing emergency care to a choking victim in a restaurant. The other examples listed are not situations covered by the Good Samaritan law. 11. A nursing student is making notes that include client data on a clipboard. Which statement by the nursing instructor is most appropriate? o “Clipboards with client data should not leave the unit.” o “You can get an electronic printout of client lab data to take with you.” o “Be sure to write down specific information for your clinical paperwork.” o “Be sure to put the client’s name and room number on all paperwork.”  HIPAA has created several changes that protect client confidentiality and affect the workplace. One such change is that the names of clients on charts can no longer be visible to the public, and clipboards must obscure identifiable names of clients and private information about them. Therefore, writing down clinical information, taking the data off the unit, and including client identifiers are inappropriate. 12. A client rings a call bell to request pain medication. Upon performing the pain assessment, the nurse informs the client that the nurse will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? o fidelity o nonmaleficence o autonomy o justice Emma Lodato  Fidelity is keeping one's promises and never abandoning a client entrusted to care without first providing for the client's needs. Autonomy respects the rights of clients or their surrogates to make healthcare decisions. Nonmaleficence is avoiding causing harm. Justice involves giving each his or her due and acting fairly. 13. Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified? o Nonmaleficence o Beneficence o Veracity o Fidelity  Fidelity involves keeping promises. Veracity is truth-telling while beneficence is doing good and nonmaleficence is avoiding harm. 14. Nurse A is having difficulty logging into the automated medication-dispensing system, and asks Nurse B to log in momentarily so that Nurse A is not delayed in administering client medications. What is Nurse B’s appropriate response? o “I am giving you my password so you can log in.” o “I will log in so that you can proceed with medication delivery.” o “I will get the hospital’s information system's phone number for you.” o “I can log in and give the medications for you.”  Passwords and logins should never be shared with anyone else, nor should a nurse use his or her own password or login information to allow another individual to access the automated medication-dispensing system. Nurse B will not log in and give the medications, but rather will provide a solution by offering contact information for information systems to Nurse A so that he or she can work through their login issue. 15. When making ethical decisions about caring for preschoolers, a nurse should remember to o make decisions that will prevent legal trouble. o do what the nurse would do for a close child or loved ones. o provide beneficial care and avoid harming the child. o be sure to do what the physician says.  Nurses must provide beneficial care and avoid harming all clients. A nurse shouldn't base any decision solely on the desire to prevent legal trouble, on the nurses own feelings for loved ones, or what the physician says. 16. What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)? o A description of case studies featuring ethical dilemmas o Information about what to do when confronted with an ethical dilemma o A guideline for nurses regarding ethical conduct o Pathways to follow for each of the ethical principles  The ANA's Code of Ethics for Nurses guides ethical decision-making. 17. The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation? o Tell the doctor that the procedure is not in the best interests of this girl and ask him to respect the rights of the family. o Reassure the family that the doctor is acting in their best interests and they should reconsider the treatment.