Bioethics a.

The process by which a person or community of faith

attempts to discover God's will for understanding and
responding to the dilemmas and questions that human
1. What are the three values relevant to the nurse in beings face when seeking the "right" and the "good.
assisting client/patient with the end-of-life b. A judgment of practical reason that helps us to
recognize and seek what is good and to reject what is
decision-making? Select all that apply. evil"
c. That which regards ethical and value judgments as
 Health and well being
expressions of feeling or attitude and prescriptions of
 Privacy and confidentiality
action, rather than assertions or reports of anything.
 Autonomy and Choice
d. Are very important if we are to understand our moral
 Human dignity
situation and arrive at a good moral decision, to
 Quality of life
which we are called
2. Lowenberg and Dolgoff (1992) have prioritize ranking
7. When it is God's will that lead us the time to come for
of ethical principles. This is an approach for ordering
moving on, in spite of the times of dramatic change, loss
social work values that might help you get off the "horns
and sadness, or gain, one also felt an inner comfort.
of a dilemma." Rank the following principles from the
highest to the lowest. A. Autonomy and freedom B. a. Gifts
Equality C. Least harm D. Privacy and confidentiality E. b. Serenity
Protection of life F. Quality of life G. Truthfulness and full c. Desire
disclosure d. Development
a. F, A, D, E, B, G, C 8. What important element in making moral decision is
b. E, B, A, F, C, D, G described when we need to discern accurately the elements
c. E, B, A, C, F, D, G of every moral acts - nature of the act, intention of the
d. A, C, B, E, F, G, D person and circumstances of the act.
3. A patient wishes to have a Do Not Resuscitate (DNR) to a. Inquire
prevent heroic measures in the event of cardiac or b. Investigate
respiratory arrest. Which of the following principles is the c. Implement
nurse upholding by supporting the decision? d. Implore
a. Beneficence 9. The primary care provider wrote a do-not-resuscitate
b. Autonomy (DNR) order. The nurse recognizes that which applies in
c. Nonmaleficence the planning of nursing care for this client?
d. Justice
a. The nurses will continue to implement all treatments
4. One of the easiest to remember is the MORAL Model in focused on comfort and symptom management.
ethical decision making which step wherein one carefully b. The client and family know that the client will most
review the issues and options and apply basic moral likely die within the next 48 hours.
principles. c. A DNR order from a previous admission is valid for
the current admission
a. Resolve the dilemma
d. The client may no longer make decisions regarding
b. Outline the options
his or her own health care.
c. Look back and evaluate
d. Massage the dilemma
e. Act by applying chosen option
10. Nurses agree to be advocates for their patients.
5. One OB nurse remarks, "I don't see how these young Practice of advocacy calls for the nurse to:
single women can keep on having babies without being
married. Everyone knows a child needs a father." This a. Work to understand the law as it applies to the
nurse is exhibiting: client's clinical condition.
b. Document all clinical changes in the medical record
a. moral uncertainty. in a timely manner.
b. ethnocentrism. c. Seek out the nursing supervisor in conflicting
c. cultural relativism. situations
d. values clarification. d. Assess the client's point of view and prepare to
articulate this point of view.
6. Moral Discernment -
11. Which of the following is the best example of an ethical a. A living will is invoked only when the client has a
dilemma faced by the nurse? terminal condition or is in a persistent vegetative
state.
a. Deciding whether or not to place a client in a private b. The client cannot make changes in the advance
room directive once the client is admitted into the hospital.
b. Deciding whether or not to ask another nurse to care c. A living will allows an appointed person to make
for a very complex patient health care decisions when the client is in an
c. Deciding the order in which staff members should incapacitated state.
take their breaks d. A durable power of attorney for health care is
d. Deciding whether or not to tell a client about the invoked only when the client has a terminal condition
client's diagnosis or is in a persistent vegetative state
12. An approach to ethical dilemma when we use 17. A hospitalized client tells the nurse that a living will is
discussion and negotiation in a mutually acceptable being prepared and that the lawyer will be bringing the
decision. will to the hospital today for witness signatures. The client
a. Evaluation approach asks the nurse for assistance obtaining a witness to the will.
b. Implementation approach Which is the most appropriate response to the client?
c. Assessment approach a. "Whoever is available at the time will sign as a
d. Planning approach witness for you."
13. Which documents are correctly identified as advance b. "You will need to find a witness on your own.'
directives? Select all that apply. c. "I will call the nursing supervisor to seek assistance
regarding your request."
 Last Will and Testament. d. "I will sign as a witness to your signature."
 Living Will.
 Client's Bill of Rights. 18. A living will includes which of the following? Select all
 Durable Power of Attorney for Health Care. that apply -

14. A written physician's order instructing health care  Immunity from liability for following the living
providers not to attempt Cardio-Pulmonary Resuscitation, will
often requested by family and must be signed by a  How the patient's valuables are distributed among
physician to be valid. the family
 Documentation requirements
a. Physician orders for life sustaining treatment  Which family member will inherit the patient's
(POLST) home
b. Allowing natural death (AND)  How and when the living will takes effect
c. Do not resuscitate (DNR)
d. Advance directives in health (ADHC)

15. A patient who has coronary artery disease and 19. In this ethical theory that treats self-interest as the
congestive heart failure shows his physician his advance foundation of morality, claims that everyone ought to act
directive that states he wants to receive cardiopulmonary selfishly.
resuscitation and other forms of life-sustaining treatment a. Egotism, ethical
has deeply held beliefs that suggest that not trying to live is b. Egoism, descriptive
tantamount to committing suicide. What should the doctor c. Egotism, psychological approach
do and say to the patient in response to this? d. Egoism, common approach
a. The doctor should educate the patient about the near 20. What important element in making moral decision is
futility of CPR under these circumstances. described that one must have the courage and resolve to do
b. All of the choices above are correct what has decided upon and take the risk.
c. The doctor might want to ask the patient to explore
this further with the chaplain. a. Implore
d. The patient's expression of a preference should be b. Implement
explored to understand its origins. c. Imagine
d. Inquire
16. The nurse notes that an advance directive is in the
client's medical record. Which of the followingstatements 21. An elderly man with end-stage emphysema presents to
represents the best description of guidelines a nurse would the emergency room awake and alert and complaining of
follow in this case? shortness of breath. An evaluation reveals that he has
pneumonia. His condition deteriorates in the emergency
room and he has impending respiratory failure, though he c. Physician orders for life sustaining treatment
remains awake and alert. A copy of a signed and witnessed d. Medical power of attorney
living will is in his chart stipulates that he wants no
"invasive" medical procedures that would "serve only to 26. An elderly patient with respiratory failure informs the
prolong my death." No surrogate decision maker is nurse that she does not want to be placed on a ventilator.
available. Should mechanical ventilation be instituted? What should the nurse do NEXT?

a. The potential risks and benefits of mechanical a. Notify the physician

ventilation need not be presented to the patient b. Have the patient sign a DNR form.
because of the presence of a valid living will. c. Consult with the patient's family.
b. The presence of a living will or other advance d. Notify the hospice team
directive obviates the responsibility to involve a 27. Which moral development theory when it is the ability
competent patient in medical decision making. to select an appropriate course of action among multiple
c. If the patient has remained awake and alert, his living good alternatives.
will is irrelevant to medical decision making.
d. Even if the patient refuses mechanical ventilation a. Moral motivation
therapy, his wishes need not be honored because he is b. Moral judgment
in the emergency room. c. Moral character
d. Moral sensitivity
22. Privacy and confidentiality of all client information is
legally protected. In which of the following situations 28. Successful ethical discussion depends on people who
would the nurse make an exception to this practice? have a clear sense of personal values. When many people
share the same values it may be possible to identify a
a. When the client threatens self-harm and harm to philosophy of utilitarianism, with proposes that:
others
b. When the nurse decides that the family has a right to a. The value of something is determined by its
know the client's diagnosis usefulness to society.
c. When a visitor insists that he has been given b. The best way to determine the solution to an ethical
permission by the client dilemma is to refer the case to the attending
d. When a family member offers information about their physician.
loved one c. The value of people is determined solely by leaders
in the Unitarian church.
23. Ethical dilemmas often arise over a conflict of opinion. d. The decision to perform a liver transplant depends on
Once the nurse has determined that the dilemma is ethical, a measure of the moral life that the client has led so
a critical first step in negotiating the difference of opinion far.
would be to:
29. The nurse returns to the client's room in exactly four
a. Ensure that the attending physician has written an hours to administer the next dose of pain medication as
order for an ethics consultation to support the ethics promised. Which of the following ethical rules is best
process. demonstrated by the nurse?
b. List the ethical principles that inform the dilemma so
that negotiations agree on the language of the a. Confidentiality
discussion. b. Nonmaleficence
c. Consult a professional ethicist to ensure that the steps c. Fidelity
of the process occur in full. d. Justice
d. Gather all relevant information regarding the clinical,
30. A terminally ill patient has identified her husband as
social, and spiritual aspects of the dilemma.
her durable power of attorney. The husband then demands
24. Allows the person to die with comfort measures only that a new physician take over his wife's care. How should
and without the interference of technology the nurse react?

a. Out of hospital code a. Respect the wishes of the husband

b. Full code b. Continue calling the original physician for orders
c. Comfort code c. Ask the patient's children which physician they prefer
d. Chemical code d. Tell the husband that he doesn't have the right to
change physicians for his wife
25. A written document specifying the patient's wish to be
allowed to die without heroic or extraordinary measures 31. When an older nurse complains that nurses just aren't
ethical anymore, which reply reflects the best
a. Directive to physician understanding of moral development?
b. Health care proxy
 a. "I don't agree that nurses were more ethical in the b. "What were you told about the procedure you are
past. It's a new age and the ethics are new! going to have?"
b. "The ability to behave ethically must be carefully c. "Do you have any questions about the procedure?"
cultivated; maybe we don't value this sufficiently to d. "The doctor has asked that you sign the consent
pay it the attention it deserves." form."
c. "No kidding! Who could be ethical in a practice
setting like this?" 36. Nurses agree to be advocates for their patients.
d. "Ethics is genetically determined....its like having Practice of advocacy calls for the nurse to:
blue or brown eyes. Maybe we're evolving out of the a. Document all clinical changes in the medical record
ethical sense you and your generation had." in a timely manner.
32. Which Principles of Discernment is described simply b. Work to understand the law as it applies to the
articulating that God most often moves us in stages rather client's clinical condition.
than in sudden and dramatic ways. c. Seek out the nursing supervisor in conflicting
situations
a. Organic Development d. Assess the client's point of view and prepare to
b. Gifts and Talents articulate this point of view.
c. Serenity and Peace
d. State of Life 37. The nurse is aware that values clarification supports
nursing practice by (select all that apply):
33. Resolution of an ethical dilemma involves discussion
with the patient, the patient's family, and participants  Enhancing peer relationships.
from all health care disciplines. Which of the following  Guiding decision making.
best describes the role of the nurse in the resolution of  Helping understand himself or herself.
ethical dilemmas?  Gaining the confidence of supervisors.
 Giving insight to clients.
a. To articulate the nurse's unique point of view,
including knowledge based on clinical and 38. The idea that a person's beliefs, values, and practices
psychosocial observations. should be understood based on that person's own culture,
b. To study the literature on current research about the rather than be judged against the criteria of another.
possible clinical interventions available for the a. Transculturalism
patient in question. b. Cultural Relativism
c. To hold a point of view but realize that respect for the c. Naturalism
authority of administrators and physicians takes d. Ethnocentrism
precedence over personal opinion.
d. To allow the patient and the physician to resolve the 39. Which moral development theory when there is the
dilemma on the basis of ethical principles without courage and skills to follow a course of action in response
regard to personally held values or opinions. to a situation.

34. In most ethical dilemmas, the solution to the dilemma a. Moral sensitivity
requires negotiation among members of the health care b. Moral judgement
team. The nurse's point of view is valuable because: c. Moral character
d. Moral motivation
a. The nurse's code of ethics recommends that a nurse
be present at any ethical discussion about client care. 40. A well-formed conscience is an ongoing process. Which
b. Nurses develop a relationship to the client that is one that would lead us to ask God's intervention
unique among all professional health care providers.
a. Awareness of the truth, right and flexible
c. The principle of autonomy guides all participants to
b. Examine background information about the choices
respect their own self-worth.
c. Reflect prayerfully for discernment
d. Nurses have a legal license that encourages their
presence during ethical discussions. d. Review church teachings and the Holy Scripture

35. A primary care provider's orders indicated that a

surgical consent form needs to be signed. Since the nurse
was not present when the primary care provider discussed
the surgical procedure, which statement "best" illustrates
the nurse fulfilling the client advocate role?

a. "Remember that you can change your mind and

cancel the procedure."