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Chapter 11: Ethical and Legal Considerations
MULTIPLE CHOICE
1. Nurses are consistently considered to be honest and ethical professionals by most respondents
in an annual Gallup poll. This is because professional nurses understand that ethics are:
a. internal values developed outside the influence of societal norms.
b. influenced by family, friends, and socioeconomics, among other variables.
c. societal in nature and do not involve personal influences.
d. totally independent from a person’s character.
ANS: B
Family, friends, beliefs, education, culture, and socioeconomic status influence the
development of ethical behavior. The study of ethics considers the standards of moral conduct
in a society. Personal ethics are influenced by values, societal norms, and practices. Behaviors
that are judged as ethical or unethical, right or wrong, reflect a person’s character.
DIF: Remembering REF: p. 144 OBJ: 11.1

TOP: Assessment MSC: NCLEX Client Needs Category: Psychosocial Integrity
NOT: Concepts: Ethics
2. The nurse is providing patient care and pays special attention to meeting the needs of the
patient while maintaining the patient’s right to privacy, confidentiality, autonomy, and
dignity. This nurse is applying what ethical theory?
a. Deontology
b. Utilitarianism
c. Autonomy
d. Accountability
ANS: A
Deontology is an ethical theory that stresses the rightness or wrongness of individual
behaviors, duties, and obligations without concern for the consequences of specific actions.
Meeting the needs of patients while maintaining their right to privacy, confidentiality,
autonomy, and dignity is consistent with the tenets of deontology. Compared with deontology,
utilitarianism is on the opposite end of the ethical theory continuum. Utilitarianism maintains
that behaviors are determined to be right or wrong solely on the basis of their consequences.
Autonomy, or self-determination, is the freedom to make decisions supported by knowledge
and self-confidence. Accountability is the willingness to accept responsibility for one’s
actions.
DIF: Remembering REF: pp. 144-145 OBJ: 11.1

3. The nurse is caring for a patient recently diagnosed with cancer that is being asked to
participate in a new chemotherapy trial. How would the nurse respond if working under the
ethical principle of utilitarianism?
a. “The patient should be allowed to decide.”
b. “As your nurse, I’ll support your right to refuse.”
c. “You should do this because many could benefit from it.”
d. “If this is against your beliefs, you should not do it.”
ANS: C
Compared with deontology, utilitarianism is on the opposite end of the ethical theory
continuum. Utilitarianism maintains that behaviors are determined to be right or wrong solely
on the basis of their consequences. Deontology is an ethical theory that stresses the rightness
or wrongness of individual behaviors, duties, and obligations without concern for the
consequences of specific actions. Meeting the needs of patients while maintaining their right
to privacy, confidentiality, autonomy, and dignity is consistent with the tenets of deontology.
and self-confidence. The remaining responses are examples of either deontology or autonomy.
DIF: Applying REF: pp. 144-145 OBJ: 11.1 TOP: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity NOT: Concepts: Ethics
4. The nurse realizes that a medication error has been made. The nurse then reports the error and
takes responsibility to ensure patient safety despite personal consequences. This nurse has
exhibited:
a. autonomy.
b. accountability.
c. justice.
d. advocacy.
ANS: B
Accountability is the willingness to accept responsibility for one’s actions. Autonomy, or
self-determination, is the freedom to make decisions supported by knowledge and
self-confidence. Supporting or promoting the interests of others or doing so for a cause greater
than oneself defines advocacy. To do justice is to act fairly and equitably.

5. The nurse is providing care for a patient who has had a stroke recently and has multiple
self-care deficits. The nurse is coordinating care with in-home agencies and arranging for the
delivery of needed equipment. What ethical concept is being applied?
a. Advocacy
b. Confidentiality
c. Autonomy
d. Accountability
ANS: A
Supporting or promoting the interests of others or doing so for a cause greater than ourselves
defines advocacy. Confidentiality is the ethical concept that limits sharing private patient
information. Autonomy, or self-determination, is the freedom to make decisions supported by
knowledge and self-confidence. Accountability is the willingness to accept responsibility for
one’s actions.

6. A nurse has been asked to care for a patient who is an inmate from a nearby prison. During
shift report, the nurse asks, “Why was the man convicted and imprisoned?” Another nurse
responds that this is not important since nurses are required to provide compassionate care for
all people in all circumstances. The responding nurse has displayed what concept?
a. Beneficence
b. Advocacy
c. Confidentiality
d. Autonomy
ANS: A
In its simplest form, beneficence can be defined as doing good. Nurses demonstrate
beneficence by acting on behalf of others and placing a priority on the needs of others rather
than on personal thoughts and feelings. The ethical concept of beneficence necessitates
providing care for the prisoner without reproach. Nurses are required by beneficence to
provide compassionate care for all people in all circumstances. Supporting or promoting the
interests of others or doing so for a cause greater than ourselves defines advocacy.
Confidentiality is the ethical concept that limits sharing private patient information.
and self-confidence.

7. The nurse is providing care to a patient experiencing pain. The nurse assesses the pain and
promptly administers the ordered analgesics as promised to the patient. This nurse has
applied:
a. autonomy.
b. accountability.
c. confidentiality.
d. fidelity.
ANS: D
Keeping promises or agreements made with others constitutes fidelity. In nursing, fidelity is
essential for building trusting relationships with patients and their families. Following through
on promises is a critical factor in establishing strong professional relationships with patients
and their families. Autonomy, or self-determination, is the freedom to make decisions
supported by knowledge and self-confidence. Accountability is the willingness to accept
responsibility for one’s actions. Confidentiality is the ethical concept that limits sharing
private patient information.

8. “First, do no harm” defines what ethical principle?

a. Beneficence
b. Justice
c. Fidelity
d. Nonmaleficence
ANS: D
First, do no harm is the colloquial definition of nonmaleficence. Unlike beneficence, which
requires actively doing good, nonmaleficence requires only the avoidance of harm. In its
simplest form, beneficence can be defined as doing good. To do justice is to act fairly and
equitably. Keeping promises or agreements made with others constitutes fidelity.

9. The nurse is caring for a patient whose family does not want the patient to be told about the
new diagnosis of cancer because of the poor prognosis. Keeping this secret from the patient is
in direct conflict with the ethical concepts of:
a. autonomy and veracity.
b. veracity and advocacy.
c. justice and nonmaleficence.
d. confidentiality and justice.
ANS: A
and self-confidence. Truthfulness defines the ethical concept of veracity. Supporting or
promoting the interests of others or to do so for a cause greater than ourselves defines
advocacy. To do justice is to act fairly and equitably. First, do no harm is the colloquial
definition of nonmaleficence. Unlike beneficence, which requires actively doing good,
nonmaleficence requires only the avoidance of harm. Confidentiality is the ethical concept
that limits sharing private patient information.

10. The Code of Ethics for Nurses is:

a. like the Constitution and not revisable.
b. a succinct statement of ethical obligations.
c. required by entry level nurses only.
d. a negotiable document dependent on individual conscience.
ANS: B
The current nursing code, the Code of Ethics for Nurses with Interpretive Statements, was
adopted by the ANA House of Delegates in 2001. It is anticipated that a revised code will be
published in 2015. The Code of Ethics for Nurses is “a succinct statement of the ethical
obligations and duties of every individual who enters the nursing profession,” the profession’s
“nonnegotiable ethical standard,” and “an expression of nursing’s own understanding of its
commitment to society.”
DIF: Understanding REF: p. 147 OBJ: 11.3

11. Which of the following statements indicates an appropriate understanding by the student nurse
(SN)?
a. “I will be held to the same ethical standards as professional nurses.”
b. “I will not be held ethically accountable until I graduate.”
c. “My nurse educators are responsible for my ethical standards.”
d. “Ethics are not important as a student.”
ANS: A
The Code of Ethics for Nurses is “a succinct statement of the ethical obligations and duties of
every individual (not just nurse educators) who enters the nursing profession,” the
profession’s “nonnegotiable ethical standard,” and “an expression of nursing’s own
understanding of its commitment to society.” This is a powerful mandate for all nurses to
communicate and act professionally to prevent inflicting physical or emotional pain on others
while pursuing nursing education and engaging in nursing practice.

12. The nurse is caring for a patient who has been belligerent and is in four-point “leather”
restraints. The patient is verbally abusive and still tries to kick and punch staff even though he
is restrained. The nurse should:
a. ignore the patient’s needs until he “calms down.”
b. strike the patient if necessary to protect herself/himself.
c. continue to attempt to meet the patient’s needs.
d. threaten the patient with retaliation if he doesn’t stop.
ANS: C
Provision 1.5 (of the Nursing Code of Ethics) states, “The principle of respect for persons
extends to all individuals with whom the nurse interacts. The nurse maintains compassionate
and caring relationships with colleagues and others with a commitment to the fair treatment of
individuals, to integrity-preserving compromise, and to resolving conflict.” It continues by
saying, “This standard of conduct precludes any and all prejudicial actions, any form of
harassment or threatening behavior, or disregard for the effect of one’s actions on others.” It is
expected that nurses (including student nurses) will not engage in behaviors that show
“disregard for the effect of one’s actions on others.” This is a powerful mandate for all nurses
to communicate and act professionally to prevent inflicting physical or emotional pain on
others while pursuing nursing education and engaging in nursing practice.
DIF: Applying REF: p. 147 OBJ: 11.3 TOP: Implementation

13. Which one of the following actions by the nursing student would be considered uncivil?
a. Prompt arrival to class
b. Texting during class
c. Attentive listening
d. Active participation in class
ANS: B
Civility (i.e., acting politely) is essential in all interactions among faculty and nursing
students. Respectful interaction between students and faculty members establishes
professional communication patterns and affects the way in which students interact with
patients. Nurse educators and students report instances of incivility in the education setting.
Faculty members report student behaviors such as tardiness, inattentiveness (e.g., texting
during class), disrespectful remarks, and more aggressive offenses. Students report being
belittled or treated with disrespect by clinical staff, instructors, or classmates.

14. The nurse is providing end-of-life care. It is essential for the nurse to:
a. tell the patient what he might like to hear to relieve anxiety.
b. begin making health care decisions for the patient.
c. provide the patient with the nurse’s personal opinions.
d. offer unconditional support for the patient and family.
ANS: D
Two major roles of a nurse caring for a dying patient are (1) providing accurate information
regarding the disease process and treatment options and (2) offering support for the patient
and family without interjecting personal opinions. An essential ethical concept is autonomy,
which underscores the importance of allowing patients to make their own health care
decisions.

15. The nurse frequently cares for patients who are nearing the end of life. A strategy that is
designed to prolong the time of death rather than restoring life is:
a. establishing a do-not-resuscitate (DNR) order.
b. adherence to living will requests.
c. removal of extraordinary measures already in place.
d. continuance of futile care.
ANS: D
Ethical dilemmas in end-of-life care exist regarding the establishment of do-not-resuscitate
(DNR) orders, adherence to living will and organ donation requests, removal of extraordinary
measures already initiated, and continuance of futile care (i.e., care that is useless and
prolongs the time until death rather than restoring life).

TOP: Assessment
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care
NOT: Concepts: Caregiving
16. In the nursing profession, ethical issues:

a. are rare occurrences, but take a great deal of time to resolve.
b. have required The Joint Commission to mandate ethics committees.
c. most frequently lead to legal intervention in patient care matters.
d. lead to ethics committees made up entirely by nurses.
ANS: B
All nurses are faced with ethical decisions each day in practice, and some choose to obtain
further education and experience in the field of bioethics and participate on institutional ethics
committees along with physicians, ethicists, attorneys, and academicians. Ethics committees
are required by The Joint Commission to respond to ethical challenges related to patient care
requiring consultation. The work of the ethics committees in health care institutions helps to
prevent unnecessary legal intervention in patient care matters. If acceptable resolutions are not
achieved through consultation with the ethics committee, patients, families, and health care
providers, the legal system may become involved.

TOP: Assessment
17. Each state has a nurse practice act that establishes the standards of care required for legal
nursing practice. In order to protect herself/himself from litigation, the nurse should
understand that:
a. laws create liability issues for nurses.
b. licensure laws are devised to protect the nurse.
c. the nurse is not responsible for other disciplines’ mistakes.
d. keeping current with changing laws can protect the nurse.
ANS: D
Laws delineate acceptable nursing practice, provide a basis on which many health care
decisions are determined, and protect nurses from liability in cases in which safe practice is
maintained. Each state has a nurse practice act that establishes the standards of care required
for legal nursing practice. Licensure, laws, rules, and regulations governing nursing practice
are enforced to protect the public from harm. In many cases, the nurse is the last line of
defense to prevent an error in medication administration or other types of patient care.
Keeping current with changing laws related to nursing practice and technology can ensure
safety for nurses and their patients.
DIF: Understanding REF: p. 150 | p. 153

OBJ: 11.5 TOP: Assessment
18. Practicing nursing without a license is a:

a. misdemeanor.
b. statute.
c. felony.
d. tort.
ANS: C
Practicing nursing without a license, child abuse, and illegal drug dealing are examples of
felonies. A misdemeanor is a crime of lesser consequence that is punishable by a fine or
incarceration in a local or county jail for up to 1 year. A felony is a more serious crime that
results in the perpetrator’s being imprisoned in a state or federal facility for more than 1 year.
Statutory law is created by legislative bodies such as the U.S. Congress and state legislatures.
Statutory laws are often referred to as statutes. Civil law includes a category of law known as
torts, which are wrongs committed against another person that do not involve a contract.

TOP: Assessment
NOT: Concepts: Health Care Law
19. Starting an intravenous (IV) infusion line on a patient against his will may be classified as:
a. assault.
b. battery.
c. a felony.
d. a misdemeanor.
ANS: B
Actual physical harm caused to another person is battery. The threat to hurt someone is
carried out. Battery may involve angry, forceful touching of people, their clothes, or anything
attached to them. Performing a surgical procedure without informed consent is an example of
battery. Actions much more subtle, such as inserting an intravenous catheter or urinary
catheter against the will of a patient, also may be classified as battery. Assault is a threat of
bodily harm or violence caused by a demonstration of force by the perpetrator. A feeling of
imminent harm or feeling of immediate danger must exist for assault to be claimed. A
misdemeanor is a crime of lesser consequence that is punishable by a fine or incarceration in a
local or county jail for up to 1 year. A felony is a more serious crime that results in the
perpetrator’s being imprisoned in a state or federal facility for more than 1 year.

TOP: Assessment
20. The nurse is caring for a patient who has had many admissions and readmissions. The nurse
believes that the patient keeps coming to the hospital because the patient “wants his drugs,”
and is “non-compliant” at home with his diabetic therapy. To reduce the risk of slander
against this patient, the nurse should:
a. write observations and opinions in the medical record only.
b. never share observations.
c. make judgmental statements only when necessary.
d. Avoid stating judgmental statements.
ANS: D
Defamation of character occurs when a public statement is made that is false and injurious to
another person. Oral defamation of character is slander. Slander is spoken information that is
untrue, causing prejudice against someone or jeopardizing that person’s reputation. Written
forms of defamation of character are considered libel. Broadcasting or reading statements
aloud that have the potential to hurt the reputation of another person is considered libel.
21. The nurse is providing care for a patient who demands discharge from the hospital against the
physician’s orders. In order to remove liability from the institution and the physician, the
nurse has the patient review and sign the:
a. Against Medical Advice form.
b. Code of Academic and Clinical Conduct.
c. Nursing Code of Ethics.
d. Informed consent form.
ANS: A
Preventing patients from leaving a health care facility at their request may be considered false
imprisonment. To prevent health care providers and institutions from being held liable if a
patient chooses to leave a facility when physicians and nurses think that it is in the patient’s
best interest to remain hospitalized, the patient is asked to sign an against medical advice
(AMA) form. A signed AMA form documents that the patient has chosen to leave the facility
when leaving could jeopardize the patient’s condition. The National Student Nurses
Association adopted the Code of Academic and Clinical Conduct, in which students agree to
“promote the highest level of moral and ethical principles” and “promote an environment that
respects human rights, values, and choice of cultural and spiritual beliefs.” The Code of Ethics
for Nurses is “a succinct statement of the ethical obligations and duties of every individual
who enters the nursing profession.” Informed consent is permission granted by a patient after
discussing each of the following topics with the physician, surgeon, or advanced practice
nurse who will perform the surgery or procedure: (1) exact details of the treatment, (2)
necessity of the treatment, (3) all known benefits and risks involved, (4) available alternatives,
and (5) risks of treatment refusal.
DIF: Applying REF: p. 147 | p. 152 | p. 155 OBJ: 11.7

TOP: Implementation
22. The nurse has been involved sexually with a patient. This is considered an act of:
a. malpractice.
b. libel.
c. slander.
d. battery.
ANS: A
Malpractice may occur when a professional such as a nurse acts unethically, demonstrates
deficient skills, or fails to meet standards of care required for safe practice. Examples of these
types of malpractice include engaging in sexual activity with a patient, and administering
penicillin to a patient with a documented penicillin allergy, resulting in the patient’s death
from a severe allergic (anaphylactic) reaction. Written forms of defamation of character are
considered libel. Broadcasting or reading statements aloud that have the potential to hurt the
reputation of another person is considered libel. Oral defamation of character is slander.
Actual physical harm caused to another person is battery.
TOP: Assessment
23. State legislatures give authority to administrative bodies, such as state boards of nursing, to:
a. create statutory laws.
b. establish regulatory laws.
c. try case law cases.
d. create laws based on social mores.
ANS: B
Statutory law is created by legislative bodies such as the U.S. Congress and state legislatures.
Statutory laws are often referred to as statutes. State legislatures give authority to
administrative bodies, such as state boards of nursing, to establish regulatory law, which
outlines how the requirements of statutory law will be met. Judicial decisions from individual
court cases determine case law. Case law was historically referred to as common law because
it originally was determined by customs or social mores that were common at the time.

TOP: Assessment
24. Which of the following nurses has committed a serious documentation error?
a. Susan documents all medications for her patients prior to administration.
b. Jim documents medication administration as the medications are given.
c. Jane documents assessments as they are completed.
d. Jon documents meal intake as he picks up meal trays.
ANS: A
Documentation must be accurate to provide a realistic view of a patient’s condition. Serious
documentation errors include (1) omitting documentation from patient records, (2) recording
assessment findings obtained by another nurse or unlicensed assistive personnel (UAP), and
(3) recording care not yet provided. Nurses sometimes document that a patient has received
medication before its administration; this is a serious violation of the law and becomes a
medication error of omission if the nurse is distracted before administering the patient’s
medication.

TOP: Assessment
25. Who is ultimately responsible for explaining the content of the informed consent?
a. The registered nurse
b. The hospital social worker
c. Educated family members
d. The provider of the procedure
ANS: D
Informed consent is permission granted by a patient after discussing each of the following
topics with the physician, surgeon, or advanced practice nurse who will perform the surgery
or procedure: (1) exact details of the treatment, (2) necessity of the treatment, (3) all known
benefits and risks involved, (4) available alternatives, and (5) risks of treatment refusal.

TOP: Assessment
26. Which law protects health care professionals from charges of negligence when providing
emergency care at the scene of an accident?
a. Good Samaritan Act
b. HIPPA
c. Licensure
d. Living wills
ANS: A
All 50 states have enacted Good Samaritan laws offering protection for physicians and other
health care professionals who provide emergency care at the scene of a disaster, emergency,
or accident. Good Samaritan laws protect health care professionals from charges of negligence
in providing emergency care if (1) the care is within the professional’s scope of knowledge
and standards of care and (2) no fee is received or charged for services. The Health Insurance
Portability and Accountability Act (HIPAA) was enacted in 1996 to protect the privacy of
health care information. Licensure and certification of nurses seek to ensure professional
competence. The laws of each state require graduates of accredited nursing schools and
colleges pass the National Council Licensure Examination (NCLEX) before beginning
professional practice. A living will specifies the treatment a person wants to receive when
he/she is unconscious or no longer capable of making decisions independently.
DIF: Understanding REF: pp. 156-158 OBJ: 11.1

TOP: Assessment
MULTIPLE RESPONSE
1. In addition to maintaining current professional practice knowledge, competent practice skills,

and professional relationships with patients and their families, nurses should: (Select all that
apply.)
a. maintain confidentiality.
b. follow legal guidelines for sharing information.
c. block document once per shift.
d. change nursing procedures according to latest journal articles.
e. meet licensure and continuing education requirements.
ANS: A, B, E
In addition to maintaining current professional practice knowledge, competent practice skills,
and professional relationships with patients and their families, nurses should follow guidelines
to practice legally and avoid charges of malpractice, maintain confidentiality, follow legal and
ethical guidelines when sharing information, document punctually and accurately, adhere to
established institutional policies governing safety and procedures, comply with legal
requirements for handling and disposing of controlled substances, meet licensure and
continuing education requirements, and practice responsibly within the scope of personal
capabilities, professional experience, and education.

2. Which statements are correct regarding informed consent and someone who requires an
interpreter? (Select all that apply.)
a. A professional interpreter is needed.
b. A family member may interpret when convenient.
c. Detailed medical information remains a priority.
d. Professional interpreters are not effective in providing medical information.
e. If necessary, family members can make decisions regarding informed consent.
ANS: A, C, E
If a patient is illiterate or requires an interpreter, the method of obtaining informed consent
must be adapted appropriately. Use of a professional interpreter rather than a family member
is essential to provide detailed medical information accurately. A patient whose culture
prefers to allow other family members to make final health care decisions is inconsistent with
nursing’s ethical belief in autonomy. However, in this situation, the method of obtaining
informed consent may need to be adapted to meet the patient’s beliefs within the scope of the
law.

TOP: Assessment
3. Health care providers are required to supply patients with written information regarding their
rights to make medical decisions and implement advance directives, which consist of three
documents. Which of the following are considered “advanced directives”? (Select all that
apply.)
a. Living will
b. Durable power of attorney
c. Health care proxy
d. Patient’s Bill of Rights
e. The Uniform Anatomical Gift Act
ANS: A, B, C
Advance directives consist of three documents: (1) living will, (2) durable power of attorney,
and (3) health care proxy, commonly referred to as a durable power of attorney for health
care. The Patient’s Bill of Rights informs consumers of health care about specific privileges
of which they should be aware. Patients should expect (1) excellent care, (2) a safe
environment, (3) participation in planning their care, (4) privacy, (5) help with discharge
arrangements, and (6) assistance with fulfilling financial responsibilities. The Uniform
Anatomical Gift Act was approved to allow people over the age of 18 to donate their bodies or
body parts after death for transplantation, deposit in tissue banks, or research.
DIF: Understanding REF: pp. 155-156 OBJ: 11.9

TOP: Assessment

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DIF: Remembering REF: p. 144 OBJ: 11.1

DIF: Remembering REF: pp. 144-145 OBJ: 11.1

DIF: Applying REF: pp. 144-145 OBJ: 11.1 TOP: Implementation

DIF: Remembering REF: pp. 145-146 OBJ: 11.2

DIF: Remembering REF: pp. 145-146 OBJ: 11.2

DIF: Remembering REF: pp. 145-146 OBJ: 11.2

DIF: Remembering REF: pp. 145-146 OBJ: 11.2

8. “First, do no harm” defines what ethical principle?

DIF: Remembering REF: pp. 145-146 OBJ: 11.2

DIF: Remembering REF: pp. 145-146 OBJ: 11.2

10. The Code of Ethics for Nurses is:

DIF: Understanding REF: p. 147 OBJ: 11.3

DIF: Understanding REF: p. 147 OBJ: 11.3

DIF: Applying REF: p. 147 OBJ: 11.3 TOP: Implementation

DIF: Remembering REF: p. 148 OBJ: 11.3

DIF: Applying REF: p. 149 OBJ: 11.4 TOP: Implementation

DIF: Understanding REF: p. 149 OBJ: 11.4

16. In the nursing profession, ethical issues:

DIF: Understanding REF: p. 150 OBJ: 11.4

DIF: Understanding REF: p. 150 | p. 153

18. Practicing nursing without a license is a:

DIF: Remembering REF: p. 151 OBJ: 11.7

DIF: Remembering REF: pp. 151-152 OBJ: 11.7

DIF: Applying REF: p. 147 | p. 152 | p. 155 OBJ: 11.7

DIF: Understanding REF: p. 151 OBJ: 11.6

DIF: Understanding REF: p. 154 OBJ: 11.8

DIF: Understanding REF: p. 155 OBJ: 11.9

DIF: Understanding REF: pp. 156-158 OBJ: 11.1

1. In addition to maintaining current professional practice knowledge, competent practice skills,

DIF: Applying REF: p. 153 OBJ: 11.5 TOP: Implementation

DIF: Understanding REF: p. 155 OBJ: 11.9

DIF: Understanding REF: pp. 155-156 OBJ: 11.9

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