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Professional Nursing Practice: Concepts and
Perspectives, 7e
Chapter 4: Ethical Foundations of Professional Nursing
Question 1
What are the processes for acquiring values?
1. Prescribed by the dominant religion.
2. Formal education and study.
3. Discussions with clergy.
4. Choosing, prizing, and acting.
Correct Answer: 4
Rationale: The valuing process includes cognitive, affective, and behavioral
components, referred to as choosing, prizing, and acting. While people may be exposed
to a value system through religion, by formal education and study, and through
discussions with clergy, these avenues only introduce a value. The person must then
choose to adopt the value as his or her own.
Cognitive Level: Understanding
Client Need: Safe and Effective Care Environment
Client Need Sub: Management of Care
QSEN Competencies: II.A.1. Describe own strengths, limitations, and values in
functioning as a member of a team.
AACN Essential Competencies: VII.3. Assess health/illness beliefs, values, attitudes,
and practices of individuals, families, groups, communities, and populations.
NLN Competencies: Context and Environment; Ethical Comportment; Show respect for
others’ values; Appreciate diversity.
Nursing/Integrated Concepts: Assessment; Nursing Process
Learning Outcome: 2. Explain how nurses can help clients clarify their values to
facilitate ethical decision-making.
Page Number: p. 55
Question 2
Which statement about values is correct?
1. Most everyone adopts the same values.
2. Once adopted, values are not changed.
3. Values clarification is associated with personal growth.
4. People must have values identified for them.
Correct Answer: 3
Rationale: Values clarification promotes personal growth by fostering awareness,
empathy, and insight. A principle of values clarification is that no one set of values is
right for everyone. When people are able to identify their values, they can retain or
change them based on freely chosen values.
Cognitive Level: Remembering
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Page Number: p. 55
Question 3
The nurse has a strong personal value system and is concerned that these values may
conflict with the values of a newly assigned nursing unit. What should the nurse do?
(Select all that apply.)
1. Identify personal values.
2. Be watchful for situations in which there may be a values conflict.
3. Hold personal values in check if it is still possible to provide effective care.
4. Refuse to be transferred to this unit.
5. Discuss the situation with the nursing supervisor.
Correct Answer: 1, 2, 3, 5
Rationale: In order to identify potential values conflicts, the nurse must first be aware of
his or her personal value system. The nurse should be watchful for situations in which a
values conflict may occur so that unrecognized conflict will not interfere with care. If
possible, the nurse should hold personal values in check as long as effectiveness and
quality of care are not compromised. If a values conflict occurs, the nurse should discuss
the situation with the nursing supervisor. If this nurse has already accepted this
assignment, refusal to provide care may constitute abandonment, which is not ethical and
could result in action against the nurse’s license to practice.
Cognitive Level: Applying
Nursing/Integrated Concepts: Implementation; Nursing Process
Page Number: p. 55
Question 4
The client has made a difficult decision to refuse treatment for a potentially curable
malignancy. The nurse asks the client, “How are you going to tell your spouse about this
decision?” What is the nurse attempting to assess?
1. Whether the client has considered all of the treatment options available.
2. Whether the client was able to choose freely among treatment options.
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3. Whether the client is prepared to act on the decision.
4. Whether the client feels good about the decision made.
Correct Answer: 3
Rationale: This question helps to determine whether the client is prepared to act on the
decision made. A question to assess whether the client has considered all of the treatment
options available would be something like, “What are the benefits and risks of your
decision?” A question to assess whether the client was able to choose freely among
treatment options would be something like, “Did you have any say or choice in this
decision?” A question to assess whether the client feels good about the decision made
would be something like, “How do you feel about your decision?”
Cognitive Level: Analyzing
Page Number: p. 56
Question 5
The nurse educator asks the nursing student about the difference in standards between
codes of ethics and legal standards. Which response by the student indicates the greatest
level of understanding?
1. “Standards in codes of ethics and legal standards are generally the same.”
2. “Codes of ethics are much higher standards than legal standards.”
3. “Legal standards are much higher than codes of ethics standards.”
4. “Codes of ethics are usually higher, and can be no lower, than legal standards.”
Correct Answer: 4
Rationale: Codes of ethics have standards that are generally higher than those of legal
standards, and they can never be less that the legal standards of the profession. The
standards are not the same, but are generally similar, so it is neither correct to state that
codes of ethics are much higher than legal standards nor the reverse.
AACN Essential Competencies: VIII.1. Demonstrate the professional standards of
moral, ethical, and legal conduct.
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Nursing/Integrated Concepts: Evaluation; Nursing Process
Learning Outcome: 5. Explain the uses and limitations of professional codes of ethics.
Page Number: p. 61
Question 6
How is the Code of Ethics for Nurses with Interpretative Statements most useful for
nurses?
1. It gives direction for actions as related to specific cases of ethical dilemma.
2. It gives suggestions for use in cases of general-duty ethical dilemma.
3. It is best used to make suggestions to solve problems in critical situations.
4. It offers general guidelines for the ethical delivery of nursing care.
Correct Answer: 4
Rationale: Codes of ethics give general guidelines for how the profession believes
ethical care should be delivered. There are no specific guidelines for cases in general duty
or in critical situations and no guidelines for specific cases.
Page Number: p. 62
Question 7
What is the framework for nurses to use for decision making in an ethical dilemma?
1. The ANA social policy statement
2. The Bible
3. The ANA Code of Ethics for Nurses
4. The nurse practice act
Correct Answer: 3
Rationale: The ANA Code of Ethics for Nurses provides the framework for nurses to use
for decision making in an ethical dilemma. The other options may provide some help in
making decisions, but the Code is the standard for ethical issues.
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Page Number: p. 62
Question 8
Which scenario represents a nurse working at Kohlberg’s preconventional stage of moral
development?
1. The nurse agrees to work overtime today if he or she can have a weekend shift off.
2. The nurse agrees to work overtime today to gain the approval of the new nursing
supervisor.
3. The nurse agrees to work overtime today because the hospital administration has
released a rule stating that each nurse must work one overtime shift per month.
4. The nurse agrees to work overtime today because the other nurse who was asked to
work the overtime shift needs to attend his or her child’s school play.
Correct Answer: 1
Rationale: At the preconventional level, the person takes action to satisfy personal needs.
At the conventional level, the person takes action to please another and to gain approval
as in the option regarding the new nursing supervisor. When the nurse takes an action to
follow a rule as in the option regarding the rule stating that each nurse must work one
overtime shift per month, he or she is also working at the conventional level. The
postconventional level is represented by the remaining option in which the nurse respects
the other nurse’s need and acts to protect the interests of another.
Nursing/Integrated Concepts: Evaluation; Nursing Process
Learning Outcome: 1. Discuss how cognitive development, values, moral frameworks,
and codes of ethics affect decision-making.
Page Number: p. 57
Question 9
According to Gilligan, which statement is true?
1. Men usually follow the moral development path of nonviolence.
2. Women usually follow the moral development path of equality.
3. Men usually follow the moral development path of fairness.
4. Women usually follow the moral development path of justice.
Correct Answer: 3
Rationale: According to Gilligan, for women moral maturity is less a matter of abstract,
impersonal justice or equality and more an ethic of caring relationships. Men generally
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follow the path of justice or fairness, based upon the idea that everyone should receive
the same treatment. Women typically follow the path of caring, which is based upon the
premise of nonviolence: that no one should be harmed or abandoned.
Page Number: p. 58
Question 10
What knowledge or skill must the nurse possess to make the best use of the teleologic
theory of ethics in decision-making?
1. Ability to predict the outcome of decisions.
2. What the rules are concerning the decision to be made.
3. Ability to see how good character traits impact the decision.
4. What the central caring goal of the decision is.
Correct Answer: 1
Rationale: In teleology, the ends justify the means, and applying this requires that the
person be able to predict the outcomes of actions when making decisions. Concern for
rules reflects the deontologic focus. Good character traits are associated with virtue
ethics. Caring is a separate basis of nursing ethics.
Nursing/Integrated Concepts: Planning; Nursing Process
Page Number: p. 59
Question 11
The nurse who is faced with an ethical dilemma refers to the Code of Ethics for Nurses
with Interpretative Statements for guidance. What help can the nurse expect from this
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document?
1. Specific guidelines for common ethical issues.
2. Some ideas of the ethics of nursing that are negotiable depending upon circumstance.
3. The basis for ethical analyzing and decision making for nurses practicing in the United
States.
4. A lengthy description of the need for ethical behavior and decision making in nursing
Correct Answer: 3
Rationale: The Code of Ethics for Nurses with Interpretative Statements is a statement of
the ethical obligations and duties of every individual who enters the nursing profession in
the United States. It is succinct, not lengthy, and is nonnegotiable. There are no specific
guidelines for individual cases; instead it is an expression of nursing’s own understanding
of ethics and its commitment to society.
Page Number: p. 62
Question 12
The nurse has a strong personal belief that life begins at conception. Can this nurse
legally refuse to assist with an abortion?
1. Yes, but only if there is no health danger to the mother if the abortion is not performed.
2. Yes; most states have conscience clauses or provisions to protect the nurse in this
situation.
3. No; if the nurse has willingly taken a job where assisting with an abortion is a
possibility, he or she cannot refuse to assist.
4. No; because abortions are considered medical procedures, the nurse is ethically
required to assist.
Correct Answer: 2
Rationale: Assisting with an abortion is an ethical decision that each nurse must make.
Most states have provisions known as conscience clauses that permit individual
physicians and nurses, as well as institutions, to refuse to assist with an abortion if doing
so violates their religious or moral principles. Nurses are not required to violate their
religious or moral principles and may choose to leave a position in a facility that provides
abortions. The health danger to the mother is not a factor in the nurse’s decision.
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Learning Outcome: 6. Discuss common bioethical issues currently facing healthcare
professionals.
Page Number: p. 67
Question 13
The nurse has been caring for a ventilator-dependent patient for several days. The family
has made the decision to withdraw ventilatory support. How should the nurse interpret
this decision?
1. As active euthanasia
2. As illegal euthanasia
3. As passive euthanasia
4. As alleviation euthanasia
Correct Answer: 3
Rationale: There are two types of euthanasia discussed in the textbook: active and
passive. Withdrawal of life-sustaining technology is considered passive euthanasia.
Active euthanasia is purposefully doing something that will result in the client’s death,
such as knowingly and purposefully administering a medication overdose. Alleviation
and illegal are not forms of euthanasia discussed in the textbook.
AACN Essential Competencies: IX.18. Develop an awareness of patients as well as
healthcare professionals’ spiritual beliefs and values, and how those beliefs and values
impact health care.
professionals.
Page Number: p. 67
Question 14
What ethical issues arise from organ donation and transplantation? (Select all that
apply.)
1. Allocation of organs.
2. Selling of organs.
3. Advanced consent for donation.
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4. Involvement of children as donors.
5. Cloning for the manufacture of organs.
Correct Answer: 1, 2, 4, 5
Rationale: The ethical issues that arise from organ donation and transplantation include
allocation of organs, selling of organs, involvement of children as donors, and cloning for
the manufacture of organs. Advanced consent for donation is a way to assure that the
wishes of the donor are followed, which helps to avoid an ethical situation.
professionals.
Page Number: p. 68
Question 15
What is the major ethical argument related to allocation of health resources?
1. The question of whether health care is a right or a privilege.
2. How to provide low-cost prescription medication to low-income persons.
3. Whether physician or nurse practitioners provide the most cost-effective care.
4. Whether medication therapy is superior to diet therapy in the control of chronic illness.
Correct Answer: 1
Rationale: All of these options are ethical dilemmas faced by healthcare providers, but
the major argument is whether health care is a right or a privilege. The other options
reflect this basic argument.
professionals.
Page Number: p. 68
Question 16
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What is the major benefit of ethics education courses that include both nursing students
and medical students?
1. The nursing students learn how difficult medical school is.
2. The medical students learn how difficult nursing school is.
3. It helps bring about better team communication in practice.
4. Both groups learn that medicine is a business, not just a service.
Correct Answer: 3
Rationale: Interdisciplinary education courses including both nursing students and
medical students would have all of these options as benefits. The major benefit is that
they bring about better team communication in practice.
Learning Outcome: 3. Analyze ways in which nurses can enhance their ethical decision-
making abilities.
Page Number: p. 69
Question 17
Why are nurses valuable members of ethics committees?
1. They have more time to work on committees than many healthcare providers.
2. Their wages are lower than many disciplines so it is more cost effective.
3. They are direct and to the point and make decisions quickly.
4. They frequently have more contact with clients and families than other disciplines.
Correct Answer: 4
Rationale: Nurses are valuable because they have more direct contact with clients and
families than any other discipline. They do not have any more time than others to work
on committees. Nursing salaries are higher than many disciplines. Although nurses can
make quick decisions, this is not a quality that is beneficial in an ethics committee.
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making abilities.
Page Number: p. 69
Question 18
The nurse wishes to participate in educational ethics rounds at the hospital. What is
essential in these rounds?
1. The client must give consent.
2. The group must be interdisciplinary.
3. These rounds must be conducted privately.
4. The cases must be hypothetical.
Correct Answer: 1
Rationale: Ethics rounds use hypothetical or real cases and incorporate the traditional
rounding approach to education whereby discussions may be held at the client’s bedside.
The client must give consent. These ethics rounds may or may not be interdisciplinary.
making abilities.
Page Number: p. 70
Question 19
To what does the moral principle of nonmaleficence refer?
1. Truth telling
2. Duty to do no harm
3. Faithfulness
4. Doing good
Correct Answer: 2
Rationale: Nonmaleficence is duty to do no harm. Veracity is truth telling. Fidelity is
faithfulness. Beneficence is doing good.
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Learning Outcome: 4. Identify the moral principles involved in ethical decision-making.
Page Number: p. 60
Question 20
To what does the moral principle of beneficence refer?
1. Truth telling
3. Faithfulness
4. Doing good
Correct Answer: 4
Rationale: Beneficence is doing good. Veracity is truth telling. Nonmaleficence is duty
to do no harm. Fidelity is faithfulness.
Page Number: p. 60
Question 21
To what does the moral principle of fidelity refer?
1. Truth telling
3. Faithfulness
4. Doing good
Correct Answer: 3
Rationale: Fidelity is faithfulness. Veracity is truth telling. Nonmaleficence is duty to do
no harm. Beneficence is doing good.
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Page Number: p. 60
Question 22
To what does the moral principle of veracity refer?
1. Truth telling
3. Faithfulness
4. Doing good
Correct Answer: 1
Rationale: Veracity is truth telling. Nonmaleficence is duty to do no harm. Fidelity is
faithfulness. Beneficence is doing good.
Page Number: p. 60
Question 23
What is the focus of client advocacy?
1. The nurse is responsible for the client’s health.
2. The nurse should influence the client to make the right decision.
3. The focus is respect for the client’s decisions and enhancement of autonomy.
4. Emphasis is on correcting the client’s reported weaknesses.
Correct Answer: 3
Rationale: Client advocacy is focused on respect of the client’s decision-making and
enhancement of the client’s autonomy. The nurse should assist the client with decision-
making, but not influence the decision. The nurse is not responsible for the client’s
health; that is the client’s responsibility. The nurse is not responsible for correcting the
client’s weaknesses.
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Learning Outcome: 7. Describe the advocacy role of the nurse.
Page Number: p. 72
Question 24
The nurse working at the bedside traditionally participates in which advocacy role?
(Select all that apply.)
1. Legal
2. Self
3. Collective
4. Class
5. Citizen
Correct Answer: 2, 5
Rationale: The bedside nurse is most likely to participate in self-advocacy and citizen
advocacy roles. Self-advocacy refers to supporting the nurse’s needs at work and the
client and family needs in health care. Citizen advocacy is concerned primarily with
empowering people through an individual relationship, so bedside nurses also work in
this role. Legal advocacy is more limited to attorneys or other court-appointed agents.
Collective or class advocacy refers to relatively large organizations that pursue the
interests of a category of people.
Page Number: p. 70
Question 25
Which attribute is necessary for the nurse who wishes to be a client advocate?
1. Restricting work to those areas in which the nurse has expertise and experience.
2. Referring any political action needs to a political action committee.
3. Avoiding conflicts with physicians and healthcare agency administrators.
4. Being assertive in representing the needs of the client and family.
Correct Answer: 4
Rationale: The client advocate nurse must be assertive in representing the needs of the
client and family. The nurse must be willing to become politically active and to work in
areas and with agencies that are unfamiliar. The nurse must also be aware that conflicts
with physicians, agency administrators, and others in health care may arise in the
advocacy role and must accept this conflict rather than trying to avoid it.
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Page Number: p. 71
Question 26
The nurse is assisting a client with values clarification. In which order should the nurse
suggest that the client complete the steps in this process?
1. Choose freely
2. List alternatives
3. Act on the choice
4. Affirm the choice
5. Act with a pattern
6. Feed good about the choice
7. Examine consequences of choices
Correct Answer: 2, 7, 1, 6, 4, 3, 5
Rationale: The following steps may help clients clarify their values: 1. list alternatives;
2. examine possible consequences of choices; 3. choose freely; 4. feel good about the
choice; 5. affirm the choice; 6. act on the choice; and 7. act with a pattern.
others’ values; appreciate diversity.
Page Number: p. 56
Question 27
The nurse is preparing an education seminar that focuses on moral development. In which
order should the nurse explain Kohlberg’s stages?
1. Instrumentalism/self-interest
2. Good boy/good girl
3. Obedience and punishment
4. Social contract
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5. Law and order
6. Universal moral principle
Correct Answer: 3, 1, 2, 5, 4, 6
Rationale: Kohlberg’s stages of moral development are: 1. obedience and punishment; 2.
instrumentalism/self-interest; 3. good boy/good girl; 4. law and order; 5. social contract;
and 6. universal moral principle.
Nursing/Integrated Concepts: Implementation; Teaching/Learning
Page Number: p. 57
Question 28
The nurse is participating on a committee to address an ethical dilemma. The bioethical
decision-making process will be used. In which order should the steps of this process be
implemented?
1. Implement the action.
2. Evaluate the action taken.
3. Identify ethical theories and principles.
4. Gather relevant facts related to the issue.
5. Develop alternative actions and project outcomes.
Correct Answer: 4, 3, 5, 1, 2
Rationale: The steps in the bioethical decision-making process are as follows: 1. gather
relevant facts related to the issue; 2. identify ethical theories and principles; 3. develop
alternative actions and project outcomes; 4. implement the action; and 5. evaluate the
action taken.
professionals.
Page Number: pp. 65–66
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