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Guido
Chapter 2
Learning Objective 2.1 Examine professional codes of ethics.
1. The health care team is involved in a situation in which there are two equally undesirable
options. One of these options must be chosen and applied to the situation. What term
describes this situation?
1. Ethical challenge
2. Ethical dilemma
3. Ethical paradox
4. Ethical contradiction
Answer: 2
Rationale: An ethical dilemma is an ethical situation that necessitates a choice between two
equally undesirable options. All ethical situations are challenges. An ethical paradox is a
contradictory statement that may nonetheless be true. An ethical contradiction is when
inconsistencies or discrepancies exist.
Nursing Process: Planning
Client Need: Safe and Effective Care Environment
Cognitive Level: Application
2. The hospital is developing an ethics committee. In planning this committee, the group
should consider that they are most likely to be asked to consider which type of ethical
dilemma?
1. Patient’s right to die
2. Patient’s right to privacy
3. Nurse’s violation of the Code of Ethics
4. Conflicts in basic human rights
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Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
Answer: 4
Rationale: While ethical situations may arise concerning patients’ right to die or their right to
privacy, the dilemma centers on what is the best action to take to protect basic human rights. A
specific nurse’s violation of the Code of Ethics would likely not be a common topic for the
hospital’s ethics committee.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
3. The nurse intends to lobby the state legislature to write a new code of ethics for the nurses
in the state. Is this an appropriate idea?
1. Yes, the code of ethics is written and published by individual state legislatures.
2. No, federal lawmakers have jurisdiction over codes of ethics.
3. No, the code of ethics is the product of hospital associations across the nation.
4. No, professional nursing organizations write the code of ethics for nurses.
Answer: 4
Rationale: Codes of ethics for nursing are written by nursing organizations, not legislators or
hospital associations.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
4. The student nurse is writing an essay on the development of ANA’s Code of Ethics for
Nurses with Interpretive Statements. Which information should be included in that
essay?
1. The document was originally written in 1980.
2. This code of ethics sets ethical standards that are negotiable according to the nurse’s
practice area.
3. The document expresses nursing’s own understanding of its commitments to society.
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©2010 by Pearson Education, Inc.
Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
4. Once written, the document has never required revision.
Answer: 3
Rationale: The ANA’s Code of Ethics for Nurses with Interpretive Statements is an expression
of nursing’s own understanding of its commitments to society. It was originally published in
1950 and was last revised in 2001. The standards delineated are nonnegotiable.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 2.2 Analyze and apply decision-making models in resolving ethical
dilemmas, with specific application of the MORAL model.
1. The nurse uses the MORAL model for ethical decision making at the bedside. Which
option reflects the first step (M) of this model?
1. The nurse investigates the opinions of everyone involved in the issue.
2. The nurse implements an intervention and thinks about its impact.
3. The nurse considers the benefits and risks of possible solutions to the problem.
4. The nurse evaluates the situation after an intervention is implemented.
Answer: 1
Rationale: In the first step of the MORAL model the participants “massage the problem,”
thinking of it from everyone’s point of view. Implementation occurs in the “A” step.
Considering benefits and risks occurs in the “O” stage. Evaluation is the last step, occurring in
the “L” stage.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 2.3 Evaluate slippery slope arguments in the application of ethical decisionmaking models.
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©2010 by Pearson Education, Inc.
Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
1. The hospital administration asks nursing services to assume housekeeping duties from
midnight until 6:00 a.m. Nurses are fearful that this is the first step to shifting complete
24-hour-per-day responsibility for housekeeping duties to nursing services. The nurses
believe this would take away from their ability to provide quality nursing care to their
patients. This scenario is an example of which ethical concept?
1. Slippery slope thinking
2. The MORAL argument
3. Reluctance model
4. Relevance thinking
Answer: 1
Rationale: Slippery slope thinking or arguments suggest that an action will initiate a chain of
events that cumulate in an undesirable event later. MORAL is an ethical decision-making
model. Reluctance model and relevance thinking are not ethical concepts.
Nursing Process: Assessment
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 2.4 Analyze the role of advocacy from an ethical perspective.
1. The patient who has been diagnosed with metastatic cancer declines chemotherapy
treatments. The nurse assists this patient in explaining this position to other health care
providers. What advocacy model is this nurse exemplifying?
1. Rights protection model
2. Values-based decision model
3. Jurisprudence model
4. Patient advocate model
Answer: 1
Rationale: The rights protection model is also known as the autonomy model, in which nurses
assist patients in asserting their autonomy rights. In the values-based decision model, the nurse
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Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
assists the patient by discussing his or her needs and desires and helps the patient make choices
that are most consistent with those wishes. In this case, the patient has already made the choice.
The patient advocate model is also known as the respect for persons model and focuses on
inherent human dignity and respect. This model is not as specific as the other models. The
jurisprudence model is not an advocacy model.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Analysis
2. The nurse provides information about treatment options to a patient who has been
diagnosed with diabetes mellitus. What patient advocacy model is this nurse using?
1. Autonomy model
2. Values-based decision model
3. Respect for persons model
4. Patient benefit model
Answer: 2
Rationale: The values-based decision model is predicated on sharing of information and
assisting the individual to become empowered to speak on his or her own behalf. The patient
benefit model is used for incompetent patients. The autonomy model allows for decision making
by the competent patient. The patient advocate model is also known as the respect for persons
model and focuses on inherent human dignity and respect. This model is not as specific as the
other models. The jurisprudence model is not an advocacy model.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Application
3. The nurse believes that a physician’s order is contrary to the accepted standard of care and
could potentially harm the patient. What should the nurse do?
1. Follow the order anyway since the physician should know what is correct.
2. Ask another nurse to complete implementation of the order in question.
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Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
3. Ask a lawyer who would be liable if the patient is harmed.
4. Question the physician regarding the order.
Answer: 4
Rationale: Nurses should be aware of hospital policy and procedures, as well as standards of
care. If an order appears to violate either of these types of standards or appears dangerous to the
patient, the nurse should question the physician about the order. Following orders without
question is dangerous for the patient and legally dangerous for the nurse. There is no need to
involve a lawyer at this point in the situation. Asking another nurse to complete the questionable
order does not protect patient safety.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 2.5 Define moral distress, its effect on nurses in practice settings, and ways
of coping with moral distress.
1. The nurse manager is conducting a performance review with a nurse who has worked on
the unit for 10 years. During the review, the nurse begins to cry and tells the manager, “I
just can’t do this anymore. I can’t sleep because I have such bad nightmares about
patients. I can’t eat and I’ve already lost 15 pounds.” The nurse manager identifies these
findings as being possible signs of which problem?
1. Moral distress
2. Too much focus on the patient
3. Problems at home
4. Developing incompetence
Answer: 1
Rationale: Signs and symptoms of moral distress include powerlessness, guilt, loss of selfworth, self-criticism, low self-esteem, and physiologic responses such as crying, depression, loss
of sleep, nightmares, and loss of appetite. These comments by the nurse are a call for help and
are not indicative of too much focus on the patient or developing incompetence. There is no
evidence that this nurse is experiencing problems at home.
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©2010 by Pearson Education, Inc.
Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
Nursing Process: Diagnosis
Client Need: Safe, effective care environment
Cognitive Level: Analysis
2. Unrest on the nursing unit has progressed to moral outrage among the nursing staff.
Which statement, made by the nurse manager to the chief nursing officer, indicates an
understanding of this issue?
1. “We may experience turnover in staff positions if this tension continues.”
2. “This will be a good opportunity to get rid of the unit trouble-makers.”
3. “I am going to try to divert this energy by asking the nurses to help rewrite the policy
and procedures manual.”
4. “I think we need to hire some more unlicensed personnel to shift the direct patient care
work off the registered nurses.”
Answer: 1
Rationale: Moral outrage on a nursing unit may increase turnover as nurses resign to rid
themselves of stress. This is not a good time to focus on getting rid of anyone. Moral energy
takes maximum energy, and it is not a good time to ask the nurses to take on new
responsibilities. Most nurses get into the profession because they like to care for patients, so
asking nurses to stop caring for patients and start managing more unlicensed personnel will not
decrease stress.
Nursing Process: Assessment
Client Need: Safe, effective care environment
Cognitive Level: Analysis
3. Which change would be helpful in assisting nurses to cope with moral distress?
1. Relieving the nurses from service on ethics committees
2. Having unlicensed personnel provide all direct patient care
3. Encouraging free discussion of ethical concerns
4. Increasing compensation for overtime hours worked
Answer: 3
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Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
Rationale: Open communications assists nurses in dealing with moral distress. Allowing nurses
to serve on ethics committees gives the group active participation in the issues. Most nurses get
into the profession because they like to care for patients, so asking nurses to stop caring for
patients and start managing more unlicensed personnel will not decrease distress. While
everyone likes to be adequately compensated for work done, simply raising the rate of pay
without addressing the causative factors will not have a positive impact on moral distress.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Analysis
Learning Objective 2.6 Discuss therapeutic jurisprudence and its place in ethical decision
making.
1. In nursing school, the student learns that the nurse should always consider the possible
outcomes of any nursing action taken. What ethical concept does this consideration
support?
1. Slippery slope arguments
2. Therapeutic jurisprudence
3. Autonomy model
4. Perception model
Answer: 2
Rationale: The essence of therapeutic jurisprudence as it applies to nursing is that the nurse
should always consider the possible outcomes of any nursing action. Slippery slope arguments
are concerns that one decision may lead to it being taken for granted that other actions are also
considered ethical. The autonomy model refers to protecting the patient’s rights of autonomy.
There is not an ethical model titled perception model.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 2.7 Examine the role of health policy as it relates to resolving ethical
dilemmas in nursing practice.
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©2010 by Pearson Education, Inc.
Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
1. Nurses are revising the policy and procedure manual for the nursing unit. They work to
ensure that the policies address more than one person and more than one set of
circumstances. Which aspect of policy does this reflect?
1. Scale
2. Normativity
3. Generality
4. Decision determination
Answer: 3
Rationale: A policy has generality when it addresses more than one person and more than one
set of circumstances. A policy has normativity when it formalizes judgments about what course
of action is better among alternatives and the rules under which those alternatives will be
determined. A policy has scale in that policies apply at different levels of an organization or
society, and policies at one level can supersede policies at lesser levels. Decision determination
is not an aspect of policy.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Application
2. Nurses believe that there is a need to change policy for their clinical unit. What is the first
step these nurses should take when considering this need for new policy?
1. Looking for ethical arguments regarding the policy
2. Finding out who has authority to change the policy
3. Determining how many people are affected by the policy
4. Identifying the problem
Answer: 4
Rationale: Changing and writing policy is a thoughtful and methodical process that should
follow a distinct framework. The first step of this framework is identifying the problem.
Nursing Process: Implementation
Client Need: Safe, effective care environment
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©2010 by Pearson Education, Inc.
Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e
Cognitive Level: Application
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©2010 by Pearson Education, Inc.
Guido, Test Item File for Legal & Ethical Issues in Nursing, 5/e