Deck 3: Ethical Issues

Question 1

A patient who is intubated has periods of lucidity mixed with periods of confusion or stupor. During one lucid episode, the patient wrote, "take this tube out and let me die." Which of the following should the nurse do?

A) Determine that the patient is experiencing side effects of medications and ignore the request
B) Determine that the patient is unable to make decisions because of being intubated
C) Realize that the patient has a mental disability
D) Inform the physician of the patient's comment

Answer 1

Inform the physician of the patient's comment

Question 2

A patient tells the nurse that she has a living will and a form that she filled out from her pastor that address the kind of care that she would like if she ever could not make decisions on her own. The nurse realizes the patient is describing which of the following?

A) Physician Order for Life-Sustaining Treatment form
B) Respecting Choices form
C) Durable Power of Attorney
D) Advance directive

Answer 2

Respecting Choices form

Question 3

A patient tells the nurse that he wants to establish a durable power of attorney for health care but can't decide who should be appointed as the surrogate. Which of the following should the nurse tell the patient?

A) It might be best if you ask a close friend to be your surrogate
B) The best person would be your spouse
C) One of your older children should be your surrogate
D) Appoint the person who will follow your directions and can make hard decisions

Answer 3

Appoint the person who will follow your directions and can make hard decisions

Question 4

The nurse, caring for a patient in a persistent vegetative state, is told by the patient's brother that the patient would not want to be kept alive artificially. The nurse realizes that the brother's issue could be addressed under which of the following?

A) Federal grand jury
B) State board of nursing laws
C) State legislature
D) Doctrine of substituted judgment

Question 5

A patient with a history of bipolar depression tells her physician that she no longer wants to live with the breast cancer treatment and wants to die. The patient resides in Oregon. Which of the following should be done first?

A) Ask the patient when she would like to have the procedure to end her life done
B) Determine whether the patient's decision to die is valid or a result of depression
C) Suggest that the patient finalize all personal activities before the act is done
D) Ask the patient if she would like anyone in attendance during the procedure

Question 6

A patient tells the nurse that he has a "piece of paper" signed by his doctor that says what care he is supposed to get if an ambulance needs to come to his home. Which of the following should the nurse also assess in this patient?

A) Signed natural death form
B) Living will
C) Respecting Choices form
D) An advance directive

Question 7

A patient needs emergency surgery for a bleeding ulcer however is unconscious and unable to provide consent and does not have an advance directive. In this situation, who would the physician discuss the patient's care needs?

A) Patient-designated surrogate
B) Clinically-designated surrogate
C) Judicially-designated surrogate
D) Statutorily-designated surrogate

Question 8

An elderly patient tells the nurse that he never really thought about what kind of care he would want if he couldn't make the decisions himself, since he knows that his children would be able to make these decisions for him. Which of the following responses should the nurse give this patient?

A) Children will always make choices that prolong the life of their parents.
B) I'm sure your children know what's best for you.
C) Making your wishes known would make it easier on your children.
D) This is a wise decision.

Question 9

A patient tells the nurse that he is sorry that he started chemotherapy because if he knew then what he knows now, he would have refused it. What does this statement indicate to the nurse?

A) The patient was not fully informed
B) The patient should have written an advance directive
C) The patient is improving
D) The patient is experiencing side effects and does not realize what he is saying

Question 10

The nurse asks to not be assigned to a dying patient because of personal attitudes about the care the patient is receiving. The nurse's request would be considered as which of the following end-of-life competencies?

A) Promote the provision of care of the dying as an important skill
B) Recognize one's own attitudes and feelings about death
C) Assess multiple dimensions to improve quality at end of life
D) Identify barriers to the patient's effective use of resources

Question 11

A patient tells the nurse that he wants to end his life and asks to talk with the doctor about assisted suicide. Which of the following should the nurse do to assist this patient?

A) Ask the physician to document that the patient is incompetent for making healthcare decisions
B) Determine that the patient is not fully informed of his decision and ask him if he realizes what he is asking to be done
C) Remind the patient that his decision cannot be changed now that he has stated his intentions
D) Contact the patient's physician to discuss his decision

Question 12

The family of a deceased patient tells the nurse that they believe the physician provided the patient with an overdose of pain medication in order to assist the patient to die. Which of the following needs to be determined in this situation?

A) According to the state, did the pain medication dose cause suicide or assist it?
B) Who approved the dose of pain medication and what legal recourse does the family have?
C) What else is the family not saying about the patient's death?
D) The cause of death will be due to an overdose of pain medication and is most likely going to be ruled as accidental.

Question 13

A patient, admitted with a grave head injury, does not have an advance directive. The patient is unmarried and does not have living parents. With whom should the health care provider discuss the patient's ongoing care?

A) Adult niece
B) Adult brother
C) Minor sister
D) Best friend

Question 14

The nurse, caring for a terminally ill patient in a coma, reads the patient's living will and realizes that most of the care provided has been in violation of the will. Which of the following will most likely occur with the nurse, physician, and care organization?

A) Nothing because there is usually no legal enforcement of the living will
B) The nurse, physician, and care organization will be sued for criminal activity
C) The nurse, physician and care organization will be sued for civil liability
D) Since the will was just read, all previous care would be null and void but going forward, care has to be provided according to the will

Question 15

A patient tells the nurse that he does not want surgery to remove an abdominal tumor but would like to discuss other treatment options including pain medication and radiation. The nurse realizes that the patient's requests for additional discussion would be included in which of the following?

A) Physician Order for Life-Sustaining Treatment form
B) Living will
C) Natural death act
D) Informed consent

Question 16

The nurse meets with a social worker to discuss hospice options with a patient approaching end-of-life and then discusses the options with the patient and family. The nurse was implementing which of the following end-of-life competencies for nurses?

A) Demonstrate respect for the patient's views and wishes during end-of-life care
B) Promote the provision of comfort care as an important skill
C) Communicate effectively about end-of-life issues
D) Identify barriers to patient's effective use of resources

Question 17

The Ethics Committee is meeting to discuss continuing care for a patient in a persistent vegetative state. The husband wants the patient to continue to receive care yet the mother and sister of the patient claim that they were told repeatedly by their daughter/sister that in no way did she want to be a burden to the healthcare industry. Which of the following should the Ethics Committee members do regarding the patient's care?

A) The issue is too big for the committee and must be taken to the state supreme court
B) The Committee members must do everything to keep the patient safe and alive
C) The information provided by the mother and sister must be taken into consideration
D) The committee members should tell the husband to work it out between his mother and sister-in-law and come to a decision

Question 18

A patient being treated for a terminal illness tells the nurse that even though he signed a natural death act a few years ago, he does not want to have it followed. Which of the following should be done to support this patient?

A) Instruct the patient that once it is signed, it has to be followed
B) Deem the document as invalid
C) Remind the patient that even though he signed the document, it is up to the doctor to follow it or not
D) Ask the patient if his attorney is willing to go to court to have the document revoked

Question 19

A clinically-designated surrogate decision maker is discussing with the physician the choices that most effectively address the patient's ongoing healthcare needs. This surrogate is utilizing which of the following standards when determining the patient's wishes?

A) Futility
B) Substituted judgment
C) Best interest
D) Consent

Question 20

The nurse, attending a basic cardiac life support review session, learns that cardiopulmonary resuscitation impacted patient care in which of the following ways?

A) Cardiopulmonary resuscitation was done to keep patients alive until organ transplantation could occur
B) Cardiopulmonary resuscitation became the standard of care in the 1960s for patients with cardiac and/or respiratory arrest
C) The use of cardiopulmonary resuscitation ensured positive patient outcomes at a time when hospitals were viewed as houses of death
D) Cardiopulmonary resuscitation was the only way to keep patients alive and comfortable at a time when health care had limited resources