1. A nurse who exhibits unprofessional conduct may be subject to discipline by
a. physiciansb. nursing associationsc. state boards of nursingd. none of these
2. Nurses' ethical values
a. may cause conflict with physiciansb. protect patients from incompetent, unethical, or illegal conductc. may cause them to leave a specific cased. all of these
3. The societal factors that have increased ethical decision-making problems for nurses are:
a. changing career opportunitiesb. changing religious viewsc. changing moral standardsd. none of these
4. Ethics are
a. religious tenetsb. standards of conductc. legally enforceabled. all of these
5. Aside from abortion, the most highly controversial issue of this decade is:
a. the right to die with dignityb. nurse's salariesc. confidentiality in patient's mattersd. ethics and morality
6. What is beneficence? Discuss with example. (5 points)7. As a health care provider, if you have to make an ethical decision, what are the elements of your decision making framework. (5 points)8. Discuss your understanding of death with dignity. (2 points)9. Define euthanasia. (2 points)10. Does an individual have a right to ‘choose death’? Discuss. (4 points)11. Define informed consent with examples. (2 points)12. What are the rights of the fetus? (2 points)13. What are the rights of the society towards the pregnant mother? (3 points)14. Based on the discussion of your book, discuss in detail why do you think obtaining an informed consent is necessary before any invasive procedures? (3 points)15. Write 3 ethical dilemmas facing the abortion issue today. (3 points)16. If you believe in patients' autonomy in relation to informed consent then justify autonomy to explain the right and obligations of a pregnant woman. (4 points)17. Discuss your thought in sterilizing a mentally retarded person. (4 points)18. Discuss your thought on genetic engineering, genetic cloning and genetic testing and stem cell research in relation to citizen’s health. (8 points)19. In U.S. as a citizen, what kind of health care system you think we should have. (4 points)20. Discuss the case study and answer all the questions. (9 points)You are a new grad of 6 months working the night shift on a small cancer unit. There re two RNs on this unit and you are the most senior. Mr. V. has been in and out of this unit several times over the last few months. He has liver cancer and has gone through several episodes of chemotherapy. His last admission, however, was for an unsuccessful suicide attempt. At the time, you learned that he had made several such attempts in the last few weeks. Mr. V. recently joined the hospice program. His current admission is for pain control and the orders are to start a morphine drip to be titrated for pain. The only set parameters are to decrease the drip for respirations less than four per minute. Mr. V. requests that the drip be increased several times during your shift. Even though he does not appear to be in any discomfort, you accept his assessment and increase the drip. His wife has been staying with him since his admission. On a routine check, you note that his respirations are now four per minute and he is unarousable. You turn off the drip, telling the wife that you will turn it back on if he arouses at all or shows any signs of being in pain but that his respirations are dangerously low. After about an hour be begins to arouse and you resume the drip at a lower level. After about 10 more minutes, Mr. V. wakes up and is furious with you, accusing you of bringing him back from death. "I have a do-not-resuscitate order; you are supposed to let me die." You reply that you did not bring him back; you stopped pushing him toward death.
1. How do you ethically define what is happening in this situation.2. If you had keep the morphine turned on, would you be letting him die or causing him to die? Is there a difference? How do you justify your actions?3. What is at stake in this situation?
21. Discuss the case study and answer all the questions. (9 points)Ms. B. recently graduated
magna cum laudefrom a very prominent law school. She is married to a very successful architect, Mr. C., and they currently live on the West Coast. They have been waiting to start a family until she completed law school, and she quickly became pregnant after graduation. She is somewhat ambivalent about the pregnancy, but her husband is anxious to start a family.Ms. B. is offered the very prestigious honor of clerking for a Supreme Court Justice just as she enters her eighth week of pregnancy. This is a life long dream come true and she wants very much to accept this position. However, she realizes it would be impossible to care for a child in the way she and her husband value while carrying out the demanding work of a Supreme Court Clerk. She now views this pregnancy as a hindrance and wants to obtain an abortion. He husband would like to have the child. She decides to have an abortion.
1. What constitutes a legitimate reason for an abortion? Is having a legitimate reason necessary?2. What are Ms. B.’s rights and Mr. C.’s rights in this situation?3. What are your moral judgments in this case and how would they affect your care of Ms. B.?
22. Discuss the case study and answer all the questions. (9 points)Mary Elizabeth is from a large and well-to-do family. She is 24 years old and living on the streets. Her family has paid to have her admitted to many expensive private psychiatric facilities for treatment of her schizophrenia. Mary Elizabeth always signs herself out. Since she is not judged to be dangerous, she cannot be held against her will.Mary Elizabeth=s symptoms can be well controlled with psychotropic medication. However, she does not take the drugs and says she does not like the way she feels when she is on them. She writes beautiful poetry and says she finds "my own reality" much more interesting than the boring and tedious life she experiences when on the medication. She prefers the friends she makes on the street to the dullness of "so-called normal people."Her sister arranges to have her poetry published and sends the meager proceeds to Mary Elizabeth. She is occasionally picked up for vagrancy, however, and brought in for treatment. Her parents are always contacted. Mary Elizabeth does not maintain contact with them otherwise.
1. Does Mary Elizabeth have the right to live in her "own reality"? What are society=s rights and responsibilities toward "vulnerable" individuals like Mary Elizabeth?2. Should Mary Elizabeth be required to take her medications? How? Why? By whom?3. What responsibility do Mary Elizabeth’s parents have for her?
23. Discuss and answer all questions. (9 points)The home health nursing service in your hospital is facing budget cuts and staff limitations. In order to accommodate the patients who are being discharged earlier with more acute nursing needs in the home, your manager has proposed limiting visits to some chronic patients. She has proposed closing cases of Anon-complaint@ patients, and patients who show no improvement in spite of visits from the home health nurse for several months.One such patient is Mrs. Lombardi. She is a 76-year-old woman with a stasis ulcer on her right ankle. You have been visiting her twice a week for the last 7 months, doing dressing changes on the wound and monitoring her diabetes. She has very brittle diabetes, is overweight, and lives alone. The wound is clean but has shown no sign of healing. Mrs. Lombardi is a heavy smoker with a 55-year history of smoking two packs per day. You have counseled her regularly about the risks of smoking but she says she has no interest in stopping at this late stage of her life and besides, she has tried many times to quit using many different methods and has never been successful. She is aware that her ability to heal the ulcer may be compromised by continuing to smoke.Your manager now says that, because Mrs. Lombardi continues to smoke, she is noncompliant with her treatment. Se recommends, additionally, that you close her case and stop the home visits since the wound shows no evidence of healing.
1. Is Mrs. Lombardi acting irresponsibly regarding her health by continuing to smoke?2. Does she have a right to expect continued treatment given the fact that the ulcer is unhealed?3. What is your responsibility as her visiting nurse in this situation?
24. Cindy is a 26-year-old, low functioning, developmentally disabled woman living in a county-certified group home with other developmentally disabled clients. She tells the home operator that she was raped by a man also living in the home.The police are contacted but refuse to make a police report because she would not be a competent witness and the case would never go to trial. Additionally, the accused man would never be deemed competent to stand trial and denies her claim. The local emergency department refuses to send out a rape kit and counselor since no police report has been filed. You are the nurse who case manages the home. (8 points)
1. What are Cindy’s rights in this situation? Are her rights lessened because she is developmentally disabled?2. What are the obligations of the nurse? Are these reduced once the police are contacted? Should this be pursued as a criminal matter?3. What is the best way to see that Cindy’s needs are met in this situation?4. What about the man involved in the rape, what are his needs and rights? How should these be addressed?