Ethical And Legal Issues In Canadian Nursing 4th Edition By Margaret Keatings, Pamela Adams TEST BAN

Chapter 01: An Introduction to the Ethics and the Law: A Perspective for Nurses Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following mandates that nurses have a basic understanding of the Canadian

legal system? a. Provincial and federal nursing bodies b. The Supreme Court of Canada c. Provincial nursing labor unions d. The Drug and Pharmacies Regulation Act, 1990 ANS: A Feedback A

B C D

Correct! Provincial and territorial regulatory bodies, have certain requirements related to nurses’ knowledge/skill, which includes knowledge of the legal system.

Incorrect—The Supreme Court, which is the final court of appeal in Canada, is not involved in the regulation of health care professionals.

Incorrect—Labour unions do not focus on nursing standards and knowledge; rather, they represent the collective bargaining rights of nurses.

Incorrect—This Act is relevant to nursing in that it regulates the prescribing, dispensing, and handling of drugs. It does not mandate the knowledge nurses require about the legal system.

DIF: Cognitive level: Comprehension 2. Identify one of the reasons why nurses need to have an understanding of ethics. a. Nurses do not share the same perspectives regarding health care with other health

care professionals. b. Morality and care are at the heart of nursing practice. c. Ethics provides a clear answer to nurses regarding the correct course of action. d. Convincing family members of compassionate courses of action is best done by

nurses.

ANS: B Feedback A

B C

Incorrect—Professional values may be shared across multiple professions, and perspectives on issues may be similar. When views on an issue differ, then knowledge of ethics assists in clarifying and defending one’s position to others.

Correct! One reason for nurses studying ethics is that morality and care are at the heart of nursing practice.

Incorrect—Ethical theories can provide a framework for the exploration of the ethical questions and moral issues faced in health care. These theories guide how morality is understood within the sphere of nursing practice and the nurse–patient or nurse–client relationship. Ethical theories and frameworks can assist/guide nurses as they consider multiple options to choose the best or the

D

least wrong course of action.

Incorrect—Nurses as members of the health care team are in a strong position to support families. They respect the values and beliefs of clients and families and support them in decision making regarding the right course of action.

DIF: Cognitive level: Synthesis 3. Why is it advantageous for nurses to have knowledge of ethical theories and principles? a. Ethical theories encourage nurses to critique others’ points of view. b. Nurses are able to justify and defend their positions on a situation. c. Ethical theories help nurses explain to the rest of the team why nurses have a

greater understanding of the patient’s perspective. d. This knowledge allows nurses to convince patients to choose comfort measures

only.

ANS: B Feedback A

B

C D

Incorrect—Ethics encourages nurses to respect the values of others and assists in understanding opposing points of view. Ethics offers tools to nurses to respectfully argue in favour of their positions while respecting the perspectives of others.

Correct! When views differ, ethical theories help clarify one’s position and make arguments in support of it. Nurses ensure that all relevant information is shared with the team and the client.

Incorrect—The perspective of all team members is important and is based on the unique relationships each nurse has with the patient or client.

Incorrect—This approach is paternalistic. Nurses and the health care team, while respecting a person’s autonomy, support him or her in making decisions about what is best in a particular context. This includes ensuring that patients are aware of all the options available to them.

DIF: Cognitive level: Comprehension 4. Why must nurses be familiar with the legal system? a. Some nursing actions are governed by the law. b. Nurses’ decisions may not be supported by the law. c. Nurses are sometimes at risk for litigation. d. All are correct.

ANS: D Feedback A

B

Incorrect—Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.

Incorrect—Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have

C

D

untoward consequences, and errors or omissions may lead to negligence claims.

Incorrect—Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.

Correct! Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.

DIF: Cognitive level: Analysis 5. What existing legislation has been influenced by the shifting of Canadian values over

time? a. The abolition of capital punishment b. Privacy c. Medical Assistance in Dying d. All are correct ANS: D Feedback A

B C

D

Incorrect—One reason for the abolition of capital punishment is based on the belief in the sanctity of life and the concern that an innocent person may be executed.

Incorrect—Respect for autonomy and privacy led to legislation in provinces across Canada.

Incorrect—Shifting views regarding euthanasia for the terminally ill led the Supreme Court to create a law regarding assistance in dying. This resulted in the legislation “Medical Assistance in Dying,” which was introduced in 2016.

Correct! All of these are examples of how shifting Canadian values have influenced legislation.

DIF: Cognitive level: Comprehension TRUE/FALSE 1. In addition to having obligations to clients, nurses also have rights regarding what they can

expect as professionals.

ANS: T Feedback Correct

Incorrect

Like all Canadians, nurses have rights under the Charter of Rights and Freedoms. Nurses consider these rights in the context of their responsibilities and obligations to clients.

Like all Canadians, nurses have rights under the Charter of Rights and Freedoms. Nurses must consider these rights in the context of their responsibilities and obligations to clients.

DIF: Cognitive level: Comprehension 2. Through the Canada Health Act, the federal government is given authority over health

care in Canada.

ANS: F Feedback Correct Incorrect

Health Care is a provincial responsibility. Only the conditions under which the federal government funds health care is specified in the Act. Health Care is a provincial responsibility. Only the conditions under which the federal government funds health care is specified in the Act.

DIF: Cognitive level: Knowledge 3. The field of ethics is gaining greater prominence, in part, because of the growing

sophistication of science and technology.

ANS: T Feedback Correct

Incorrect

Recent advances in genetics, transplantation, and reproductive biotechnology, have opened up an entirely new array of ethical dilemmas, not previously known. This raises the question “Just because you can do something, should you?”

Recent advances in genetics, transplantation, and reproductive biotechnology, have opened up an entirely new array of ethical dilemmas, not previously known. This raises the question “Just because you can do something, should you?”

DIF: Cognitive level: Comprehension 4. A nurse is justified in accessing the chart of a friend who is a patient on another unit

because she is aware of her friend’s serious allergy to antibiotics and wants to make sure this is documented.

ANS: F Feedback Correct

Incorrect

It is inappropriate for a nurse to access the record of a patient who is outside of his or her “circle of care.” If the friend is not capable of disclosing this information, then to prevent serious harm, the nurse should disclose this information to the team if the friend’s family or substitute decision maker is not available to do so.

It is inappropriate for a nurse to access the record of a patient who is outside of his or her “circle of care.” If the friend is not capable of disclosing this information, then to prevent serious harm, the nurse should disclose this information to the team if the friend’s family or substitute decision maker is not available to do so.

DIF: Cognitive level: Comprehension 5. A resident in long-term has been deteriorating for a number of days. His daughter has been

with him most of the time and is exhausted. The nurse encourages her to go home to get some rest. A few hours later, it becomes clear to the staff that death is imminent.

Appreciating how exhausted the daughter is, the nurse is justified in not disturbing her.

ANS: F Feedback Correct

Incorrect

The nurse is denying the daughter the opportunity to be present with her father so that he does not die alone. It is the daughter’s, not the nurse’s, choice to make. This may also have implications for the grieving process.

The nurse is denying the daughter the opportunity to be present with her father so that he does not die alone. It is the daughter’s, not the nurse’s, choice to make. This may also have implications for the grieving process.

DIF: Cognitive level: Comprehension

Chapter 02: Ethical Theories: Their Meaning for Nursing Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. How may ethics be best described? a. The philosophical study of morality b. The process of value clarification c. The beliefs and norms of a society d. The application of ethical principles to moral issues ANS: A Feedback A B

C D

Correct! Ethics, the philosophical study of morality, is a comprehensive approach to the systematic exploration of what is morally right and wrong.

Incorrect—Value clarification is a process through which individuals come to understand the values they hold and the relative importance of each of these values and hence come to understand the various and shared perspectives they hold.

Incorrect—The beliefs and norms of a society influence ethical perspectives and are explored in the study of ethics.

Incorrect—Applying ethical principles to moral issues helps provide frameworks for ethical decision making and is a component of the study of ethics.

DIF: Cognitive level: Knowledge 2. Which of the following is the focus of normative ethics? a. The analysis of morality without taking a moral position b. The question of what is right or wrong c. Explaining how moral attitudes and beliefs differ from person to person d. Distinguishing between what is normal and what is not ANS: B Feedback A B

C D

Incorrect—This is a focus of descriptive ethics.

Correct! Normative ethics focuses on the reasons, principles, or arguments that guide decisions about what is right and wrong. Basic principles and virtues are identified to guide morality and provide coherent, systematic, and justifiable answers to moral questions.

Incorrect—A person’s differing moral attitudes and beliefs help to shape his or her personal values; and influence views about what is right or wrong.

Incorrect—People’s ideas of normal and abnormal could be based on values, but these distinctions are not necessarily ethical.

DIF: Cognitive level: Comprehension

3. Which of the following fields of ethics applies ethical theories and principles to actual

moral problems? a. Philosophical ethics b. Biomedical ethics c. Nursing ethics d. Applied ethics ANS: D Feedback A B C D

Incorrect—Ethics in general is a philosophical study.

Incorrect—Biomedical ethics explores moral issues and ethical questions associated with health care.

Incorrect—Nursing ethics focuses on moral questions within all domains of nursing.

Correct! Applied ethics is a specific field of ethics where theories and principles are applied to actual moral problems to assist in guiding decision making.

DIF: Cognitive level: Knowledge 4. Which of the following exists when mutually exclusive alternatives can both be supported

by strong moral reasons? a. Moral distress b. An ethical dilemma c. A value conflict d. An ethical violation ANS: B Feedback A

B C D

Incorrect—Moral distress results when a person is faced with ethical issues or conflicting values and cannot deal effectively with them or is obstructed from doing so.

Correct! An ethical dilemma arises when the best course of action is unclear and there are strong moral reasons supporting each opposing position.

Incorrect—A value conflict occurs when people encounter other individuals or groups whose value system are in conflict with their own.

Incorrect—An ethical violation occurs when actions and behaviours contradict what is clearly the right action or fail to meet an ethical standard or code of ethics.

DIF: Cognitive level: Comprehension 5. What is the result when a nurse believes that a course of action is correct, but is prevented

(e.g., through a law or policy) from carrying out that action or influencing the decision, resulting in feelings of guilt? a. An ethical dilemma b. Moral distress c. Ethical reasoning d. Moral irresponsibility

ANS: B Feedback A B C D

Incorrect—An ethical dilemma arises when the best course of action is unclear and there are strong moral reasons supporting each opposing position.

Correct! Moral distress results when a person is faced with ethical issues or conflicting values and cannot deal effectively with them.

Incorrect—Ethical reasoning is the process of ethical decision making, not the result of a situation.

Incorrect—Moral responsibility refers to the duty to act in accordance with the moral principles that guides groups or society. Moral irresponsibility would occur if a nurse disregarded professional or organizational ethical standards or codes of ethics.

DIF: Cognitive level: Comprehension 6. What is the correct term to describe a framework of principles and guidelines that helps to

identify ethical issues and reconcile conflicts? a. Metaethics b. Ethical theory c. Ethical values d. Descriptive ethics ANS: B Feedback A

B C

D

Incorrect—Metaethics analyzes the meanings of concepts, such as right, obligation, good, and virtue, and attempts to distinguish between what is moral and what is not—for example, the difference between a moral rule and a social rule.

Correct! Ethical theory is the study of the nature and justification of general ethical principles that can be applied to moral problems.

Incorrect—Ethical values are ideals and may vary across individuals, groups, or populations; they do not resolve conflicts but help in understanding various perspectives on an issue.

Incorrect—Descriptive ethics encompasses explanations and factual descriptions of moral behaviour and beliefs; it does not identify ethical issues or resolve conflicts.

DIF: Cognitive level: Knowledge 7. Which of the following best describes the concept of equality for all Canadians? a. A belief b. A value c. A principle d. A moral dilemma ANS: B Feedback A

Incorrect—A belief is individual and is something felt to be true; the concept of

B C D

equality is not simply an individual belief.

Correct! Equality for all is a societal value; the majority of Canadians subscribe to this ideal. A value has significant meaning to an individual, group, or society.

Incorrect—Principles help to guide moral decisions; the concept of equality is based on the principle of justice.

Incorrect—A moral dilemma occurs when the right course of action is not clear.

DIF: Cognitive level: Application 8. A nurse’s support of client autonomy is based on which of the following? a. An “a priori” principle b. A personal value c. A professional value d. A legal requirement ANS: C Feedback A

B C

D

Incorrect—Ethical principles are considered “prima facie”; that is, their application may be relative to another principle that may have more weight or priority in a given situation. They are not considered “a priori” or binding.

Incorrect—A nurse’s support of client autonomy may be an example of a personal value, but not exclusively.

Correct! Professional values build and expand on personal values. The value of client autonomy is a professional (and possibly personal) value and is evident in codes of ethics and professional standards for nurses.

Incorrect—Some legal doctrines, such as informed consent, are based on the principle of autonomy, but generally, supporting client autonomy is not a legal requirement.

DIF: Cognitive level: Comprehension 9. Which of the following theories may guide nurses to choose actions that will lead to the

best consequences, outcomes, or results? a. Utilitarian b. Deontological c. Normative d. Relative ANS: A Feedback A B C

D

Correct! Utilitarianism is a teleological theory in which the ethical choice is the one with the best consequences, outcomes, or results.

Incorrect—Deontological theories make explicit the duties and principles that should guide people’s actions; they do not focus on the consequences of actions.

Incorrect—Normative theories are intended to provide frameworks and rules to guide decisions about what is right or wrong, but they do not focus on the consequences of actions.

Incorrect—Relativism states that there are no moral absolutes and that the

concept of morality varies across cultures and among individuals; it does not provide a guide to choosing the best actions.

DIF: Cognitive level: Knowledge 10. What is the main principle underlying a rule-based theory of utilitarianism? a. The theory is always deontological. b. The theory considers individual acts. c. The theory considers general patterns of behaviour. d. The theory is the foundation of nursing ethics.

ANS: C Feedback A

B C

D

Incorrect—Deontological theory (which includes the belief that standards for moral behaviour exist independently of means or ends) includes both rule- and act-based theories but is not the main underlying principle.

Incorrect—Rule-based theories consider general patterns of behaviour, whereas act-based theories consider individual acts.

Correct! General patterns of behaviour are the foundation of rule-based theories.

Rule-based theories consider general patterns of behaviour, whereas act-based theories consider individual acts. Both rule- and act-based theories are utilitarian (in which the best choice is the one with the best outcomes).

Incorrect—Such approaches as caring ethics and ethical principles, not rule-based theories, are the foundation of nursing ethics.

DIF: Cognitive level: Comprehension 11. Which of the following is the basis for ethical decision-making frameworks? a. Ethical reasoning b. Ethical values c. Ethical dilemmas d. Ethical principles ANS: D Feedback A B C

D

Incorrect—Ethical reasoning is a process of ethical decision making using a framework.

Incorrect—Ethical values are beliefs held by an individual or a group and may evolve over time; they are not the basis for ethical decision-making frameworks.

Incorrect—Ethical dilemmas arise when the best choice of action is unclear and when strong moral reasons support each position; they are not the basis for ethical decision-making frameworks.

Correct! Ethical principles serve as rules to guide moral conduct and provide a framework for ethical decision making.

DIF: Cognitive level: Knowledge 12. What is the main difference between deontological and teleological theories?

a. Teleological theory focuses on the use of principles to choose the correct actions. b. Deontological theory focuses on ends or outcomes and consequences of decisions. c. Deontological theory suggests that standards for moral behaviour are independent

of the ends or outcomes of actions. d. All teleological theories are rule based.

ANS: C Feedback A B C

D

Incorrect—Teleological theory is focused on the end results or outcomes of actions.

Incorrect—Deontological theory is focused on acts and rules that support principles or duties, not on the ends or outcomes of decisions.

Correct! Deontological theory suggests that standards for moral behaviour are independent of the ends or outcomes of actions, whereas teleological theory focuses on the outcomes and consequences of actions.

Incorrect—Teleological theory is focused on the end results or outcomes of actions. Although rule utilitarianism, a teleological theory, considers the utility of general patterns of behaviour rather than that of specific actions.

DIF: Cognitive level: Comprehension 13. Which of the following ethical principles is the foundation of informed consent? a. Beneficence b. Justice c. Nonmaleficence d. Autonomy ANS: D Feedback A B C D

Incorrect—Beneficence holds that one must make a positive move to produce some good or benefit for another; it is not the foundation of informed consent.

Incorrect—Justice is based on the notions of fairness and equity; it is not the foundation of informed consent.

Incorrect—Nonmaleficence obliges people to act in such a way as to prevent or remove harm; it is not the foundation of informed consent.

Correct! Autonomy, or self-determination (including the right to choose one’s own path), is the foundation of informed consent.

DIF: Cognitive level: Analysis 14. Which of the following influenced the shift in ethical thinking away from abstract rules

that reinforce a deductive reasoning process? a. Patricia Benner b. Maternalistic attitudes c. Feminine ethics d. The principle of nonmaleficence ANS: C

Feedback A

B C

D

Incorrect—Patricia Benner observed the value of a nurse’s intuition and proposed that emotions are central to perception and rationality; she did not influence this shift in ethical thinking.

Incorrect—Maternalistic attitudes have not influenced shifts in ethical thinking.

Correct! Feminine ethics argues for an inductive process in which the starting point is the individual’s circumstances or personal story. It has influenced the shift in ethical thinking away from abstract rules that reinforce a deductive reasoning process.

Incorrect—Nonmaleficence is an ethical principle meaning “do no harm.” This longstanding principle was also present during periods when abstract rules reinforced a deductive reasoning process.

DIF: Cognitive level: Knowledge 15. Which of the following considers the influence of the nurse–patient relationship on ethical

decision making? a. Social Justice b. Autonomous ethics c. Feminine ethics d. Relational ethics ANS: D Feedback A

B C D

Incorrect—Social justice addresses equity and fairness within a society. Nurses advocate for strategies that address the societal issues that affect the health and well-being of persons in Canadian society.

Incorrect—Autonomy is an ethical principle; however, “autonomous ethics” is not a recognized form of ethics.

Incorrect—Feminine ethics emphasizes relational ethics, but relational ethics is not the main focus of feminine ethics.

Correct! Relational ethics considers the influence of the nurse–patient relationship on ethical decision making. If the entire focus is on ethical principles and the relationship between the nurse and the patient is ignored, then relational ethics is not present and the nurse may become disengaged.

DIF: Cognitive level: Comprehension 16. Which of the following aligns with the use of the narrative in nursing ethics? a. Ethic of care b. Relational ethics c. Value clarification d. Moral perspectives of Indigenous peoples ANS: D Feedback A

Incorrect—An ethic of care offers an approach to ethics that values feelings, emotions, empathy, and care. It recognizes the importance of relationships and

B

C D

the uniqueness and context of particular situations. It recognizes the value of knowing the person and his or her context; however, the use of narrative is not the major focus.

Incorrect—Relational ethics considers the influence of the nurse–patient relationship on ethical decision making. Although understanding a person’s story is part of relationship building, it is not the major focus.

Incorrect—Value clarification assists individuals in understanding the values they hold and the perspectives they may share with others.

Correct! The use of stories to uncover the complexity of moral issues is part of the rich oral Indigenous culture. Through stories, shared from generation to generation, they have created a strong system of knowledge and mythology that guides their moral thinking and actions. In nursing narrative ethics encourages the sharing of stories to gain a clearer understanding of the ethical issues and challenges embedded in them.

DIF: Cognitive level: Comprehension TRUE/FALSE 1. Rationality is related to the notion of thinking and reasoning. It is associated with

comprehension, intuition, and intelligence.

ANS: F Feedback Correct Incorrect

Rationality is associated with comprehension, intelligence, or inference; intuition is not considered a component of rational thinking.

Rationality is associated with comprehension, intelligence, or inference; intuition is not considered a component of rational thinking.

DIF: Cognitive level: Comprehension 2. Ensuring open visiting for those important to the person is an expression of a Canadian

value.

ANS: T Feedback Correct

Incorrect

Canadians value equity, individual rights, health and well-being, quality of life, and human dignity. Most Canadians, whatever their cultural background may be, value their family and friends—those closest to them.

It is the person’s choice to make as to who should be present with them when they are unwell. Of course, this has to be balanced with the rights of others in the same setting.

Canadians value equity, individual rights, health and well-being, quality of life, and human dignity. Most Canadians, whatever their cultural background may be, value their family and friends—those closest to them.

It is the person’s choice to make as to who should be present with them when they are unwell. Of course, this has to be balanced with the rights of

others in the same setting.

DIF: Cognitive level: Synthesis 3. Cultural relativists value democracy is the most ethical way to govern.

ANS: F Feedback Correct

Incorrect

Relativists believe that the moral values and principles of one culture do not govern the conduct of others. What may be considered moral in one culture may be considered immoral in another. Although some societies value democracy, others disagree and value utilitarian regimes, which may be the most appropriate, or the best, for that particular society.

Relativists believe that the moral values and principles of one culture do not govern the conduct of others. What may be considered moral in one culture may be considered immoral in another. Although some societies value democracy, others disagree and value utilitarian regimes, which may be the most appropriate, or the best, for that particular society.

DIF: Cognitive level: Comprehension 4. W. D. Ross identified prima facie duties as those duties that one must always act upon

unless they conflict with duties of equal or stronger obligation.

ANS: T Feedback Correct

Incorrect

Ross proposed that “right” choice or action is the one consistent with all the rules. When all of the duties are consistent, then the choice is based on preference. When there is conflict, then one appeals to the higher rule to resolve the conflict (e.g., sanctity of life versus veracity).

Ross proposed that “right” choice or action is the one consistent with all the rules. When all of the duties are consistent, then the choice is based on preference. When there is conflict, then one appeals to the higher rule to resolve the conflict (e.g., sanctity of life versus veracity).

DIF: Cognitive level: Knowledge 5. Indigenous peoples have a consistent view of morality, and this is embedded in their rich

oral tradition.

ANS: F Feedback Correct

Incorrect

Not all Indigenous communities hold to one philosophical view, religious belief, or moral code; however, all share an oral tradition that transmits history, traditions, and culture across generations.

Not all Indigenous communities hold to one philosophical view, religious belief, or moral code; however, all share an oral tradition that transmits

history, traditions, and culture across generations.

DIF: Cognitive level: Comprehension

Chapter 03: Guiding Ethical Decision Making: Resources for Nurses Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following was a focus of codes of ethics during earlier nursing times? a. Professional standards b. Practice standards c. The scope of practice standards d. The virtue and morality of nurses ANS: D Feedback A B

C

D

Incorrect—Professional standards have evolved in the current Code of Ethics for Registered Nurses; they were not a focus of historical codes of ethics.

Incorrect—Practice standards were not a part of historical codes of ethics and are not part of the modern Code of Ethics. Practice standards set out requirements related to specific aspects of nurses’ practice.

Incorrect—The scope of practice standards were not a part of historical codes of ethics and are not part of the modern Code of Ethics. Scope of practice standards articulate standards, limits, and conditions related to the scope of practice of nurses and nurse practitioners.

Correct! The virtue, character, and morality of nurses were the focus of early nursing codes of ethics, in addition to the key principles guiding nursing practice.

DIF: Cognitive level: Comprehension 2. Which of the following is true of the Canadian Nurses Association’s Code of Ethics for

Registered Nurses? a. It offers suggestions on resolving routine practice issues. b. It contains a dispute resolution mechanism. c. It offers a framework and guide for ethical practice. d. It is closely aligned with the physician’s code of ethics.

ANS: C Feedback A B C

D

Incorrect—Practice issues are not discussed in the Code of Ethics; these are regulatory body issues.

Incorrect—Dispute resolution mechanisms are part of a collective agreement, not of a code of ethics.

Correct! The Code of Ethics contains nursing values and ethical responsibilities, as well as ethical endeavours, all of which guide and frame ethical reflection and decision making in nursing practice.

Incorrect—There may be similarities between the two codes because they are both informed by ethical principles; however, there is no alignment between these two codes.

DIF: Cognitive level: Application 3. Which primary value from the Canadian Nurses Association’s Code of Ethics is being

followed by a nurse who intervenes to address an unsafe nursing practice? a. Being accountable b. Providing safe, compassionate, competent, and ethical care c. Promoting justice d. Promoting health and well-being ANS: B Feedback A B

C

D

Incorrect—Nurses are accountable for their actions and answerable for their practice, but this is not directly related to the situation mentioned above.

Correct! Nurses question and intervene to address unsafe, noncompassionate, unethical, or incompetent practice or conditions that interfere with their ability to provide safe, compassionate, competent, and ethical care.

Incorrect—Nurses uphold justice by safeguarding human rights, equality, and fairness and by promoting the public good, but this is not directly related to the situation mentioned above.

Incorrect—Nurses help people attain their highest possible level of health and well-being, but this is not directly related to the situation mentioned above.

DIF: Cognitive level: Application 4. Which primary ethical nursing value is being followed by a nurse who respects the wishes

of a patient to decline to receive information about his or her health condition? a. Promoting and respecting informed decision making b. Preserving dignity c. Being accountable d. Promoting health and well-being ANS: A Feedback A B C D

Correct! Nurses respect the autonomy and self-determination of people by allowing them to make their own choices.

Incorrect—Nurses recognize and respect the intrinsic worth of each person, but this is not directly related to the person’s decision making.

Incorrect—Nurses are individually accountable for their own practice, but this does not have a direct impact on the decisions of the patient.

Incorrect—Nurses help people attain their highest possible level of health and well-being. This is an important aspect of a patient’s decision making; however, it does not directly involve a person’s autonomy.

DIF: Cognitive level: Application 5. Which of the following statements best describes the “ethical responsibilities” in the

Canadian Nurses Association’s Code of Ethics? a. Ethical responsibility deals with ethical endeavours.

b. Nurses’ ethical responsibilities are informed by seven primary values. c. Social justice must be addressed consistently. d. Primary nursing values outline caring responsibilities.

ANS: B Feedback A

B C

D

Incorrect—Ethical endeavours describe approaches nurses may take to address broader societal inequalities, but they are not directly linked with nurses’ ethical responsibilities.

Correct! The seven primary values in Part I of the Code of Ethics inform nurses’ ethical responsibilities, which help guide nurses’ decision making.

Incorrect—Broader societal inequalities may be addressed by approaches promoted by the ethical endeavours section of the Code of Ethics, but this statement is not a description of ethical responsibilities.

Incorrect—Primary nursing values, which include ethical responsibilities, do not strictly outline these responsibilities.

DIF: Cognitive level: Comprehension 6. Which of the following rationale explains the development of the ethical endeavours

section of the Canadian Nurses Association’s Code of Ethics? a. Nurses are expanding their advocacy role. b. Canadians have become more diverse and have different health care needs. c. Nurses work with more “English as a second language” clients. d. Health resources are increasingly scarce.

ANS: B Feedback A B

C D

Incorrect—Although advocacy is required, this is not the rationale that explains the development of the ethical endeavours section of the Code of Ethics.

Correct! Canadians have become more diverse and have different health care needs. Nurses today work with the homeless, within the military, and with new immigrants to Canada. Increased numbers of immigrants, for instance, are at risk of deteriorating health as part of the transition to living in Canadian society.

Incorrect—This may be true, but it is not the rationale that explains the development of the ethical endeavours section of the Code of Ethics.

Incorrect—Appropriate use and distribution of resources is important; however, this was not the primary reason for the development of the ethical endeavours section of the Code of Ethics.

DIF: Cognitive level: Comprehension 7. Which of the following statements best describes an outcome of the ethical

decision-making process? a. There must only be one possible outcome. b. There must be several equally acceptable options. c. The goal is to discuss options, not decisions. d. More than one proposed intervention may be ethical.

ANS: D Feedback A B C D

Incorrect—Several possible outcomes may be examined in the ethical decision-making process.

Incorrect—Acceptable options may not be equal in value to all parties, so this is not the intended result of the ethical decision-making process.

Incorrect—This is not the goal of the ethical decision-making process.

Correct! More than one proposed intervention may be ethical and reflective of good ethical practice.

DIF: Cognitive level: Comprehension 8. Which of the following is being used by an interdisciplinary team that implements and

evaluates a plan of action after considering key players, clarifying values, and exploring alternatives? a. A code of ethics b. An ethics committee c. Practice standards d. An ethical decision-making model ANS: D Feedback A B C D

Incorrect—A code of ethics helps inform ethical decision making but does not directly guide the process described.

Incorrect—An ethics committee may be involved in the ethical decision-making process, but not the entire process, as described.

Incorrect—Practice standards may be part of the discussion when exploring alternatives but are not involved in the entire process described.

Correct! The process described is standard in ethical decision-making models.

DIF: Cognitive level: Analysis 9. Which of the following best describes the goals of an ethics committee? a. To provide a single view toward the outcome of an ethical issue b. To present various views or “lenses” on the issues c. To develop standards of practice for nurses d. To ensure that comfort is achieved ANS: B Feedback A B C D

Incorrect—This statement does not describe the goals of an ethics committee.

Correct! Ethics committees present various views of or “lenses” on the issues, and there can be more than one alternative outcome.

Incorrect—Standards of practice are the responsibility of the regulatory body.

Incorrect—Comfort may be a goal of care that is considered, but, depending on the situation, the key players, and the other goals being considered, may not be the result.

DIF: Cognitive level: Comprehension 10. Which of the following is demonstrated when a nurse takes an unresolved ethical situation

forward to an ethics committee? a. Nonmaleficence b. Beneficence c. Accountability d. Promoting justice ANS: C Feedback A B C

D

Incorrect—Nonmaleficence means “do no harm.” This may be one aspect of what this nurse is doing, but it does not directly describe this action.

Incorrect—Beneficence means taking an action that benefits others. This may be an aspect of what this nurse is doing, but it does not directly describe this action.

Correct! Being accountable is one of the primary nursing values in the Canadian Nurses Association’s Code of Ethics. This nurse is demonstrating responsibility and accountability by taking action that will hopefully help in addressing the issue of concern.

Incorrect—Not enough is known about this situation to determine if promoting justice is involved.

DIF: Cognitive level: Synthesis 11. What is the main role of an ethics committee? a. Consultation b. Education c. Policy d. All are correct ANS: D Feedback A

B

C

D

Incorrect—Ethics committees offer suggestions but do not direct care decisions.

Educating staff on ethical issues is a key responsibility. Changing technologies require the need for evolving policies and guidelines around everyday ethical issues, and the committee is the expert opinion on these matters.

Incorrect—Ethics committees offer suggestions, but do not direct care decisions.

Educating staff on ethical issues is a key responsibility. Changing technologies require the need for evolving policies and guidelines around everyday ethical issues, and the committee is the expert opinion on these matters.

Incorrect—Ethics committees offer suggestions, but do not direct care decisions.

Educating staff on ethical issues is a key responsibility. Changing technologies require the need for evolving policies and guidelines around everyday ethical issues, and the committee is the expert opinion on these matters.

Correct! Ethics committees offer suggestions but do not direct care decisions.

Educating staff on ethical issues is a key responsibility. Changing technologies require the need for evolving policies and guidelines around everyday ethical

issues, and the committee is the expert opinion on these matters.

DIF: Cognitive level: Comprehension 12. Of those listed below, who is most likely to be a member of a hospital ethics committee? a. Funeral director b. Chaplain c. Community activist d. Palliative care volunteer ANS: B Feedback A B

C

D

Incorrect—Funeral directors may be involved as a community member but this is not the norm.

Correct! Chaplains are often part of an ethics committee. The committee is usually made up of professional staff with a certain level of experience in and knowledge of ethical issues.

Incorrect—Community members might be on the occasional ethics committee, but activists are not likely to be included because they may be advancing a specific cause or agenda.

Incorrect—Volunteers may know the patients but may not have the educational background to be able to participate on the ethics committee. They may participate as a community member, but this is not the norm.

DIF: Cognitive level: Comprehension TRUE/FALSE 1. Ethical principles inform only modern codes of ethics.

ANS: F Feedback Correct Incorrect

Ethical principles have been documented as far back as 1780 b.c. and form the basis of both historical and modern codes of ethics.

This is not a true statement.

DIF: Cognitive level: Knowledge 2. A code of ethics identifies disciplinary actions and resulting consequences for nurses who

are investigated for misconduct.

ANS: F Feedback Correct Incorrect

A professional body normally implements discipline and consequences.

A code of ethics establishes a standard by which the nurse is assessed if disciplinary or legal action against the nurse occurs; it does not identify disciplinary actions and resulting consequences.

DIF: Cognitive level: Comprehension 3. The use of an ethical decision-making model ensures the protection of an organization

from liability.

ANS: F Feedback Correct

Incorrect

Decision-making frameworks provide a process or guide to help identify the best choice of action. Their presence does not protect an organization from liability but their use helps justify the action or actions taken and demonstrates due process.

Decision-making frameworks provide a process or guide to help identify the best choice of action. Their presence does not protect an organization from liability but their use helps justify the action or actions taken and demonstrates due process.

DIF: Cognitive level: Synthesis 4. All nurses in Canada are expected to meet the ethical standards embedded in the Canadian

Nurses Association Code of Ethics for Registered Nurses.

ANS: F Feedback Correct

Incorrect

There are a number of nursing codes of ethics in Canada that share similar principles and values but focus on a specific category of nurses, such as registered nurses, nurse practitioners, or licensed/registered practical nurses. The principles and values embedded in these codes guide the practice of nursing, but only legislation and regulation (through regulatory bodies) can mandate standards for nurses.

There are a number of nursing codes of ethics in Canada that share similar principles and values but focus on a specific category of nurses, such as registered nurses, nurse practitioners, or licensed/registered practical nurses. The principles and values embedded in these codes guide the practice of nursing, but only legislation and regulation (through regulatory bodies) can mandate standards for nurses.

DIF: Cognitive level: Knowledge 5. The Registered Nurses Association of Ontario has introduced over 50 best practice

guidelines that were developed by nurses across Canada and have been adopted internationally.

ANS: T Feedback Correct

Expert Canadian nurses were engaged in guideline development. These guidelines are used not only in Canada but also internationally.

Incorrect

Expert Canadian nurses were engaged in guideline development. These guidelines are used not only in Canada but also internationally.

DIF: Cognitive level: Knowledge

Chapter 04: The Canadian Legal System Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. When a legal decision is being made, which of the following source of common law has

the highest degree of authority? a. Doctrine b. Case law c. Statute law and regulations d. Custom ANS: C Feedback A B C D

Incorrect—Doctrine, the opinion of a legal expert, does not have the highest degree of authority.

Incorrect—Case law is dependent on the level of the court that renders the decision and does not have the highest degree of authority.

Correct! Statute law and regulations are the most authoritative source of common law.

Incorrect—Custom has the lowest level of authority and is used only when there is a complete absence of guidance from other sources.

DIF: Cognitive level: Synthesis 2. Which of the following is being done by a judge when attempting to determine negligence

by applying principles from previous precedents and elaborating on them before making a decision? a. Naming a litigant b. Developing common law c. Developing civil law d. Preparing the case for the superior court ANS: B Feedback A B

C D

Incorrect—This does not describe what this judge is doing. A litigant is a party to a lawsuit.

Correct! Centuries of judgements, precedents, and previous cases all build on each other to form common law. The judge in this example is developing common law.

Incorrect—This does not describe what this judge is doing. Civil law uses a civil code to guide all decisions.

Incorrect—This is not applicable.

DIF: Cognitive level: Analysis 3. Which of the following statements accurately describes statute law?

a. A set of reasons for a decision in a particular case based on decisions made in

previous cases b. A formal written set of rules passed by a legislative body c. The absence of specific and applicable legal principles d. A system of rules and doctrines developed over time ANS: B Feedback A

B

C

D

Incorrect—This statement describes case law, not statute law. Case law is a body of precedent that contains rules, definitions of legal concepts, and legal principles fashioned by judges over time.

Correct! Statute law is a formal written set of rules passed by Parliament or other legislative body to regulate a particular area, such as Ontario’s Regulated Health Professions Act (1991), which regulates all of the health care professions in Ontario.

Incorrect—This statement describes custom, not statute law. Custom means that in the absence of specific and applicable legal principles in case law, statutes, or doctrine, the courts will be guided by the longstanding practices of a particular industry, trade, or other endeavour.

Incorrect—This statement describes common law, not statute law.

DIF: Cognitive level: Knowledge 4. Which of the following statements regarding the priority of a regulation is accurate? a. An act is inferior to the regulation from which it flows. b. The regulation is considered a guideline. c. A regulation is known as “subordinate legislation.” d. A regulation is known as “inordinate legislation.”

ANS: C Feedback A B C

D

Incorrect—This is not an accurate statement.

Incorrect—This is not an accurate statement. Regulations are more than a guideline, and they have the same force of law as statutes or acts.

Correct! A regulation is additional legislative detail written to assist in explaining a statute or act and its application. Thus, regulations are known as “subordinate legislation,” and the regulation is inferior to the act from which the regulation flows; the statute takes priority.

Incorrect—“Inordinate” means excessive, or disorderly, and is irrelevant with regard to regulations and legislation.

DIF: Cognitive level: Application 5. Which of the following is the most accurate description of jurisprudence in the Quebec

legal system? a. A body of precedent in Canadian common law that is superior to the civil code b. A body of precedent in Quebec common law that is superior to the civil code c. A body of precedent in the Canadian civil system that is inferior to the civil code

d. A body of precedent in the Quebec civil system that is inferior to the civil code ANS: D Feedback A B C D

Incorrect—Common law does not use a civil code.

Incorrect—Quebec does not use common law.

Incorrect—In Canada, only Quebec has a civil law system; the rest of Canada is based on a common law system. The civil code is part of civil law.

Correct! Jurisprudence is a body of precedent used in Quebec civil law. It is merely evidence of how previous courts have treated a particular provision of the Civil Code of Quebec and is subordinate to the Code and not binding on a subsequent court.

DIF: Cognitive level: Comprehension 6. Which of the following is the feature of justice that encompasses the notion that all people

are equal before the law and entitled to the same rights and benefits? a. Procedural fairness b. Due process c. Natural justice d. Rule of law ANS: B Feedback A B

C D

Incorrect—Procedural fairness means that all individuals are treated fairly and consistently; it does not directly relate to the notion described.

Correct! Due process is the feature of justice that encompasses the notion that all people are equal before the law and entitled to the same rights and benefits arising from the law.

Incorrect—Natural justice refers to what is fair and good in human relationships; it does not directly relate to the notion described.

Incorrect—The rule of law means that those responsible for administering and enforcing laws will do so appropriately; it does not directly relate to the notion described.

DIF: Cognitive level: Knowledge 7. A nurse named in a lawsuit is involved in a preparatory legal proceeding, where it

becomes apparent that the opponent has enough evidence to prove the case. What is this preparatory meeting called? a. Documentary discovery b. Examination for discovery c. Pretrial conference d. Disclosure ANS: B Feedback A

Incorrect—Documentary discovery is the process used to prove that the parties

B

C D

involved have disclosed all relevant documents; it is not the preparatory meeting described.

Correct! During examination for discovery, each party has the opportunity to answer questions relevant to any matter raised, in the presence of both parties’ lawyers. No judge is present at this stage.

Incorrect—A pretrial conference is one last effort before the trial to resolve the dispute; it is not the preparatory meeting described.

Incorrect—Disclosure is achieved through two mechanisms: documentary discovery and the oral examination for discovery; it is not the preparatory meeting described.

DIF: Cognitive level: Synthesis 8. Which of the following statements accurately describes an indictable offence? a. A “wrong” committed against another person under common law b. A less serious type of criminal offence c. The most serious type of offence under common law d. The most serious type of criminal offence ANS: D Feedback A B C D

Incorrect—This “wrong” is known as a tort, not an indictable offence.

Incorrect—A criminal offence of a minor or relatively less serious nature is known as a summary conviction offence, not an indictable offence.

Incorrect—An indictable offence falls under criminal law, not common law.

Correct! An indictable offence is the most serious type of criminal offence.

Murder in the first degree is an example of an indictable offence.

DIF: Cognitive level: Knowledge 9. Which of the following is considered an administrative tribunal? a. A collective bargaining team b. A nurses’ association review board c. An appellate court d. A trial court ANS: B Feedback A B

C D

Incorrect—A collective bargaining team is not a tribunal.

Correct! This review board would be considered an administrative tribunal.

Administrative tribunals are not courts in the strict sense, although the adjudication is based on the respective rights and obligations of the parties who come before them.

Incorrect—An appellate court is an appeals court and is the highest level of provincial court, not a tribunal.

Incorrect—A trial court is a provincial court, not a tribunal.

DIF: Cognitive level: Synthesis

10. Which of the following statements is the most accurate with regard to the impact of an

appeal of a judgement to an appellate court? a. A new trial with new witnesses will be involved. b. It must be referred to a higher provincial court. c. The matter must be referred to the trial court. d. No new witnesses will be called.

ANS: D Feedback A B

C

D

Incorrect—There is no new trial in this appeal, only a review of the trial proceedings.

Incorrect—There is no higher provincial court after the appellate court. The matter must be referred to the Supreme Court of Canada, which is the final court of appeal.

Incorrect—Trial courts are provincial courts and are subordinate to the appellate court. The matter must be referred to the Supreme Court of Canada, which is the final court of appeal.

Correct! In an appeal to an appellate court, there is no new trial, only a review of the trial proceedings. There are no new witnesses called, and new evidence is seldom heard. The appeal ensures no errors of law were made and that findings of fact are based on properly admitted evidence.

DIF: Cognitive level: Analysis 11. What are the two primary sources of common law? a. Statute law and custom law b. Doctrine and statute law c. Civil code and case law d. Case law and statute law ANS: D Feedback A B C D

Incorrect—Custom applies if no other sources of law are available and is not a primary source of law.

Incorrect—Doctrine is a legal opinion that may be considered but is not a primary source of law.

Incorrect—Civil code is not applicable to common law.

Correct! Statute law (a formal written set of rules) and case law (a collection of legal rules and principles based on precedents) make up the foundation for common law.

DIF: Cognitive level: Comprehension 12. Which of the following are the three components of Canada’s government? a. The judicial branch, the executive branch, and the legislative branch b. The parliamentary branch, the Supreme Court, and the Commonwealth Doctrine c. The Commonwealth Doctrine, the executive branch, and the judicial branch

d. The Court of Appeal, the Queen, and all statute laws ANS: A Feedback A

B C D

Correct! The three components of Canada’s government are the judicial branch, or the court system; the executive branch, or the Queen and her ministers, who enforce the law; and the legislative branch, which consists of Parliament and the provincial legislatures.

Incorrect—The Commonwealth Doctrine does not exist.

Incorrect—The Commonwealth Doctrine does not exist.

Incorrect—These are parts of the components, but not the components themselves.

DIF: Cognitive level: Comprehension TRUE/FALSE 1. Civil law is a component of common law.

ANS: F Feedback Correct

Incorrect

Civil law, which is used in Quebec, is a system of law that is different from the common law system. Civil law is based on formally written, or codified, legal rules and principles. The majority of common law, unlike civil law, is not formally written down or codified. The rules and principles in common law are contained in an extensive body of precedent.

This is not a true statement.

DIF: Cognitive level: Comprehension 2. A superior court must use, on the basis of common law, the same principles and rules as

would an inferior court to decide a case with similar circumstances.

ANS: F Feedback Correct

Incorrect

An inferior court must use, on the basis of common law, the same principles and rules as would a superior court to decide a case with similar circumstances. An inferior court (usually a trial court) is judicially subordinate to a superior court or an appellate (appeal) court in the hierarchical court structure. The superior court sets the precedent. This is known as the doctrine of stare decisis (“to abide by the decision”).

This is not a true statement.

DIF: Cognitive level: Analysis 3. Provincial or territorial laws, known as “statute laws,” take priority over common law.

ANS: T Feedback Correct

Incorrect

Statute laws are passed by Parliament or provincial or territorial legislatures, whereas common law is set by the courts over time. Statute laws take priority over common law and may confirm, clarify, alter, limit, or rescind common law as determined by the courts.

This statement is true.

DIF: Cognitive level: Comprehension 4. The Parliament of Canada is the only body that can overturn a ruling by the Supreme

Court of Canada.

ANS: F Feedback Correct

Incorrect

Parliament cannot appeal a decision made by the Supreme Court of Canada, which is the final interpreter of the meaning and scope of the Constitution and the Charter. Its decisions are final until and unless the law is changed or the Constitution is amended to alter or reverse the Court’s interpretation.

Parliament cannot appeal a decision made by the Supreme Court of Canada, which is the final interpreter of the meaning and scope of the Constitution and the Charter. Its decisions are final until and unless the law is changed or the Constitution is amended to alter or reverse the Court’s interpretation.

DIF: Cognitive level: Comprehension 5. Proof beyond a reasonable doubt exists when the judge or jury is satisfied that, based on

the evidence, the accused committed the offence, and there is no real or logically compelling reason to believe otherwise.

ANS: T Feedback Correct Incorrect

This statement is true.

This statement is true.

DIF: Cognitive level: Comprehension

Chapter 05: Regulation of the Nursing Profession Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following is an aspect of self-regulation? a. Setting standards of entry into a profession b. Representing coworkers during disciplinary meetings with an employer c. Self-evaluating practice d. Determining expectations regarding scheduling practices ANS: A Feedback A

B C D

Correct! Self-regulation is a privilege granted to a profession by a provincial or territorial government. Setting standards of entry into the profession is one aspect of self-regulation.

Incorrect—This is usually the responsibility of a labour union.

Incorrect—The “self” in “self-regulation” refers to the profession as a whole, not the individual worker.

Incorrect—Negotiating working conditions is the responsibility of a labour union.

DIF: Cognitive level: Knowledge 2. Which of the following clarifies the nature and scope of nursing practice? a. A provincial regulatory body b. A national nursing association c. A nurse practitioner regulation d. The Criminal Code of Canada ANS: A Feedback A B C D

Correct! A provincial regulatory body (or the legislation under which it falls) will describe and define the nature and scope of nursing practice.

Incorrect—A national nursing association has no direct regulatory role regarding the nature and scope of nursing practice.

Incorrect—A nurse practitioner regulation identifies the scope of a specific category of nurse but does not clarify the nature and scope of nursing practice.

Incorrect—The Criminal Code of Canada may deal with extreme violations of nursing practice (indictable offenses, such as criminal negligence) but does not clarify the nature and scope of nursing practice.

DIF: Cognitive level: Analysis 3. What is the main difference between a two-tier regulatory system for nurses and a

single-tier system? a. A two-tier system ensures due process in the complaint resolution process.

b. A single-tier system does not deal with complaints about a nurse’s practice. c. A single-tier system is not self-regulatory. d. A two-tier system has a regulatory branch underneath a higher level body.

ANS: D Feedback A B C D

Incorrect—Whether a system is two-tier or single-tier is irrelevant to due process.

Incorrect—Both single-tier and two-tier systems have mechanisms for managing complaints about a registrant’s practice.

Incorrect—Both single-tier and two-tier systems are based on self-regulation.

Correct! A two-tier system has a regulatory branch underneath a higher level body. The higher level body may be involved with complaints and appeal and may have a broader scope than nursing alone. In a single-tier system, a provincially created regulatory body has a complete legislative mandate.

DIF: Cognitive level: Comprehension 4. Which of the following is an objective of a nursing regulatory body? a. The regulation of nursing education b. The promotion and advancement of nursing regulation issues on a national level c. The day-to-day governance of the affairs of the regulatory body d. The support of a high-quality and publicly funded health system ANS: A Feedback A

B C D

Correct! Regulating education, nursing roles, scope of practice, entry into the profession, standards of practice, complaints processes, and discipline of members are all objectives of a nursing regulatory body.

Incorrect—This is a national role of the Canadian Nurses Association.

Incorrect—This is the role of the Board of Directors for the regulatory body.

Incorrect—This is a national role of the Canadian Nurses Association.

DIF: Cognitive level: Analysis 5. A nurse who continues to practise while under suspension is guilty of which of the

following? a. Professional negligence b. Professional incompetence c. Professional misrepresentation d. Professional misconduct ANS: D Feedback A B C

Incorrect—Professional negligence is an error or omission during care, resulting in harm to the client; this does not describe what this nurse is doing.

Incorrect—“Professional incompetence” is not a term used in nursing.

Incorrect—A nurse under suspension is not allowed to practise as a nurse. The

D

person in this context is misrepresenting himself or herself, and this constitutes professional misconduct.

Correct! Under most provincial laws, a nurse who continues to practise while under suspension is guilty of professional misconduct.

DIF: Cognitive level: Synthesis 6. Which of the following sequence best describes the investigation process of disciplinary

and competency matters? a. Complaint, investigation, interim investigation, disciplinary committee b. Complaint, disciplinary committee, investigation, discipline c. Interim investigation, complaint, investigation, discipline d. Discipline, complaint, interim investigation, investigation ANS: A Feedback A

B C D

Correct! A written complaint relating to alleged professional misconduct is received by the regulatory body. A preliminary investigation verifies if the complaint is well founded. If the complaint is well founded, it is referred for an interim investigation to a disciplinary committee or professional conduct committee. Before a hearing is scheduled to consider the matter, the disciplinary committee will notify the nurse against whom the claim was brought. After hearing the evidence, the committee will make its decision.

Incorrect—This is not the correct sequence.

Incorrect—This is not the correct sequence.

Incorrect—This is not the correct sequence.

DIF: Cognitive level: Synthesis 7. A nurse teaches an unregulated care provider to administer medication through a

nasogastric tube. Which of the following terms describes this nurse’s actions? a. Assignment b. Delegation c. Reassignment d. Regulation ANS: B Feedback A B

C

D

Incorrect—Assignment means assigning skills or tasks that fall within an individual’s scope of practice; this does not describe what this nurse is doing.

Correct! Enabling a nonqualified person (through a prescribed process that includes teaching and supervision) to perform specific controlled acts is referred to as delegation.

Incorrect—Reassignment means to change the assignment of skills or tasks that fall within an individual’s scope of practice; this does not describe what this nurse is doing.

Incorrect—Regulation is not involved in this scenario because the care provider in question is unregulated.

DIF: Cognitive level: Application 8. What is the main purpose of having nursing students and nurses seeking employment

complete a criminal background check? a. To exclude anyone with a criminal record from practising nursing or entering the profession b. To avoid threats to the safety of vulnerable patients c. To identify those at risk for misappropriating narcotics d. To keep records on the number of nurses with criminal records ANS: B Feedback A B C D

Incorrect—Depending on the crime or crimes committed, a nurse with a criminal record may still practise.

Correct! A person would be excluded from the profession of nursing if the criminal record indicates a potential threat to the safety of vulnerable people.

Incorrect—This is not a goal of a criminal background check.

Incorrect—This is not a goal of a criminal background check.

DIF: Cognitive level: Analysis 9. Which of the following best describes the differences between registered nurses (RNs) and

licensed practical nurses (LPNs)? a. RNs work in complex environments, such as pediatrics, critical care, psychiatry, and dialysis. b. LPNs care for less complex and more predictable client populations. However, this is dependent on other factors, such as the environment, their level of knowledge, and access to expert resources. c. Both RNs and LPNs can join the extended class. d. RNs can work in the capacity of an LPN. ANS: B Feedback A B C D

Incorrect—With the appropriate education and immediate access to expert resources, LPNs are able to work in complex environments.

Correct! LPNs care for less complex and predictable client populations.

Incorrect—Only RNs can join the extended class.

Incorrect—An RN may fill the position of an LPN position; however, unless they have dual registration, they cannot use that title and are held accountable as an RN.

DIF: Cognitive level: Analysis 10. Regulatory bodies have established mandatory reporting requirements that include which

of the following? a. When a nurse is terminated as a result of re-structuring b. When a nurse fails a test at the end of the orientation period c. When a nurse engages in a sexual relationship with another member of the team

(e.g., a physician) d. When a nurse makes repeated medication errors and the employer has initiated a disciplinary process ANS: D Feedback A B

C

D

Incorrect—This is a human resource issue and is based on union processes not any practice issues.

Incorrect—This might require an additional learning plan and an extension of orientation for this nurse but, at this point, does not necessarily indicate incompetence.

Incorrect—This is an internal human resource issue if it affects the dynamics of the team. It would also be appropriate for the nurse to disclose this to his or her manager to mitigate any conflict-of-interest concerns.

Correct! Although the College expects to be notified when an employer initiates a disciplinary process, it also expects the employer to manage professional competence and conduct issues through internal human resource processes.

DIF: Cognitive level: Analysis TRUE/FALSE 1. Professional standards and practice standards of a nursing regulatory body describe the

ability and functioning of the majority of registrants.

ANS: F Feedback Correct Incorrect

The standards describe the minimum expectations of registrants; however, the majority of registrants exceed the minimum expectations for practice.

The standards describe the minimum expectations of registrants; however, the majority of registrants exceed the minimum expectations for practice.

DIF: Cognitive level: Synthesis 2. The use of a registration process assures the public that nurses meet appropriate standards

and can practise safely.

ANS: T Feedback Correct

Incorrect

Through registration, the member is recognized as a person who is then authorized to practise nursing in the particular province or territory concerned. The use of registration assures the public that nurses meet appropriate standards and can practise safely. The public can verify the registration of a nurse online.

This statement is true.

DIF: Cognitive level: Analysis

3. The investigation of a nurse’s fitness and capacity to practise indicates a likelihood of

professional misconduct.

ANS: F Feedback Correct

Incorrect

Investigation may reveal concern about a nurse’s physical or mental abilities, but does not necessarily indicate incompetence or misconduct.

Physical or psychological examinations may be required.

There are numerous reasons for investigation, so this is not necessarily a true statement.

DIF: Cognitive level: Comprehension 4. The terms “controlled acts” and “reserved acts” are specific to the nursing profession.

ANS: F Feedback Correct

Incorrect

Several professions may have some controlled, reserved, or restricted acts (medical actions and procedures that may be performed, and who may perform or delegate them; the terms vary, depending on the province) in common. For example, some controlled acts and reserved acts are common to both physicians and nurses.

This statement is false. A controlled act or reserved act may be common to several different health care professions.

DIF: Cognitive level: Comprehension 5. The primary purpose of nursing regulatory bodies is the protection of the public.

ANS: T Feedback Correct

Incorrect

As Canadians become more aware of their legal rights, they question the ability of health care professionals to regulate themselves in the public interest. Thus, the primary purpose of nursing regulatory bodies is to serve as a watchdog and to promote the welfare of the public.

The primary purpose of nursing regulatory bodies is the protection of the public.

DIF: Cognitive level: Comprehension 6. Regulatory bodies are responsible for maintaining processes to support the evaluation of

the ongoing competence of nurses.

ANS: T Feedback Correct

Regulatory bodies are responsible for introducing and maintaining

Incorrect

mechanisms or processes to evaluate the ongoing competence of nurses.

This statement is true.

DIF: Cognitive level: Comprehension 7. The penalty for a nurse found guilty of professional misconduct is revocation of the

nurse’s right to practise and expulsion from the regulatory body.

ANS: F Feedback Correct

Incorrect

The penalty depends on the seriousness of the offense and the extent the nurse is accountable and remorseful. Penalties may include fines, censure, conditions on practice, or suspension for a specified period.

This statement is false.

DIF: Cognitive level: Comprehension

Chapter 06: Informed Consent: Rights and Obligations Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following is a component of informed consent? a. The consent must be voluntary. b. The consent must be specific to the proposed treatment or procedure. c. The patient must be legally capable. d. All are correct.

ANS: D Feedback A

B

C

D

Incorrect—All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

Incorrect—All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

Incorrect—All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

Correct! All are correct. In addition, the patient must be told of the risks, benefits, and drawbacks of the proposed procedure; the risks of forgoing the treatment; the treatment options and benefits; and who will perform the procedure.

DIF: Cognitive level: Knowledge 2. Which of the following terms best describes a nurse who touches a client without the

client’s consent? a. Abuse b. Battery c. Misconduct d. Negligence ANS: B Feedback A B C D

Incorrect—Not enough details are known about this situation to determine if abuse of patient rights is definitely involved.

Correct! Legally, to touch another person without permission constitutes battery.

Incorrect—Not enough details are known about this situation to determine if misconduct is definitely involved.

Incorrect—Not enough details are known about this situation to determine if

negligence is definitely involved.

DIF: Cognitive level: Application 3. Which of the following ethical principles is the hallmark of informed consent? a. Autonomy b. Accountability c. Fidelity d. Beneficence ANS: A Feedback A B C D

Correct! Autonomy, or the right to determine and act on a self-chosen plan, is the hallmark ethical principle of informed consent.

Incorrect—Being accountable is a primary nursing value, not an ethical principle.

Incorrect—Fidelity is an ethical principle involved in informed consent, but it is not the hallmark principle.

Incorrect—Beneficence is an ethical principle involved in informed consent, but it is not the hallmark principle.

DIF: Cognitive level: Knowledge 4. A patient in the nurse’s care is having surgery today and has signed only a general consent

form. What other information must be documented? a. Physician documentation of the patient’s consent b. Physician documentation related to risks, consequences, and benefits of the procedure c. Time and date the consent was received d. All are correct ANS: D Feedback A B C D

Incorrect—All of the above are required in this situation.

Incorrect—All of the above are required in this situation.

Incorrect—All of the above are required in this situation.

Correct! All of the above are required in this situation.

DIF: Cognitive level: Analysis 5. The nurse tells a patient, through speech and miming, that she will be giving an enema to

the patient. The patient implies consent by nodding her head. The patient suffers rectal trauma and bleeding during the procedure. Is the nurse liable, and why? a. The nurse is not liable because she explained the procedure and received the patient’s consent. b. The nurse is liable because she did not have written, procedure-specific consent from the patient. c. The nurse is liable because she did not note the date and time of the consent.

d. The nurse is liable because she did not obtain informed consent.

ANS: D Feedback A B C D

Incorrect—Telling the patient that the procedure will be done is not the same as explaining the procedure.

Incorrect—Written, procedure-specific consent is not usually required for the administration this type of procedure.

Incorrect—Noting the date and time of the consent is important, but this does not relate to the nurse’s liability in this case.

Correct! The nurse did not explain to the patient the possible risks of the procedure and is, therefore, liable because she did not obtain informed consent.

DIF: Cognitive level: Synthesis 6. The nurse administering an enema is concerned because the patient appears to be trying to

stop the procedure. The nurse does not stop because the fluid is only partially administered, and the nurse continues with the task until it is completed. Is this nurse liable for battery? a. This nurse is not liable for battery because once a procedure is started, it must be completed. b. This nurse is liable for battery because there was too much fluid and this caused the patient discomfort. c. This nurse is liable for battery because the patient withdrew consent. d. This nurse is not liable for battery because consent was never obtained.

ANS: C Feedback A B C

D

Incorrect—A procedure can be stopped at any time because the patient has the right at any time to withdraw consent to treatment.

Incorrect—The amount of fluid administered is not the deciding factor in this situation.

Correct! Patients have the right at any time to withdraw consent to treatment.

Such withdrawal may occur in difficult circumstances, and it is important for the health care professional to ascertain whether the consent has been withdrawn.

This may not always be clear.

Incorrect—Consent must always be obtained.

DIF: Cognitive level: Analysis 7. Who is first considered to be a substitute decision maker if a married client cannot make

decisions? a. The client’s spouse b. The client’s adult child c. The physician d. The client’s parent ANS: A

Feedback A B C D

Correct! The client’s spouse is considered the substitute decision maker before any others are considered.

Incorrect—This client’s adult child would not first be considered a substitute decision maker.

Incorrect—The physician would not be considered the substitute decision maker.

Incorrect—This client’s parent would not first be considered the substitute decision maker.

DIF: Cognitive level: Analysis 8. In provinces where children have the right to make decisions about their own health care,

at which of the following ages or stages must a child be to give consent to treatment? a. The child must be at least 12 years old. b. The child must be capable of understanding the treatment. c. The child must be living away from home. d. The child must be at least 16 years old.

ANS: B Feedback A B

C

D

Incorrect—A child younger than 12 years of age may be able to make a decision about his or her own health care.

Correct! In such provinces, the child must be old enough and mature enough to understand the nature and risks inherent in a medical procedure; there is no specific age requirement.

Incorrect—Whether a child is living at or away from home is not the criterion used to determine if the child can make decisions regarding his or her own health care.

Incorrect—Being 16 years of age or older is not a requirement for a child to make decisions regarding his or her own health care.

DIF: Cognitive level: Application 9. A nurse is working in a busy emergency room (ER), and an unconscious patient needs

timely interventions to avoid rapid deterioration. Should treatment be withheld until consent can be obtained from a substitute decision maker? a. Yes, because treatment without consent in this situation would be considered battery. b. No, because this is an emergency situation, and the nurse cannot be found negligent if treatment is not given. c. Yes, because in emergency situations the nurse is not protected against liability. d. No, because in emergency situations the nurse is protected against liability.

ANS: D Feedback A B C

Incorrect—This statement is incorrect.

Incorrect—Negligence is not the issue in this situation.

Incorrect—This statement is incorrect.

D

Correct! Provincial laws protect health care professionals providing emergency care. If there is an imminent risk of further deterioration and finding a substitute decision maker would cause further delays, consent is not required, and the health care professional may administer treatment without it.

DIF: Cognitive level: Synthesis 10. Which of the following type of law regulates consent to treatment? a. Custom b. Common law c. Regulations d. Statute law ANS: D Feedback A B C D

Incorrect—Custom has no relevance regarding consent.

Incorrect—Common law does not directly regulate consent.

Incorrect—Regulations do not regulate consent, although they may describe procedural aspects related to consent.

Correct! The existing common law requirements for an informed consent to treatment are enshrined in provincial statute law.

DIF: Cognitive level: Knowledge TRUE/FALSE 1. Consent must be expressed either verbally or in writing and be based on relevant

information.

ANS: F Feedback Correct

Incorrect

In addition to verbal and written consent, consent may also be implied. For any consent to be valid, it must be based on the relevant information required by the patient or client to make that choice.

This statement is only partially true; one type of consent is missing.

DIF: Cognitive level: Synthesis 2. It is ethically appropriate for a nurse to withhold explaining all the risks of a procedure to

a client to decrease the client’s anxiety.

ANS: F Feedback Correct

It is unethical for a nurse to withhold explanation of the risks of a procedure to a client. The client must also be told all of the risks of a procedure, including the risks of forgoing the treatment, for the client’s consent to be informed. The nurses’ approach and other interventions may

Incorrect

help the person’s anxiety.

It is unethical for a nurse to withhold explanation of the risks of a procedure to a client.

DIF: Cognitive level: Analysis 3. It is the nurse’s responsibility to determine if anyone else may be present to help the

patient interpret or clarify the information being given.

ANS: F Feedback Correct

Incorrect

It is the patient’s choice whether to have a friend or family member present, not only to provide support but also to interpret or clarify the information being given. Nurses should ensure that the patient is aware that he or she has this option.

This decision is the patient’s to make; it is not the nurse’s choice.

DIF: Cognitive level: Knowledge 4. An older adult patient’s initial and seemingly irrational refusal to give consent indicates

mental incompetence.

ANS: F Feedback Correct

Incorrect

There may be any number of reasons that an older adult patient may refuse to give consent; this refusal does not necessarily indicate mental incompetence. For example, the patient may be fearful of the procedure and any consequences, may not understand the information presented, or may be in a state of denial.

There may be any number of reasons that an older adult patient may refuse to give consent; this refusal does not necessarily indicate mental incompetence.

DIF: Cognitive level: Application 5. The team caring for an incapable person must always respect the decisions of a legally

appointed substitute decision maker.

ANS: F Feedback Correct

Incorrect

If the team has concerns that the substitute decision maker is not acting in the person’s best interests, there are legal processes in place to challenge the authority of the substitute decision maker.

If the team has concerns that the substitute decision maker is not acting in the person’s best interests, there are legal processes in place to challenge the authority of the substitute decision maker.

DIF: Cognitive level: Analysis

Chapter 07: The Nurse’s Legal Accountabilities: Professional Competence, Misconduct, Malpractice, and Nursing Documentation Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following describes an employer’s responsibility in relation to the standard

of care? a. To address the effects of nurse absenteeism on patient care b. To evaluate all nurses on an annual basis to ensure that they are meeting standards c. To implement an improvement plan for nurses who do not meet standards d. To follow collective agreements regarding scheduling practices ANS: C Feedback A B C

D

Incorrect—This does not relate to the employer’s responsibility regarding the standard of care.

Incorrect—Annual evaluation is not only the responsibility of the employer, but nurses are also accountable and have the responsibility to regularly self-evaluate.

Correct! Employers have a common law duty to take active steps to ensure that nurses falling short of a standard receive the appropriate improvement plan.

Otherwise, the employer may be liable.

Incorrect—This relates to meeting the provision of union contracts; it does not relate to the employer’s responsibility regarding the standard of care.

DIF: Cognitive level: Synthesis 2. Which of the following is the best example of an intentional tort? a. A nurse assaults a patient. b. A nurse makes a medication error, which results in the patient having an adverse

reaction. c. A nurse is abusing substances while at work. d. A nurse accidentally runs a commode over a patient’s foot and bruises it.

ANS: A Feedback A

B C

D

Correct! An intentional tort is a civil wrong committed against one person by another who intends the action that causes injury or damage to either the victim or the victim’s property. A nurse who assaults a patient is committing an intentional tort.

Incorrect—This is a nonintentional tort and may constitute negligence.

Incorrect—This could be related to a medical issue or possibly an illness on the part of the nurse. If, for example, the substance is alcohol and if the nurse is impaired and as a result the patient is harmed, then this would constitute criminal negligence.

Incorrect—This event was unintentional and did not cause serious damage; it is not a tort.

DIF: Cognitive level: Analysis 3. To prove negligence, which three elements must be present? a. Duty of care is owed, duty of care is breached, and damage is a direct result. b. Duty of care is breached, indirect damage is present, and duty of care is owed. c. Duty of care is breached, damage is a direct result, and damage is permanent. d. Duty of care is breached, indirect damage results, and damage is permanent.

ANS: A Feedback A

B C D

Correct! First, the defendant must owe a duty of care in law toward the plaintiff.

Second, the defendant must have breached that duty and failed to discharge the standard of care required by law in the particular situation. Third, the plaintiff must have suffered damage or harm caused by the defendant’s breach of the duty of care.

Incorrect—The damage must be a direct result of breaching a duty of care.

Incorrect—The damage does not need to be permanent.

Incorrect—A duty of care must be owed, the damage mist by a result of breaching the duty of care and the damage does not need to be permanent.

DIF: Cognitive level: Analysis 4. A nurse whose lack of actions demonstrates disregard for the lives or safety of others is

liable for which of the following? a. Criminal incompetence b. Statutory negligence c. Professional malpractice d. Criminal negligence ANS: D Feedback A B C

D

Incorrect—“Criminal incompetence” is not a recognized term.

Incorrect—“Statutory negligence” is not a recognized term.

Incorrect—Malpractice (negligence by a professional) is not necessarily criminal; it involves performing lawful acts in a careless manner, which may not involve misconduct.

Correct! This nurse is liable for criminal negligence. If a nurse knowingly fails to perform a nursing act that is critical to a patient’s safety and well-being and it results in death or serious bodily harm, the omission in care may constitute a criminal offense.

DIF: Cognitive level: Analysis 5. Which of the following may an expert nursing witness be asked to do at a trial? a. To interpret the health care record b. To interpret the educational qualifications of the nurse in question c. To comment on the nurse’s guilt or innocence d. To describe previous malpractice incidents regarding the nurse in question

ANS: A Feedback A B C D

Correct! Nursing experts are called as witnesses to interpret the health care record and assist the court in reconstructing the events and drawing inferences.

Incorrect—If a nurse is registered, he or she is presumed competent, so educational qualifications are not the issue.

Incorrect—This would be inappropriate; however, the witness may describe what a reasonable and prudent nurse would do in a similar situation.

Incorrect—This is not applicable.

DIF: Cognitive level: Synthesis 6. How do the courts determine if a nurse’s conduct has been negligent? a. The standard of care is used as an objective measure. b. Professional standards are used as a subjective measure. c. Only an appellate court can determine this. d. This would go before a disciplinary review board, not the courts.

ANS: A Feedback A

B C D

Correct! The standard of care is what a reasonably competent professional would do in a similar situation. If a defendant’s conduct is seen as having fallen below this standard, a court may find that defendant’s conduct to be negligent.

Incorrect—Professional standards may be used to support a case but are not used to determine negligence.

Incorrect—This does not answer the question. The type of court is irrelevant in this situation.

Incorrect—Cases of misconduct, incompetence, and negligence may all be heard by a review board; however, negligence would also be judged by the courts if the nurse was involved in a lawsuit.

DIF: Cognitive level: Comprehension 7. Which of the following best explains the coroner, or medical examiner, system? a. They investigate unexplained or suspicious deaths. b. Health care professionals and the police are accountable for reporting unexplained

deaths to them. c. All recommendations made as a result of an inquest are mandatory. d. An inquest’s finding of homicide results in an immediate criminal investigation.

ANS: A Feedback A

B

Correct! An unexplained or suspicious death must be investigated to determining cause and possible prevention strategies. If there is cause for concern and the circumstances are unclear an inquest may be ordered.

Incorrect—Although there are mandatory requirements for health care professionals and the police to report, anyone can bring a concern forward.

C

D

Incorrect—Recommendations are not mandatory but are encouraged for patient safety and quality reasons. Also, responding to recommendations assist in meeting professional and accreditation standards.

Incorrect—A finding of homicide by an inquest means that the death of a person was caused by the actions of another person or persons. It may not be criminal in nature.

DIF: Cognitive level: Analysis 8. During a night shift, a nurse caring for a patient with leukemia is concerned that the

patient’s heart rate has increased and that her temperature has risen from 37.5°C to 38°C. She informs the in-charge nurse, who suggests that rather than disturbing the physician on call, she monitor the patient over the next few hours. What immediate steps should the nurse take? a. Seek out more information about leukemia. b. Accept the charge nurse’s advice, and continue to monitor the patient. c. Express concerns regarding this plan, and document this concern in the patient’s record. d. Express concern to the charge nurse regarding this plan, and page the on-call physician or nurse practitioner.

ANS: D Feedback A

B C D

Incorrect—Although it is important to seek out more information, a nurse caring for a patient with leukemia receiving chemotherapy should already be aware of the high risk of infection.

Incorrect—Physicians on call are expected to respond to patient concerns.

Incorrect—Disagreeing with the charge nurse and documenting this does not absolve this nurse of her accountability to the patient.

Correct! It is appropriate to do what is right for the patient and not be intimidated by hierarchy. This is the appropriate standard of care.

DIF: Cognitive level: Analysis 9. Should nurses obtain professional liability insurance? a. Unless nurses engage in independent practice, it is not necessary. b. It is not necessary if nurses are covered by the insurance policies of their

employers. c. No, the regulatory body does not require this. d. Yes, because the doctrine of vicarious liability does not apply in all circumstances.

ANS: D Feedback A B C

Incorrect—An employer’s insurance covers the nurse in most circumstances, but not all.

Incorrect—An employer’s insurance covers the nurse in most circumstances, but not all.

Incorrect—Regulatory bodies require this.

D

Correct! The doctrine of vicarious liability means that an employer is responsible for the negligence of nurses in their employ. However, this would not be the case if the nurse acted criminally or outside of the authority of their role.

DIF: Cognitive level: Knowledge TRUE/FALSE 1. Failing to meet a standard of practice of the nursing profession would be considered

malpractice.

ANS: F Feedback Correct

Incorrect

Failing to meet a standard of practice of the nursing profession would be considered professional misconduct. Malpractice involves performing lawful acts in a careless manner or in a manner that does not conform to a generally recognized practice standard or standard of care in the nursing profession.

This is not a true statement.

DIF: Cognitive level: Synthesis 2. A nurse who performs a procedure beyond his or her level of skill and ability would be

considered incompetent.

ANS: F Feedback Correct

Incorrect

In this situation, the nurse is not competent to perform the procedure; therefore, with performance of this action, the nurse would be considered negligent.

This is not a true statement.

DIF: Cognitive level: Synthesis 3. An assault occurs when a person intentionally threatens another person with imminent

harm.

ANS: T Feedback Correct Incorrect

Assault is the intentional threat of imminent harm. Actual physical contact is not necessary to prove assault.

This statement is true.

DIF: Cognitive level: Knowledge 4. The nurse’s duty of care to patients and clients is based on professional standards of care.

ANS: T Feedback Correct

Incorrect

Nurses owe a duty of care to patients and clients to act in a competent and diligent manner according to the standard of a reasonably competent nurse.

This statement is true.

DIF: Cognitive level: Knowledge 5. In a case where a nurse’s conduct is in question, the standard of care used in courts would

be the actions of a reasonably competent nurse in similar circumstances.

ANS: T Feedback Correct

Incorrect

The standard of care is what a reasonably competent professional would do in a similar situation. The nurse is legally required to operate and act at a level that meets or exceeds the standard of care of a reasonably prudent caregiver or health care professional.

This statement is true.

DIF: Cognitive level: Knowledge 6. Contributory negligence means that the patient, as the plaintiff, is partly responsible for

the harm suffered.

ANS: T Feedback Correct

Incorrect

Contributory negligence means that the patient, as the plaintiff, is found to be partly at fault for the harm suffered. In all common law provinces and territories, the patient may still recover damages from the defendant even if the patient is, in some way, at fault.

This statement is true.

DIF: Cognitive level: Knowledge

Chapter 08: Complexity at the End of Life: The Ethical and Legal Challenges Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following statement best describes assisted suicide? a. It is a form of withdrawal of treatment. b. It is a passive process, and the patient is mentally competent. c. It is an active process, and the patient is mentally incompetent. d. It is an active process, and the patient is mentally competent.

ANS: D Feedback A B C D

Incorrect—Assisted suicide does not necessarily involve withdrawal of treatment.

Incorrect—This statement does not accurately describe assisted suicide.

Incorrect—This statement does not accurately describe assisted suicide.

Correct! In assisted suicide, active steps are taken to end the life of a debilitated but mentally competent patient who requests the help of another person.

DIF: Cognitive level: Comprehension 2. Which of the following situation is an example of an ethical dilemma that can arise for a

team on a medical unit while caring for a terminally ill patient who is near death? a. The family wishes that the patient will live longer. b. The family requests intravenous (IV) fluids for hydration of the patient. c. The family requests administration of narcotics for the patient’s pain relief. d. The family refuses to allow the patient’s transfer to a palliative care unit.

ANS: B Feedback A B

C D

Incorrect—A family’s wish that a terminally ill patient live longer is not unethical and is a normal aspect of grief and loss.

Correct! Hydrating the patient may create respiratory discomfort, potentially prolonging his or her suffering and postponing death; therefore, this request is an example of an ethical dilemma for the nurse and the team.

Incorrect—Administering narcotics prescribed for pain management is not unethical.

Incorrect—This may conflict with the nurse’s values, but it is not unethical because the patient can still receive palliative care on the medical unit.

DIF: Cognitive level: Synthesis 3. Which of the following activities will help ensure the dignity of older adult clients,

regardless of their capacity? a. Use terminology that older adult clients can understand, such as “diapers.” b. Engage in conversation with older adult clients about their lives.

c. Take over control from older adult clients as much as possible to conserve their

energy. d. Call older adult clients by their first name only.

ANS: B Feedback A B

C D

Incorrect—Using the term “diapers” is disrespectful and demeaning to older adults.

Correct! Engaging in conversation with older adult clients about their lives helps these clients feel valued. Older adults need stimulation and socialization and want to share their stories and to be treated with the respect they have earned throughout their lives.

Incorrect—Giving older adult clients as much control as possible allows them to feel valued and helps ensure that their dignity is preserved.

Incorrect—Calling older adult clients by their first name may be disrespectful, depending on the clients’ culture and background. If the nurse is unsure, it is more appropriate to use the entire name or only the family name. When possible, it is preferable to ask clients about their wishes in this regard.

DIF: Cognitive level: Synthesis 4. Some persons in Canada disagree with the Medical Assistance in Dying (MAID),

legislation, based on the ethical principle of the sanctity of life. What principle might support the argument of others who disagree with this view? a. Autonomy b. Veracity c. Informed choice d. Responsibility and accountability ANS: A Feedback A

B

C D

Correct! Autonomy is the right of individuals to make decisions that affect their lives. The MAID legislation is based on this principle and requires the explicit consent of the person making the request for an assisted death.

Incorrect—Veracity is the duty to tell the truth. This ethical principle is central to ensuring trust within the nurse–patient or nurse–client relationship but would not likely be in conflict for nurses working with the dying.

Incorrect—Informed choice is not an ethical principle but is based on the principle of autonomy.

Incorrect—Responsibility and accountability is a professional standard, not an ethical principle.

DIF: Cognitive level: Synthesis 5. A nurse administers larger doses of narcotics prescribed for pain control, which hastens a

terminally ill patient’s death. In which of the following acts has the nurse participated? a. Medical Assistance in Dying b. Assisted suicide

c. Passive euthanasia d. An illegal act ANS: C Feedback A

B

C

D

Incorrect—MAID is a process that allows for physicians and nurse practitioners to assist in the death of a terminally ill person when certain conditions are met.

MAID results in the immediate death of a terminally ill patient; this does not describe what this nurse is doing.

Incorrect—In assisted suicide, active steps are taken to end the life of a debilitated but mentally competent patient who requests this of another person; this is not what this nurse is doing.

Correct! Passive euthanasia is generally accepted as a potential effect of withdrawal of treatment or narcotic administration in palliative care. It is not “active” because death is hastened as result of the effects of the medication necessary to relieve pain.

Incorrect—The obligation to provide palliative care and adequate pain control is also supported in law and has been upheld in Supreme Court decisions, leading to the MAID legislation.

DIF: Cognitive level: Analysis 6. A nurse decides not to raise the issue of organ donation with a patient’s family concerned

that this might interfere with the grieving process. Which of the following statements describes how this nurse is acting? a. The nurse is acting in the best interests of the family. b. The nurse is acting in the best interests of the patient. c. The nurse is being disrespectful of the patient’s autonomy. d. The nurse is acting this way because she knows the patient’s organs are unsuitable.

ANS: C Feedback A B C

D

Incorrect—This nurse is not acting in the best interests of the family.

Incorrect—This nurse is not acting in the best interests of the patient.

Correct! The nurse is being disrespectful of the patient’s autonomy. By avoiding the topic of organ donation, the nurse is making the decision for the patient/family, not to donate.

Incorrect—There is not enough information in this scenario to know if the patient’s organs are suitable or not.

DIF: Cognitive level: Analysis 7. Which of the following approach is the best way to increase the number of potential organ

donors? a. The nurse should approach all patients who are admitted through the hospital’s emergency department and ask them about organ donation. b. The nurse should wait until the patient is settled in an inpatient unit before asking about organ donation.

c. The nurse should only ask the families of dying patients in a Critical Care Unit

about organ donation. d. The nurse should provide organ donor information to patients who are discharged

from the hospital.

ANS: D Feedback A

B

C D

Incorrect—This is not the best approach because patients presenting in the emergency department are often highly anxious as a result of the urgent nature of their health status, and this stress can compromise their ability to make autonomous decisions based on informed choice.

Incorrect—This is not the best approach because inpatients may be highly stressed and dealing with uncertainty, which compromises their ability to make autonomous decisions based on informed choice.

Incorrect—In some cases, this may result in an actual organ donation, but this approach does not increase the number of potential organ donors overall.

Correct! This is the best approach for the nurse to take because education, communication, and awareness will help individuals to make informed decisions about available donation options.

DIF: Cognitive level: Synthesis 8. Which of the following people can make the decision to donate postmortem tissue? a. The nurse on duty at the time of the patient’s death b. The patient’s spouse c. The physician d. The funeral director ANS: B Feedback A

B

C D

Incorrect—Tissue donation must occur soon after death, so the nurse is often involved in the suggestion, process, or coordination of the donation. However, the nurse does not make the decision to donate.

Correct! There is a hierarchy of persons who may be approached to make this decision. The patient’s spouse would be asked first, followed by the patient’s adult children (if there is no spouse), then either of the patient’s parents or legal guardian, then siblings, then next of kin, and, if none of these is available, anyone who is in lawful possession of the body can make the decision to donate.

Incorrect—The physician is involved in the suggestion, process, or coordination of the donation. However, the physician does not make the decision to donate.

Incorrect—The funeral director has nothing to do with this decision. However, in some setting they may play a role in reminding families about this option and may play a role in retrieving tissue that does not have time limitations.

DIF: Cognitive level: Analysis 9. Which of the following best describes the engagement of nurses in MAID? a. The law imposes a duty on nurses to participate in MAID when the criteria set out

in the legislation are met. b. Organizations participating in MAID should ensure that processes and policies are in place to support those health care professionals who do not want to participate. c. Nurses can refuse to participate on the basis of their personal and religious values. d. Nurses have the right to share their views on MAID with their patients or clients.

ANS: B Feedback A B

C

D

Incorrect—The law does not require that all health care professionals participate.

Correct! The nurse has a duty to inform his or her employer about personal conscientious objection in advance so that the organization can ensure that he or she is not involved in the process.

Incorrect— Nurses may have these views but also have a duty to inform their employers of their conscientious objection in advance to ensure that they are not involved in the process.

Incorrect—It is appropriate for nurses to ensure that the client knows whether or not they will be involved, but it is not appropriate to impose their values or influence the person’s decision.

DIF: Cognitive level: Analysis 10. Nurses respect the values of various cultures best by following which of the following

practices? a. Respectfully explaining to an Indigenous family that pipe ceremonies are not permitted because of fire risk b. Ensuring that they are knowledgeable about the cultures of their clients c. Ensuring their own values are understood by their clients so that there is no confusion about the care plan d. Undertaking a comprehensive assessment of the patient or client to understand their values and beliefs.

ANS: D Feedback A B

C D

Incorrect—There are many strategies that can be employed to allow this practice while ensuring safety.

Incorrect—Although it is important that nurses have a foundational knowledge of the values and beliefs of various cultures, not all persons of those cultures hold those values.

Incorrect—It is inappropriate for nurses to impose their values on others.

Correct! It is not possible to know in advance the beliefs and rituals of all cultures; therefore, it is important to ask the patient and family what is most significant to them.

DIF: Cognitive level: Analysis TRUE/FALSE

1. The daughter of a patient in the nurse’s care states that her mother has verbally expressed

her wishes for treatment. This is an example of an advance directive or living will.

ANS: T Feedback Correct

Incorrect

An advance directive or living will is a person’s instructions regarding decisions about care if she is ever rendered incompetent. Advance directives can be made either verbally or in writing.

This statement is true.

DIF: Cognitive level: Knowledge 2. When discussing the condition of a terminally ill patient with his or her family members,

the terminology “Do Not Resuscitate” should never be discussed and offered because the family may think it means “do nothing.”

ANS: F Feedback Correct

Incorrect

The terminology “Do Not Resuscitate” can be interpreted by families as meaning “do nothing,” and this can put a burden of guilt on families when they are asked to make this decision on behalf of an incapable family member. However, this choice should still be discussed with the patient’s family at an appropriate time. Framing the decision around allowing a “natural death” can help relieve some of the burden on the family.

This statement is false.

DIF: Cognitive level: Analysis 3. For nurses, an ethical dilemma is resolved when a seriously brain-injured child is declared

brain dead and is removed from the ventilator.

ANS: F Feedback Correct

Incorrect

The situation of a dying child is extremely emotional and presents highly complex moral and ethical challenges for the nurse. There are times when a nurse’s personal or professional values may be conflict with the values of the family. Ethical dilemmas are not necessarily resolved through a death or the removal of a situation; moral distress may linger long after the child has passed away.

This statement is false.

DIF: Cognitive level: Synthesis 4. The nurse is caring for a dying patient and his family. The nurse should incorporate

cultural factors into the evaluation of care.

ANS: F

Feedback Correct

Incorrect

Cultural factors should be built into all aspects of care, not just the evaluation phase. The nurse should incorporate cultural considerations into the overall initial assessment so that they form part of the plan and implementation, as well as the evaluation. The nurse’s attention to such needs can improve the quality of the dying process and constructively influence the ensuing bereavement process.

Cultural considerations should be built into all aspects of care, not just the evaluation phase.

DIF: Cognitive level: Application 5. Under the MAID legislation, nurses are not permitted to a play a role in an assisted death.

Only physicians and pharmacists are permitted to play an active role in the process.

ANS: F Feedback Correct

Incorrect

The legislation in the Criminal Code provides the exception to both nurse practitioners and physicians. Nurses, not in the extended class, participate by providing nursing care and assistance. Nurses play a strong role in educating and supporting clients and families. They may not administer the substance or obtain consent for MAID but provide technical support, care, and comfort to the patient and family and ensure that the process is dignified and respectful of all involved.

This statement is false.

DIF: Cognitive level: Knowledge

Chapter 09: Ethical and Legal Issues Related to Advancing Science and Technology Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following technologies will have the strongest influence on future

generations? a. Gene editing b. In vitro fertilization (IVF) c. In utero surgery d. Genetic testing ANS: A Feedback A

B C D

Correct! Gene editing targets egg and sperm cells (germ cells), which would allow the change to be passed on to future generations. It involves making changes to the body’s basic foundation, that which drives all components of that person.

Incorrect—IVF involves fertilization and conception in a laboratory setting; manipulation of genes is not involved.

Incorrect—This will benefit the future of the individual.

Incorrect—Genetic testing identifies specific disorders; it does not make specific alterations to the gene itself.

DIF: Cognitive level: Analysis 2. Which of the following is a major advantage of genetic testing? a. The gene associated with diseases such as Huntington’s chorea can be identified,

and thus, the disease can be prevented. b. Genetic testing is the key to precision medicine. c. The results are shared with all family members. d. Genetic testing helps identify a person’s ancestry.

ANS: B Feedback A B C

D

Incorrect—There is no cure for diseases such as Huntington’s chorea, raising questions as to whether one would want to know this in advance.

Correct! Precision medicine targets therapies tailored to an individual's unique genome.

Incorrect—Other families may not want to know the information identified from genetic testing, nor might the individual want this information shared, raising other ethical issues.

Incorrect—Genetic testing focuses on a particular gene, not the person’s genome.

DIF: Cognitive level: Analysis

3. Which of the following ethical considerations are most relevant to whole genome

sequencing? a. Coercion and beneficence b. Informed consent and confidentiality c. Beneficence and confidentiality d. Nonmaleficence and truth telling ANS: B Feedback A

B

C D

Incorrect—There are many benefits, but there is also the potential for harm to the person tested or to others. Coercion is addressed through rigorous approaches to informed consent.

Correct! This technology raises major ethical issues related to informed consent—specifically, ensuring that the person understands all of the potential benefits and harms. There are major implications for others because genetic relationships with other individuals may be revealed. Also, the findings would have implications for other family members.

Incorrect— There are many benefits, but there is also the potential for harm to the person tested or to others.

Incorrect—There are many benefits, but there is the potential for harm to the person tested or to others. Truth telling is involved in informed consent and confidentiality.

DIF: Cognitive level: Analysis 4. Which of the following factors must be considered in ethical decisions regarding

interventions in preterm neonates? a. The risks associated with the proposed intervention b. The stress on the parents of the infant c. The comfort level of the infant d. All are correct ANS: D Feedback A

B

Incorrect—All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

Incorrect—All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

C

D

Incorrect—All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

Correct! All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

DIF: Cognitive level: Knowledge 5. Which of the following is the most significant in terms of ethical debate or potential

ethical dilemmas? a. Using birth control pills b. Defining infertility as a medical condition c. Undergoing a caesarean section d. Having ultrasonography performed during pregnancy ANS: B Feedback A B

C D

Incorrect—Birth control may conflict with the values of some people, but it is generally accepted as an ethical practice.

Correct! Birth control, ultrasonography, and caesarean sections may conflict with the values of some people but are all generally accepted as ethical practices.

Defining infertility as a medical condition, as opposed to a social condition, is an ethical debate. Classifying infertility as a disease requiring medical solutions (e.g., fertility treatments) would open the door for reproductive technologies to be publicly funded.

Incorrect—Caesarean sections may conflict with the values of some people, but they are generally accepted as an ethical practice.

Incorrect—Ultrasonography may conflict with the values of some people, but they are generally accepted as an ethical practice.

DIF: Cognitive level: Analysis 6. Which of the following is the strongest argument against egg donation? a. The donor is usually younger than the recipient. b. Ovarian stimulation is inappropriate. c. The donor may be anonymous. d. There is the potential for abuse of the system.

ANS: D

Feedback A B C D

Incorrect—The donor is usually younger than the recipient, but this is not the concern.

Incorrect—Ovarian stimulation may be an ethical issue for some, but this is not the greatest concern.

Incorrect—The anonymity of the donors may pose an ethical dilemma to some individuals, but this is not the greatest concern.

Correct! The strongest argument against egg donation is the ethical issue that there is the potential for abuse of the system, including the commodification of women’s reproduction. Presently, in Canada, the sale of human tissue or body parts, including eggs, is illegal.

DIF: Cognitive level: Analysis 7. Which of the following statement is reflective of the Assisted Human Reproduction Act

(2004)? a. The health and well-being of the parents must be given the greatest priority. b. Men and women are equally affected by reproductive technology. c. Embryos must not be stored for longer than 1 year. d. Informed consent is a fundamental principle in reproductive technology.

ANS: D Feedback A B C D

Incorrect—The health and well-being of the child must be given the greatest priority.

Incorrect—Women are at greater risk from the possible negative effects of reproductive technology.

Incorrect—Storage time limits for embryos vary across cryopreservation programs.

Correct! The principle of free and informed consent must be promoted and applied as a fundamental condition of the use of human reproductive technologies.

DIF: Cognitive level: Analysis 8. A pediatric patient’s cancer treatments will likely result in infertility. In this context, what

is the most significant ethical issue concerning the cryopreservation of sperm or eggs for future use? a. The option of sperm collection requires masturbation, which is a taboo. b. Transplanting ovarian tissue into an arm is unethical. c. The child may die before sperm or eggs can be used. d. Challenges associated with informed consent.

ANS: D Feedback A B

Incorrect—Masturbation may be a taboo in some families or cultures, but this is not the most significant ethical issue.

Incorrect—Grafting ovarian tissue into tissue in the forearm is one method of

C D

egg retrieval.

Incorrect—There is the possibility of death in any situation, so this does not present a significant ethical issue.

Correct! The ability to give informed consent depends on the child’s age and maturity level. Obtaining the child’s agreement or assent to the procedure may be challenging because young children may be uncomfortable with, or not completely understand, the discussion surrounding it.

DIF: Cognitive level: Application 9. Which of the following statements is true of the feminist ethical perspective on

reproductive technology? a. Men are most affected by reproductive technology. b. Couples and individuals, not the medical profession, should control the right to reproductive choice. c. The medical profession should control reproductive technology. d. Only male–female couples should pursue reproductive technology.

ANS: B Feedback A B

C D

Incorrect—Women are at greater risk from the possible negative effects of reproductive technology.

Correct! The intention of reproductive technology is to give couples or individuals the right to reproductive choice, but some feminists are concerned that in practice, the actual control will be held by men within the medical profession.

Incorrect—In the feminist view, the control should rest with the individuals and couples who might benefit from these technologies.

Incorrect—In the feminist view, both singles and couples, including same-sex couples, have the right to pursue reproductive technology.

DIF: Cognitive level: Knowledge 10. In 1995, the Government of Canada put a moratorium on which of the following

reproductive practices? a. Gestational surrogacy through embryo donation for couples over 50 years of age b. Commercial preconception arrangements c. Ovarian cryopreservation for premenarcheal girls d. Restricting offspring from information about sperm or egg donors until they are 18 years of age.

ANS: B Feedback A B C

Incorrect—No age limit exists.

Correct! Financial arrangements are prohibited to prevent coercion and the commodification of reproduction.

Incorrect—Although there are many ethical challenges in this area, especially related to consent, this is not prohibited.

D

Incorrect—Presently, donation is anonymous, but donors can elect to have their identity released to any offspring when they arrive at a specific age. This is not guaranteed.

DIF: Cognitive level: Comprehension TRUE/FALSE 1. Predictive testing for genetic conditions or illnesses raises an individual’s awareness of

risk and, thus, reduces the likelihood of related ethical issues.

ANS: F Feedback Correct

Incorrect

Predictive testing may raise a number of ethical issues, including the child’s right to privacy and confidentiality, the ability of the parents to demand testing for their child, and who should have a say when genetic information will have implications for other individuals.

This statement is false.

DIF: Cognitive level: Analysis 2. An adult patient with lymphoma has undergone autologous (self-donated) cell

transplantation after a course of chemotherapy. This situation poses an ethical dilemma.

ANS: F Feedback Correct

Incorrect

Autologous transplantations do not pose an ethical dilemma. There is controversy around transplanting stem cells from human embryos because it is feared that embryonic stem cell research and utilization could lead to the creation of embryos to use their stem cells for transplantation into other people.

This statement is false.

DIF: Cognitive level: Synthesis 3. A 23-year-old female patient who is the victim of a motor vehicle accident arrives in the

emergency room, where she dies as a result of her injuries. It is acceptable, at this stage, to retrieve her eggs at her husband’s request.

ANS: F Feedback Correct Incorrect

Retrieval of sperm or eggs from cadavers is prohibited, regardless of consent.

This statement is false.

DIF: Cognitive level: Synthesis

4. A preterm infant at 24 weeks of gestation should be given comfort care only because the

infant would not be considered viable.

ANS: F Feedback Correct

Incorrect

The current marker of viability is now 24 weeks of gestation. However, the future of these infants is uncertain, and outcomes are difficult to predict.

This statement is false.

DIF: Cognitive level: Synthesis 5. The Assisted Human Reproduction Act defines a fetus as “a human organism … beginning

on the 57th day following fertilization … and ending at birth.”

ANS: T Feedback Correct

Incorrect

This is how the Assisted Human Reproduction Act defines a fetus. During the first 56 days of its development, the organism is known as an “embryo.”

This statement is true.

DIF: Cognitive level: Knowledge

Chapter 10: Safeguarding Patient Rights Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following best describes a “right”? a. A legal claim or privilege b. A claim or privilege to which one is justly entitled, either legally or morally c. A claim or privilege that carries no corresponding obligations d. The rights of patients are a grey area open to interpretation ANS: B Feedback A B C D

Incorrect—Rights are not required to be legally based.

Correct! A right is a claim or privilege to which one is justly entitled, either legally or morally.

Incorrect—A right carries a corresponding obligation. Otherwise, the right loses its meaning.

Incorrect—The rights of patients are explicit and clear through standards contained in professional codes of ethics.

DIF: Cognitive level: Comprehension 2. The nurse is in the process of obtaining informed consent from a patient. Which of the

following best describes this process? a. The nurse’s right b. The nurse’s autonomy c. The nurse’s obligation d. The patient’s obligation ANS: C Feedback A B C

D

Incorrect—This process does not relate to the nurse’s rights.

Incorrect—This process relates to the patient’s autonomy, not that of the nurse.

Correct! It is the nurse’s obligation to obtain the patient’s informed consent. The nurse must ensure that all relevant information has been provided so that the patient may exercise the right to make an informed consent.

Incorrect—Although the patient’s informed consent is needed, the patient is not obligated to give it.

DIF: Cognitive level: Comprehension 3. A patient in the nurse’s care is being investigated for diarrhea. The nurse remembers this

patient from another facility and recalls that he was diagnosed as HIV-positive, but the patient denies this to the nurse. How should the nurse proceed? a. The nurse should do nothing. b. The nurse should tell her colleagues to be extra careful when attending to this

patient. c. The nurse should confront and challenge the patient about his dishonesty. d. The nurse should report this information to her manager in a private meeting.

ANS: D Feedback A B

C

D

Incorrect—This is not the correct action for the nurse to take because it potentially places others, including the patient, at risk Incorrect—The nurse should not discuss this issue with her colleagues because this would violate the patient’s right to confidentiality. Precautions are already taken in the care of every patient.

Incorrect—Rechecking with the patient for clarification of the situation is acceptable, but challenging and confronting the patient is not, especially because the nurse could be mistaken in her memory.

Correct! The nurse should report this situation to her manager in a private meeting. In many provinces, statute law requires certain patient information and conditions to be disclosed. For example, many public health laws require public health care professionals to disclose to their local medical officer of health the identity of anyone diagnosed with certain communicable or sexually transmitted diseases, including HIV/AIDS. The nurse’s manager is the most appropriate person to deal with this situation; he or she will also need to take into consideration that the nurse’s recollection may be incorrect.

DIF: Cognitive level: Synthesis 4. A patient has requested that certain information remain confidential. Which of the

following is an exception to maintaining patient confidentiality? a. The nurse must disclose the information to the unit manager. b. The nurse can disclose to the patient’s family in order validate the accuracy of the information. c. The nurse can disclose the information during morning report. d. The nurse must disclose the information if someone is in danger.

ANS: D Feedback A B

C

D

Incorrect—In most cases, discussing the matter with anyone violates patient confidentiality.

Incorrect—Disclosure to the family may be necessary only to protect the patient or others from harm. The nurse should seek support from the manager if this situation arises.

Incorrect—Confidential information must not be discussed in any report. If the nurse needs to discuss required information with a particular team member, then this discussion should take place on a one-on-one basis, not during a verbal report, when others can hear what is being said. The nurse must disclose to the patient that this information will be shared.

Correct! If a patient poses a threat to himself or others, the nurse has an ethical obligation to report the information to the authorities in the institution and to the police. Provincial law also requires disclosure in cases of suspected child abuse.

DIF: Cognitive level: Analysis 5. What should the nurse do if a patient asks to see her medical record? a. The nurse should give the patient her medical record because freedom of

information legislation permits it. b. The nurse should give the patient her medical record because it legally belongs to

the patient. c. The nurse should ask the charge nurse to review the chart with the patient. d. The nurse should refer the patient to the physician or the medical records

department.

ANS: D Feedback A

B

C D

Incorrect—Although the patient has the right to his or her information that is contained in the health record, there is an appropriate process that must be followed.

Incorrect—The patient’s record—the collection and documentation of the patient’s medical information—is the legal property of the physician or the institution.

Incorrect—The charge nurse is not normally authorized to release such information.

Correct! Although the records themselves do not belong to the patient, the information contained in the records does. However, only the physician or the medical records department may release the information contained in the patient’s medical record to the patient. There is a process to ensure that this is done appropriately and that there is no risk of harm to the patient or others if it is shared. The process depends on whether the patient remains in the hospital or has been discharged from hospital.

DIF: Cognitive level: Application 6. Most provinces have enacted legislation regulating access to personal health information.

What is the main purpose of information and privacy legislation? a. To protect health workers from malpractice suits b. To serve as an ethical decision-making framework for the disclosure of information c. To establish rules for the collection, use, and disclosure of personal health information d. To protect hospitals and health authorities ANS: C Feedback A B C

Incorrect—Legislation does not protect health care professionals from malpractice suits.

Incorrect—Legislation does not provide an ethical decision-making framework.

Correct! The purpose of information and privacy legislation is to establish rules for the collection, use, and disclosure of personal health information.

D

Incorrect—The legislation is not designed to protect hospitals or health authorities.

DIF: Cognitive level: Comprehension 7. What immediate action should a nurse take if a medication error results in harm to a

patient? a. The nurse should immediately disclose the error to the patient and the patient’s family. b. The nurse should inform the physician of the patient’s condition. c. The nurse should discuss the issue with her manager. d. The nurse should discuss the issue with her coworkers so that she feels supported.

ANS: B Feedback A

B C

D

Incorrect—When harm occurs, the ethically responsible action is full disclosure of that harm to the patient or family. However, this should not be the nurse’s first action.

Correct! If harm has resulted from the error then the physician needs to be informed immediately to ensure the appropriate remedial action is taken.

Incorrect—Once the immediate consequences of the error have been addressed, then the ethically responsible action is full disclosure of that harm to the patient or family. However, facilities have different policies regarding the disclosure and documentation of errors, so the nurse should first discuss the issue with his or her manager, who would be most familiar with these policies and also provide the appropriate support and counsel to the nurse.

Incorrect—From the patient safety perspective, it is important to share adverse events with others to minimize the risk of this happening again. This can be done by the manager in manner that respects the confidentiality of the nurse and that of the patient. However, the nurse may be open to be part of this sharing process.

DIF: Cognitive level: Application 8. A competent patient in the nurses’ care becomes angry, insists on leaving against medical

advice, and refuses to sign the waiver acknowledging that he has been advised that leaving is not recommended at this time. What should the nurse do? a. The nurse should call security to restrain the patient. b. The nurse should let the patient go but alert the police. c. The nurse should refuse to give the patient his personal effects. d. The nurse should allow the patient to leave.

ANS: D Feedback A

B

Incorrect—In cases involving psychiatric patients of unsound mind, the mental health statutes of most provinces may permit such persons to be prevented from leaving if they pose a threat or danger to themselves or to others. However, the nurse should not attempt to restrain a competent patient or ask security to do so.

Incorrect—If the patient is competent and not at risk of harming others there is

C D

no reason to alert the police.

Incorrect—The nurse cannot legally withhold a patient’s personal effects.

Correct! The nurse should alert the team because others may be able to persuade him to stay. However, ultimately, there is nothing hospital staff can do to prevent a competent patient from leaving. The nurse should give the patient his personal effects and allow him to leave. If a competent patient refuses to sign the waiver, the fact that he is leaving against medical advice should be carefully documented in the chart.

DIF: Cognitive level: Synthesis 9. What is the purpose of a mental health act? a. To ensure that everyone with a mental illness will be treated b. To protect the rights of the public c. To protect the rights of the patient d. To outline rights and obligations for health care professionals and patients ANS: D Feedback A B C D

Incorrect—Not everyone with a mental illness receives treatment.

Incorrect—The protection of the rights of the public is one aspect of a mental health act, but not the purpose.

Incorrect—The protection of patient rights is one component of a mental health act, but not the purpose.

Correct! The purpose of a mental health act is to outline rights for patients and obligations for health care professionals in relation to patients with mentally illness, such as admission to and discharge from a mental institution.

DIF: Cognitive level: Knowledge 10. Which of the following issues offer the greatest ethical concerns when nurses care for

transgender persons? a. Privacy b. Making assumptions made about their needs c. Disrespect from other clients d. All of the above ANS: D Feedback A

B

C

Incorrect—All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

Incorrect—All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

Incorrect—All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

D

Correct! All of these are important issues and relate to the autonomy and well-being of transgender persons that nurses must consider when delivering an ethical plan of care.

DIF: Cognitive level: Analysis TRUE/FALSE 1. A resident in the operating room should be allowed to participate in all aspects of a

surgery because the patient signed a general surgical consent form.

ANS: F Feedback Correct

Incorrect

Patients should be informed when residents are to perform a primary role during an operative procedure. A general surgical consent form would not provide this information. In academic hospitals, patients should be informed in some manner that students from all disciplines might be involved in their care.

This statement is false.

DIF: Cognitive level: Knowledge 2. A patient in the nurse’s care is unaware of her diagnosis of terminal cancer and asks the

nurse about it. The patient’s physician is refusing to give her the diagnosis because he is concerned about her reaction to the news. The nurse should be honest with the patient and tell her what the diagnosis is.

ANS: F Feedback Correct

Incorrect

Unless she has certain legal qualifications, the nurse is not authorized to tell the patient what her diagnosis is. Giving a diagnosis identifying a disease or disorder is a controlled act that is reserved for certain health care professionals. As an advocate for the patient, the nurse should instead endeavour to influence the physician, stressing the patient’s right to be informed.

Unless she has certain legal qualifications, the nurse is not authorized to tell the patient what her diagnosis is. Giving a diagnosis identifying a disease or disorder is a controlled act that is reserved for certain health care professionals. As an advocate for the patient, the nurse should instead endeavour to influence the physician, stressing the patient’s right to be informed.

DIF: Cognitive level: Analysis

3. With the exception of indigenous children, who are covered under the Indian Act, if a

physician or the team believes that the decisions of a parent or substitute decision maker put a child at risk and in need of protection, there is an obligation to report this to the Children’s Aid Society (CAS), who will undertake an investigation and determine the child’s need for protection.

ANS: F Feedback Correct

Incorrect

The Indian Act does not address issues related to child welfare. This obligation exists to protect all children in Canada. However, recent cases highlight that to evaluate the best interests of Indigenous children, the uniqueness of their culture, heritage, and traditions and the need to preserve their cultural identity need to be considered.

This statement is false.

DIF: Cognitive level: Analysis 4. First responders across Canada are required to initiate cardiopulmonary resuscitation

(CPR) efforts on all persons when they receive 911 calls to their homes.

ANS: F Feedback Correct

Incorrect

Historically, first responders were required to initiate resuscitation even on terminally ill persons, even if it was against the wishes of the family, and even if an advance directive from the patient was present. To address this concern, some provinces have introduced a process to ensure that the patient’s/family’s wish not to have CPR is understood, documented, and respected. A medical directive signed by a physician or nurse practitioner, which confirms the existence of a signed DNR (Do Not Resuscitate) order, is accepted by emergency responders in these provinces.

This statement is false.

DIF: Cognitive level: Knowledge 5. The Indian Act gives the government responsibility and oversight for the Indigenous

peoples of Canada with regard to such matters as status, land, administration, resources, and education.

ANS: F Feedback Correct Incorrect

This paternalistic legislation covers First Nations peoples but excludes the Métis and the Inuit.

This paternalistic legislation covers First Nations peoples but excludes the Métis and the Inuit.

DIF: Cognitive level: Knowledge

Chapter 11: Perspectives on the Rights of Nurses Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following is an example of a conscientious objection? a. A nurse refuses to care for a homosexual patient. b. A nurse refuses to care for a patient with cocaine addiction. c. A nurse refuses to assist in an abortion. d. A nurse refuses to care for patients of the opposite sex.

ANS: C Feedback A

B

C

D

Incorrect—This is not an example of a conscientious objection. Refusing to care for a patient on the basis of sexual orientation would be considered discrimination and contradict the ethical principles of beneficence and nonmaleficence and of the nurse’s professional duties and responsibilities.

Incorrect—This is not an example of a conscientious objection. Refusing to care for a patient on the basis of the patient’s behaviour would contradict the ethical principles of beneficence and nonmaleficence and of the nurse’s professional duties and responsibilities.

Correct! This would be considered a conscientious objection. As long as the procedure is not an emergency, the nurse does not have to participate in a procedure or provide care that the nurse finds objectionable on moral or religious grounds. To avoid such situations, it is important that the nurse makes his or her moral or religious position known to the employer in advance. However, the nurse cannot refuse to care for a patient who has had an abortion.

Incorrect—This is not an example of a conscientious objection. Refusing to care for a patient on the basis of gender would be considered discrimination and contradict the ethical principles of beneficence and nonmaleficence and of the nurse’s professional duties and responsibilities.

DIF: Cognitive level: Synthesis 2. Is it acceptable for a nurse to refuse to care for a patient with a highly contagious illness,

such as severe acute respiratory syndrome (SARS)? a. It is acceptable because the nurse might become infected and could then pass the infection on to her family. b. It is not acceptable because the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses states that in a natural or human-made disaster, nurses have a duty to provide care to all patients. c. It is acceptable if appropriate safety precautions are not in place. d. It is not acceptable because the principle of justice dictates that a patient with an infectious disease deserves the same care as everyone else.

ANS: C Feedback

A B C

D

Incorrect—The chance that the nurse might contract SARS is not a valid reason to refuse to care for the patient.

Incorrect—This correct, but nurses also have the right to protection.

Correct! It may be acceptable for the nurse to refuse to care for this patient if appropriate safety measures and training are not in place. The CNA Code of Ethics for Registered Nurses states that “during a natural or human-made disaster, including a communicable disease outbreak, nurses have a duty to provide care using appropriate safety precautions.” It is the responsibility of the system and organizations to put strategies in place to prevent harm to caregivers in these high-risk situations. In their advocacy role nurses also have a responsibility to ensure that these concerns are known to leaders in the organization.

Incorrect—This is not true in all circumstances.

DIF: Cognitive level: Synthesis 3. Which of the following is an indicator of a healthy work environment? a. Reduced absenteeism b. Increased staff commitment to the organization c. High levels of staff satisfaction d. All are correct ANS: D Feedback A

B

C

D

Incorrect—All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

Incorrect—All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

Incorrect—All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

Correct! All are correct. A positive and healthy work culture results in reduced absenteeism, high levels of staff satisfaction, a sustained staff commitment to the organization, and improved ability to attract and retain new employees.

DIF: Cognitive level: Knowledge 4. What is the primary purpose of occupational health and safety committees in the

workplace? a. To conform with provincial legislation b. To protect employees and keep employers from “cutting corners” c. To identify and recommend solutions to potential workplace hazards d. To meet collective agreement obligations

ANS: C Feedback A

B C

D

Incorrect—Provincial legislation may require the formation of workplace occupational health and safety committees, but the primary purpose of such committees is not to conform to this legislation.

Incorrect—Protecting employees is an effect of occupational health and safety committees, not the primary purpose.

Correct! The primary purpose of workplace occupational health and safety committees is to identify and recommend solutions to potentially hazardous conditions in the workplace.

Incorrect—Collective agreements may outline requirements for membership on occupational health and safety committees, but meeting these obligations is not the primary purpose of these committees.

DIF: Cognitive level: Comprehension 5. Which of the following is an implication of workplace violence? a. Compromising patient safety b. Injury and emotional and psychological trauma c. Impact on retention, absenteeism, morale, and productivity d. All are correct ANS: D Feedback A

B

C

D

Incorrect—All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

Incorrect—All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

Incorrect—All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

Correct! All of the above are implications of workplace violence. The rights of nurses to be protected from harm in the workplace include having a violence-free work environment.

DIF: Cognitive level: Knowledge 6. Which of the following is the most common form of nurse-to-nurse violence? a. Sexual harassment b. Nurses “eating their young” c. Assault d. Bullying ANS: D Feedback A

Incorrect—Sexual harassment is not the most common form of nurse-to-nurse

B C D

violence.

Incorrect—This phrase depicts nurse-to-nurse violence but is not an actual form of violence.

Incorrect—Assault is not the most common form of nurse-to-nurse violence.

Correct! Bullying (behaviour toward others that is intimidating, lacking in respect, coercive, critical, or belittling) and incivility (behaviour toward others that is condescending or insulting or that seeks to humiliate or ignore the victim) are the most common forms of nurse-to-nurse violence. This type of violence is often underreported.

DIF: Cognitive level: Comprehension 7. Which of the following strategies has a positive impact on reducing moral distress? a. Providing mentoring programs b. Altering the skill mix on inpatient units c. Increasing the length of nurses’ shifts d. Increasing the emphasis on justice ANS: A Feedback A B C D

Correct! Moral distress is minimized in environments in which mentorship is provided.

Incorrect—All skill mixes are susceptible to moral distress.

Incorrect—Increasing the length of nurses’ shifts has not been shown to have a positive impact on reducing moral distress.

Incorrect—Justice is an ethical principle but is not directly related to moral distress.

DIF: Cognitive level: Comprehension 8. Which of the following is the least effective way of managing workplace violence? a. Taking immediate disciplinary action when a nurse is accused of bullying

behaviour b. Undertaking risk assessments to identify vulnerable environments c. Following up on every incident d. Engaging leaders in in fostering awareness in their teams about what constitutes

workplace violence ANS: A Feedback A

B

C

Correct! Bullies are often insecure, fearful, or jealous or have been bullied themselves. They may lack insight into their own behaviour. If an investigation reveals the validity of the accusation, then the first step should be counselling and a conversation to uncover the reasons behind the behaviour.

Incorrect—Some environments place nurses at a higher risk. Also, data related to turnover, absenteeism, and so on may indicate an unhealthy work environment.

Incorrect—Victims of bullying, incivility, or interpersonal conflicts are more

D

likely to quit jobs, feel worse, and be less happy with their jobs and leaders; therefore, it is important to investigate the situation as soon as possible and ensure that the victim is receiving the appropriate support.

Incorrect—Bullying is most often found in organizations with a negative social climate and unsupportive leadership. Awareness is important, and leaders can play a key role in these discussions and model appropriate behaviour.

DIF: Cognitive level: Analysis 9. A nurse who works in a busy emergency department is invited to a family reunion planned

for the weekend she is scheduled to work 12-hour shifts. She has been unsuccessful in having her manager change the schedule or in finding colleagues to relieve her. What are her next steps? a. Engage and pay for the services of an agency nurse. b. Revisit the request with the manager, and try to negotiate a reciprocal arrangement. c. Express concerns to the manager’s supervisor. d. Plan to call in sick.

ANS: B Feedback A B C

D

Incorrect—This would not be appropriate for the nurse to do. This would be a management responsibility.

Correct! The nurse should try again and explain the importance of the family event. Perhaps the nurse and the manager can come up with a win-win solution.

Incorrect—This would not be an immediate next step. If lack of support from the manager is an ongoing issue, it would be important to discuss this view with him or her before taking it forward.

Incorrect—This constitutes professional misconduct and would put the nurse at risk of disciplinary action.

DIF: Cognitive level: Analysis 10. Union representatives are involved in which of the following two functions? a. Arbitrations and decertification processes b. Representing nurses during a disciplinary process and preventing the termination

of a nurse with cause c. Collective bargaining and the management of grievances d. Performance appraisals and sick time management ANS: C Feedback A B

C D

Incorrect—Decertification processes are initiated by dissatisfied union members, not the union executive.

Incorrect—Unions do represent nurses during the disciplinary process but they cannot prevent the termination a nurse. They can grieve this and take it to arbitration.

Correct! These functions are set out in the collective agreement.

Incorrect—These are leadership and human resource functions.

DIF: Cognitive level: Analysis TRUE/FALSE 1. Home care nurses are expected to deal with additional risk in their jobs because they are

sent to unknown environments.

ANS: F Feedback Correct

Incorrect

Home care nurses may encounter additional risk in their jobs because they are sometimes sent to unknown environments, but nurses should not expect to be put in a position of danger without adequate support or security measures. Home care nurses should never go alone to an unknown area or unknown client without some type of safety backup in place. This may include the use of communication or panic-alert devices or working with a colleague. Nurses have the right to refuse unsafe work, and home care agencies have policies covering employee safety.

This statement is false.

DIF: Cognitive level: Comprehension 2. Moral distress is the state of being convinced of the morally correct action to take but

being unable to carry out the action.

ANS: F Feedback Correct

Incorrect

Moral distress is the emotional and psychological pain that results when one is convinced of the morally correct action to take but is unable to carry out the action.

This statement is false.

DIF: Cognitive level: Comprehension 3. The main purpose of collective bargaining is the protection of workers’ rights.

ANS: F Feedback Correct

Incorrect

The main purpose of collective bargaining is the protection of the rights of both the workers and the employer. Collective bargaining involves the rights and obligations of both parties.

This statement is false.

DIF: Cognitive level: Synthesis 4. Unions in Canada are organized under the provisions of the Canada Labour Relations Act.

ANS: F Feedback Correct

Incorrect

Unions involved in provincial or territorial organizations are organized under their respective labour relations acts. Only federally regulated industries organize under the Canada Labour Relations Act. Unions involved in provincial or territorial organizations are organized under their respective labour relations acts. Only federally regulated industries organize under the Canada Labour Relations Act.

DIF: Cognitive level: Knowledge 5. A common concern of nurses considering a strike vote is based on the ethical principle of

nonmaleficence.

ANS: T Feedback Correct

Incorrect

Nonmaleficence is the ethical principle that means “do no harm.” Nurses considering strike action do not want any harm to come to their patients and may find that the values of the collective group, in terms of wages and working conditions, are in conflict with the professional values that direct nurses’ care of patients.

This statement is true.

DIF: Cognitive level: Analysis

Chapter 12: Ethical Issues in Leadership, the Organization, and Approaches to the Delivery of Care Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition MULTIPLE CHOICE 1. Which of the following organizational activities should be guided by ethical standards? a. Recruitment practices b. Leadership practices c. Resource allocation d. All are correct ANS: D Feedback A

B

C

D

Incorrect—All of the above should be guided by ethical standards.

Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

Incorrect—All of the above should be guided by ethical standards.

Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

Incorrect—All of the above should be guided by ethical standards.

Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

Correct! All of the above should be guided by ethical standards. Organizational and clinical systems and processes must meet the same ethical standards as does practice. These systems include human resource policies, such as recruitment and retention, leadership practices that involve support and mentorship for staff as well as succession planning, and ethical resource allocation.

DIF: Cognitive level: Synthesis 2. During the night-shift report, the nurse notes that a colleague does not seem to be able to

stay awake. Despite prompting, the colleague remains drowsy, and the nurse suspects substance abuse. The nurse reports this to the charge nurse. Which of the following describes the charge nurse’s responsibility? a. The charge nurse should fire the employee immediately. b. The charge nurse should send the employee home immediately. c. The charge nurse should send the employee for drug testing immediately. d. The charge nurse should suspend the employee with pay immediately.

ANS: B Feedback A B

C

D

Incorrect—Firing the employee immediately would be premature and not supportive. Firing is the role of the manager, not the charge nurse.

Correct! The employee should be sent home immediately after being told the reason for being sent home (that she is unfit for work at this time). The charge nurse notifies the manager, who then has the responsibility to follow up with this nurse prior to the nurse’s return to work, express concern, and offer support, counseling, or medical treatment.

Incorrect—Discussion with the employee must take place prior to drug testing, as the employee may admit to the substance misuse. If necessary, the manager would arrange for drug testing, not the charge nurse.

Incorrect—Discussion with the employee must take place prior to any discipline.

If necessary, the manager would be involved with the disciplinary actions, not the charge nurse.

DIF: Cognitive level: Synthesis 3. Which of the following factor has an impact on nursing shortages? a. An aging population creates a growing demand on health resources. b. An aging population means more young people are contemplating entering the

nursing profession. c. Advances in technology call for increased generalization of practice for new

nurses. d. All are correct.

ANS: A Feedback A B C D

Correct! As the population ages, its health care needs increase. An aging population results in a growing demand on health resources.

Incorrect—An aging population means fewer young people are available to potentially enter the nursing profession.

Incorrect—Advances in technology call for increased specialization of practice for new nurses.

Incorrect—All of the above are not correct.

DIF: Cognitive level: Knowledge 4. Which of the following is the most ethical method for recruiting internationally educated

nurses? a. Recruiting nurses from developing countries and offering them a better way of life in Canada b. Booking a table at an international job fair for nurses and discussing opportunities with nurses who attend the fair c. Offering large financial and transition incentives for internationally educated nurses to come to Canada d. Hiring internationally educated nurses through international recruitment agencies

ANS: B Feedback A B

C D

Incorrect—This is unethical because developing countries can little afford to lose what resources they have.

Correct! Booking a table at a job fair is the most ethical method of attracting internationally educated nurses. Recruitments are then voluntary, no incentives are necessary, and the recruiters are not perceived as “poaching.”

Incorrect—Incentives for internationally educated nurses may result in abuse from local nurses who may perceive reverse discrimination.

Incorrect—International recruitment agencies often use aggressive strategies to lure internationally educated nurses away from the developing countries with nursing shortages or promise financial or transition incentives that never materialize.

DIF: Cognitive level: Synthesis 5. Which of the following best describes the expectations of a nurse caring for a patient with

a different cultural background? a. The nurse should ask another nurse with the same cultural background as that of the patient to care for the patient. b. Nurses must be knowledgeable about all cultures and customs. c. The nurse can identify the patient’s unique cultural practices during assessment and then plan the implementation of care and interventions accordingly. d. Nurses should avoid discussion of unusual customs.

ANS: C Feedback A

B C

D

Incorrect—The nurse should be able to care for this patient without involving another nurse. It is impossible for nurses to be knowledgeable about the cultural backgrounds and values of all the patients they care for.

Incorrect—It is impossible for nurses to be knowledgeable about the cultural backgrounds and values of all the patients they care for.

Correct! Nurses should undertake a comprehensive cultural assessment of their patients in an effort to understand their unique values to design a care strategy consistent with their values and beliefs.

Incorrect—Nurses should encourage discussion of customs that are important to the patient.

DIF: Cognitive level: Application 6. Why are patients and clients from diverse cultural backgrounds at risk? a. Language barriers always interfere with care. b. Patients’ food preferences result in less than optimal nutrition. c. Patients’ reluctance to disclose their feelings is an issue. d. There may not be a shared understanding of what is meaningful to these patients

and their families.

ANS: D

Feedback A B C D

Incorrect—Language barriers can sometimes be an issue, but not always.

Incorrect—Family members may bring outside food to patients, and in most situations, the care is short term, so diet is not a major issue.

Incorrect—This is a generalization and is not appropriate.

Correct! Nurses should engage in actions that respect and empower cultural identity and make attempts to understand the values of patients and clients with different cultural backgrounds.

DIF: Cognitive level: Analysis 7. What does the term “multidisciplinarity” mean with respect to the levels of team

functioning? a. Feeling competent and confident in one’s own discipline b. Being willing and able to work with others in the joint evaluation, planning, and care of the patient c. Believing that oneself and fellow professionals in one’s discipline can make an important contribution to care d. Recognizing that other disciplines also have important contributions to make ANS: D Feedback A B C D

Incorrect—This phrase describes unidisciplinarity.

Incorrect—This phrase describes interdisciplinarity.

Incorrect—This phrase describes intradisciplinarity.

Correct! This is the correct definition of multidisciplinarity.

DIF: Cognitive level: Knowledge 8. Patients’ family members are an important aspect of care, and family-centred care is an

important model of care. Which of the following is an example of inappropriate family involvement in the care of a patient involving a language barrier? a. Translation by family members during decisions about cancer treatment b. Translation by family members to assist the patient to eat c. Translation by family members when culturally appropriate comfort measures are being provided d. Translation by family members to help identify subtle signs of discomfort in the patient ANS: A Feedback A

B C

Correct! Family translation during important treatment decisions should be a last resort. Translation for significant care issues, where possible, should be performed by professional translators to avoid coercion and to ensure that any consent or refusal of treatment by the patient is informed.

Incorrect—Family translation to assist with the patient’s mealtime is appropriate.

Incorrect—Family translation during the provision of comfort measures is appropriate.

D

Incorrect—Family translation to help identify subtle signs of discomfort in the patient is appropriate.

DIF: Cognitive level: Synthesis 9. Which of the following elements best describe family- and patient-centred care? a. Respecting the racial, ethnic, cultural, and socioeconomic diversity of clients and

families b. Designing health care that is flexible, culturally competent, and responsive to the needs and wish of the client and family c. Listening to family members because they may note important changes in the patient’s condition that may not be readily apparent to the team d. All are correct ANS: D Feedback A B C D

Incorrect—These are all important elements of family- and patient-centred care.

Incorrect—These are all important elements of family- and patient-centred care.

Incorrect—These are all important elements of family- and patient-centred care.

Correct! These are all important elements of family- and patient-centred care.

DIF: Cognitive level: Analysis 10. A nurse on a rehabilitation unit does rounds at the beginning of a night shift and discovers

that the daughter of an older gentleman, who is recovering from hip surgery, is sleeping on a vacant bed in his room. What should she do as it is not hospital policy to allow visitors during the night? a. Wake the daughter up, let her know it was inappropriate of her to sleep on the bed as now it will have to be remade. Because it is late, permit her to sleep on the chair beside her father’s bed. b. Wake the daughter up, and tell her she has to go home because visitors are not allowed during the night. c. Let the daughter sleep, and inform the staff that the bed linen needs to be changed in the morning. d. Let the daughter sleep, and meet with the manager in the morning about changing the rules to be more family centred and patient centred.

ANS: D Feedback A

B

C D

Incorrect—Allowing visitors at night might not be the policy, but this approach is against the principles of family- and patient- centred care and contravenes ethical standards.

Incorrect—Allowing visitors at night might not be the policy, but this approach is against the principles of family- and patient- centred care and contravenes ethical standards. The daughter is also at risk of travelling late at night.

Incorrect—This is respectful of the needs of the daughter and her father in the short term.

Correct! This is the respectful approach that recognizes the needs of the patient

and family and the important role families play in supporting the emotional needs of the patient. In this scenario, the nurse is meeting the standards of the CNA Code of Ethics by advocating for the greater good.

DIF: Cognitive level: Analysis TRUE/FALSE 1. Organizational ethics deals with those values that establish standards and influence how

the organization is perceived both internally and externally.

ANS: T Feedback Correct

Incorrect

The ethical culture of the organization influences its image and reputation, establishes the legitimacy of its role in society, and clarifies what the organization stands for.

This statement is true.

DIF: Cognitive level: Knowledge 2. Distributive justice refers to the perception that processes have been fair and inclusive

regardless of the outcome.

ANS: F Feedback Correct

Incorrect

Distributive justice refers to such outcomes as allocation of resources, salaries, benefits, and work conditions, whereas procedural justice refers to the perception that processes have been fair and inclusive, regardless of the outcome.

This statement is false.

DIF: Cognitive level: Knowledge 3. Nursing leaders are solely responsible for ensuring sound ethical practice and a healthy

work environment.

ANS: F Feedback Correct

Incorrect

Nurses share accountability with leaders in ensuring sound ethical practice, a healthy work environment, and staff satisfaction to create a culture and climate conducive to positive patient care outcomes.

This statement is false.

DIF: Cognitive level: Comprehension 4. It is best practice when the nursing team explores ethical issues related to the patient/client

and determines the best course of action.

ANS: F Feedback Correct

Incorrect

Morality and ethics within the health care setting should not be isolated within an individual disciplines. By working together, the interprofessional team has a greater influence on ethical practice and more likely to achieve the best outcomes for patients and families.

Morality and ethics within the health care setting should not be isolated within an individual disciplines. By working together, the interprofessional team has a greater influence on ethical practice and more likely to achieve the best outcomes for patients and families.

DIF: Cognitive level: Analysis 5. Open visiting for families includes parents, spouses, and children.

ANS: F Feedback Correct Incorrect

Family is defined by the patient or client, who may prefer support from close friends versus relatives.

Family is defined by the patient or client, who may prefer support from close friends versus relatives.

DIF: Cognitive level: Comprehension