Chapter 05: Ethical Issues Related to Health Promotion


Chapter 05: Ethical Issues Related to Health Promotion
Edelman: Health Promotion Throughout the Life Span, 8th Edition


1. Which of the following statements is true with regard to health promotion?
a. Health promotion efforts are not concerned with addressing environmental obstacles to health.
b. Advocates of health promotion are not involved in political campaigns against harmful products.
c. The business of eliminating health disparities is a unique function of Healthy People 2010 goals.
d. Health promotion involves collaboration of many professional groups.
Health promotion is not the province of a single discipline but involves individuals, health care providers, and institutions working together to create a positive environment for health and to achieve health goals.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 104

2. Which of the following types of ethical theories tells us how people act toward each other and their environments and what they believe are good or moral actions?
a. Descriptive value theories
b. Normative theories
c. Consequentialism theory
d. Duty-based theories
Descriptive theories do not tell us what actions we ought to take. They are not directive; they tell us how people act toward each other and their environments and what they seem to believe are good or moral actions.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 105

3. A nurse includes the statement, “Treat others the way you would like to be treated.” when teaching a group of adolescents about bullying. Which type of ethical theory is being used in this example?
a. Descriptive value theory
b. Normative theory
c. Consequentialism theory
d. Duty-based theory
Normative theories are concerned with ensuring good actions. They are reasoned explanations of the moral purpose of human interactions, or they are divinely “revealed” truths about good action (religious ethics).

DIF: Cognitive Level: Apply (Application) REF: p. 105

4. A nurse believes that it is his responsibility to ensure the safety of the public by administering flu shots to everyone in the community. Which ethical theory is being used by the nurse?
a. Descriptive value theory
b. Normative theory
c. Consequentialism theory
d. Duty-based theory
Consequentialism theory proposes that actions are good insofar as they are aimed at yielding the greatest amount of happiness or pleasure or cause the least amount of harm or pain to individuals and overall in society. Administration of flu vaccines proposes the best result for individuals and decreased risk for others in the community.

DIF: Cognitive Level: Apply (Application) REF: pp. 105-106

5. Which of the following statements best describes the application of moral or ethical theory to the practices involved in health promotion?
a. One can be assured of morally correct action in a given situation if one adheres to a theory of moral principles.
b. There are no identifiable criteria that can be used effectively to determine correct actions in a given situation.
c. The good of the larger population always takes precedence over the good of one individual.
d. Making ethical decisions regarding human health involves the consideration of multiple factors.
Making moral or ethical decisions about human health is not an easy task and requires assessing various criteria or theories.

DIF: Cognitive Level: Apply (Application) REF: p. 106

6. An emergency department provides care for all individuals regardless of circumstances and ability to pay. This is an example of:
a. ethic of justice.
b. ethic of care.
c. applied ethics.
d. metaethics.
The ethic of justice is impartial and nondiscriminatory. An ethic of care, however, requires an understanding of situational particularities, ensuring that we try to understand a given individual’s needs in the context of his or her life.

DIF: Cognitive Level: Apply (Application) REF: p. 108

7. A nurse uses ethical reasoning to solve an ethical dilemma. Why would the nurse use this process?
a. Assists in predicting all of the possible consequences of future actions
b. Facilitates gathering of the most important information to solve the problem
c. Considers the importance of caring when solving the problem
d. Highlights salient aspects of future actions
The purpose of ethical inquiry is to gain clarity on actual or potential moral issues arising in the context of health-promotion endeavors and to understand what is expected of the health-promotion agent viewed as a moral agent. Ethical reasoning can facilitate appropriate and in-depth data gathering, permit the uncovering of hidden agendas and interests, and focus on the most salient aspects of a particular problem.

DIF: Cognitive Level: Apply (Application) REF: p. 109

8. A nurse whose religious beliefs prohibit abortion has been asked to participate in a termination of the pregnancy of a 16-year-old victim of date rape. According to the revised American Nurses Association’s (ANA’s) Code of Ethics for Nurses, which of the following actions should the nurse take next?
a. Suspend her religious beliefs and provide comfort and support for the client.
b. Quit her job and find another source of employment.
c. Notify her supervisor about her beliefs and request a change in assignment.
d. Refuse to participate in the abortion.
In the immediacy of the situation, the ANA Code of Ethics provides for the right of nurses to refuse to participate in procedures that violate their own values, but the nurse’s ethical behavior must ensure that arrangements for the care of the client are provided.

DIF: Cognitive Level: Analyze (Analysis) REF: pp. 109-110

9. A liver for which two people are tissue-typed has become available after the death of a donor in a car accident. Client A is a 45-year-old substance abuser whose liver is damaged as a result of his use of alcohol. Client B is a 16-year-old adolescent in need of a liver transplant because of a birth abnormality. Which of the following would be useful for a nurse in giving input as to which of the two should receive the liver?
a. Advocate for Client B because he is the younger of the two and will live longer.
b. Use feminist moral theory to advocate for Client A in spite of his alcohol use.
c. Use a guided set of moral principles in decision-making before advocating for either.
d. Advocate for Client A because he has 15 to 20 years of productive life left.
Systematically using a set of moral principles in making ethical decisions assists the nurse in resolving ethical dilemmas such as that described.

DIF: Cognitive Level: Analyze (Analysis) REF: pp. 110-111

10. Which concept is aimed at interrupting potential ethical problems before they develop?
a. Feminist ethics
b. Preventive ethics
c. Metaethics
d. Normative ethics
Preventive ethics is a requirement of health promotion in which practitioners envision potential problems and institute actions that stop their development.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 111

11. When providing preoperative teaching for a client who will be undergoing total knee arthroplasty, the nurse asks the client questions to assess his understanding of the surgery. Which type of ethics is the nurse implementing?
a. Duty-based ethics
b. Normative ethics
c. Metaethics
d. Preventive ethics
Preventive ethics aims to forestall ethical problems before they develop. Preventive ethics is an important requirement of health-promotion endeavors that includes individual action by the nurse, as well as social and political activism with other nurses or professional nursing organizations. Assessing the client’s understanding of what is going to happen during a surgical procedure before the client signs the consent for the procedure makes sure the client understands the information and should help prevent ethical problems.

DIF: Cognitive Level: Apply (Application) REF: p. 111

12. A 24-year-old man with severe cognitive impairment, and no relatives participating in his care, needs to make a decision about removal of a brain tumor that will render him totally dependent for completion of all activities of daily living. The nurse participates in ethical decision making on his behalf, knowing that the client is unable to benefit from which of the following ethical concepts?
a. Autonomy
b. Justice
c. Beneficence
d. Advocacy
Because the client is cognitively delayed and is unable to understand explanations of treatment that would be given to him, the client is unable to be autonomous in making a decision regarding neurosurgery.

DIF: Cognitive Level: Apply (Application) REF: pp. 113-115

13. A client is scheduled to have open-heart surgery. His physical condition is such that he is at high risk to experience complications during the procedure, but he has not been advised of this possibility. Which of the following ethical concepts has been ignored in rendering care for this client?
a. Beneficence
b. Autonomy
c. Justice
d. Informed consent
The client is able to “substantially understand” his care. Ethical care ensures that a person has all of the appropriate information necessary to make an autonomous decision about his or her care. This client has not been informed of his chances of dying during the surgery.

DIF: Cognitive Level: Apply (Application) REF: p. 114

14. An 18-year-old woman in whom a sexually transmitted disease (STD) was recently diagnosed asks the nurse not to tell her mother that she has an STD. Her mother asks the nurse what is causing her daughter’s vaginal discharge. Which of the following actions should the nurse take?
a. Follow the principle of veracity and tell the mother the diagnosis.
b. Respect the principle of confidentiality and support the client’s request not to tell her mother the diagnosis.
c. Tell the client’s mother that she has a urinary tract infection, to protect the client’s privacy and honor the mother’s request.
d. Ignore the mother’s request for information.
The Health Insurance Portability and Accountability Act (HIPAA) guarantees client confidentiality. The client is the only person who can inform her mother of the diagnosis and the only person who can give the nurse permission to inform her mother of the diagnosis. The nurse could appropriately respond to the mother by saying, “I cannot share that information with you because of client confidentiality legislation. You might ask your daughter to share that information with you.”

DIF: Cognitive Level: Analyze (Analysis) REF: p. 117

15. A nurse is providing care to a 15-year old female who has recently been diagnosed with a sexually transmitted infection (STI). Which of the following actions should the nurse take next?
a. Seek advice from an ethics expert.
b. Facilitate interaction between the adolescent and her parents/guardians.
c. Report the STI to the appropriate authorities.
d. Contact the adolescent’s parents/guardians.
Federal and state laws generally serve to protect the privacy and autonomy of adolescents. Responsibilities of the nurse include helping an adolescent to grasp his or her authentic options and rights, facilitating interaction between the adolescent and parents or guardians, maintaining trust, and preserving confidentiality.

DIF: Cognitive Level: Apply (Application) REF: p. 117

16. An elderly client has recently been diagnosed with cancer. The client’s family has asked the nurse to withhold this information from the client because they feel that this information would cause the client to give up on life and become very depressed. The nurse believes the client should be told this information. Which ethical principle is being upheld by the nurse?
a. Justice
b. Beneficence
c. Veracity
d. Nonmaleficence
Veracity is also known as devotion to the truth. Veracity in giving people information about their health care needs facilitates autonomous choice and enhances personal decision-making. Withholding information, or providing information that is misleading or incomprehensible, in an attempt to influence someone to agree to a treatment or intervention, conflicts with veracity.

DIF: Cognitive Level: Apply (Application) REF: p. 118

17. Which of the following concepts of ethics is described as the “duty to maximize the benefits of actions while minimizing harm”?
a. Advocacy
b. Justice
c. Beneficence
d. Autonomy
Beneficence governs actions taken to further the overall health or well-being of an individual or society. “Beneficence” means doing good.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 118

18. A nurse reflects on previous experiences with minority populations and considers how these interactions have influenced her present care to these populations. Which part of values clarification and reflection has the nurse used?
a. Formulate a possible course of action.
b. Examine the influence of beliefs.
c. Reflect on practice.
d. Determine the prevalent values.
It is important for the nurse to think about the influence that beliefs and values have on his or her practice. An understanding of how personal beliefs and values are either congruent, or are liable to interfere, with the task at hand is crucial to ethical problem solving.

DIF: Cognitive Level: Apply (Application) REF: p. 121


1. A nurse is working with a community to increase its awareness about the dangers of lead poisoning. Which of the following provides the best explanation as to why the nurse is performing this action? (select all that apply)
a. It is the right thing to do.
b. It is a moral responsibility.
c. It is an ethical responsibility.
d. It is the role of the nurse.
When nurses provide service to society through health promotion interventions, their care for clients can be seen as a moral endeavor. Moral issues are confronted in the process of attempting to enhance the well-being of a society overall, as well as promoting and protecting health for individual members of a society. The ANA Code of Ethics for Nurses Interpretive Statements promises that “nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups and communities.” The terms ethical and moral are used interchangeably throughout the chapter.

DIF: Cognitive Level: Apply (Application) REF: p. 104

2. A nurse is using feminist ethics when planning a program for women to promote screening and early detection of breast cancer. Which of the following considerations would be made by the nurse? (select all that apply)
a. Importance of relationships
b. Understanding of the oppression of women
c. Importance of responsibility when caring for others
d. Understanding of the imbalance of power
Characteristics of feminist ethics include: understanding that human beings are inseparable from their relationships with others; a focus on care and responsibility aspects of relationships, rather than application of abstract principles; a concern with the development of character and attitudes that result in caring actions reflective of a person who is related to rather than detached from context; and a concern for the rights and equality of all individuals that is not limited to the oppression of women.

DIF: Cognitive Level: Apply (Application) REF: p. 108