Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City

COLLEGE OF NURSING

COMPETENCY APPRAISAL I: ETHICS

1. The Universal Health Care Act mandates is D. Explain how the client must adapt to hospital
that everyone can: routines to be effectively cared for while in the
A. Pick any physician and insurance company hospital
despite one’s income
B. Receive free medical benefits from all 6. Which activity would not be expected by the
hospitals. nurse to meet the cultural needs of the client?
C. Have equal access to all health care. A. Promote and support attitudes, behaviors,
D. Have basic care with a sliding scale payment knowledge, and skills to respectfully meet
plan from all health care facilities client’s cultural needs despite the nurse’s own
beliefs and practices
2. Which statement would best explain the role B. Ensure that the interpreter understands not
of the nurse when planning care for a culturally only the language of the client but feelings and
diverse population? The nurse will plan care to: attitudes behind cultural practices to make sure
A. Include care that is culturally congruent with an ethical balance can be achieved
the staff from predetermined criteria C. Develop structure and process for meeting
B. Focus only on the needs of the client, cultural needs on a regular basis and means to
ignoring the nurse’s beliefs and practices avoid overlooking these needs with clients
C. Blend the values of the nurse that are for the D. Expect the family to keep an interpreter
good of the client and minimize the client’s present at all times to assist in meeting the
individual values and beliefs during care communication needs all day and night while
D. Provide care while aware of one’s own bias, hospitalized
focusing on the client’s individual needs rather
than the staff’s practices 7. Ethical principles for professional nursing
practice in a clinical setting are guided by the
3. Which factor is least significant during principles of conduct that are written as the:
assessment when gathering information about A. Code of Ethics
cultural practices? B. Nurse Practice Act (NPA) written by state
A. Language, timing legislation
B. Touch, eye contact C. Standards of care from experts in the practice
C. Biocultural needs field
D. Pain perception, management expectations D. Good Samaritan laws for civil guidelines

4. Transcultural nursing implies: 8. A bioethical issue should be described as:

A. Using a comparative study of cultures to A. The physician’s making all decisions of client
understand similarities and differences across management without getting input from the
human groups to provide specific individualized client
care that is culturally appropriate B. A research project that included treating all
B. Working in another culture to practice the white men and not treating all the black
nursing within their limitations men to compare the outcomes of a specific drug
C. Combining all cultural beliefs into a practice therapy.
that is a non-threatening approach to minimize C. The withholding of food and treatment at the
cultural barriers for all clients’ equality of care request of the client in a written advance
D. Ignoring all cultural differences to provide the directive given before a client acquired
best generalized care to all clients. permanent brain damage from an accident.
D. After the client gives permission, the
5. What should the nurse do when planning physician’s disclosing all information to the
nursing care for a client with a different cultural family for their support in the management of
background? The nurse should: the client.
A. Allow the family to provide care during the
hospital stay so no rituals or customs are broken 9. When the nurse described the client as “that
B. Identify how these cultural variables affect nasty old man in 354,” the nurse is exhibiting
the health problem which ethical dilemma?
C. Speak slowly and show pictures to make sure A. Gender bias and ageism
the client always understands B. HIPAA violation
C. Beneficence A. Consent for medical treatment can be given
D. Code of ethics violation by a minor with a sexually transmitted disease
(STD).
10. The distribution of nurses to areas of “most B. A second trimester abortion can be given
need” in the time of a nursing shortage is an without state involvement.
example of: C. Student nurses cannot be sued for
A. Utilitarianism theory malpractice while in a nursing clinical class.
B. Deontological theory D. Nurses who get sick and leave during
C. Justice a shift are not abandoning clients if they call
D. Beneficence their supervisor and leave a message about
their emergency illness.
11. Nurses are bound by a variety of laws.
Which description of a type of law is correct? 17. Most litigation in the hospital comes from
A. Statutory law is created by elected the:
legislature, such as the state legislature that A. Nurse abandoning the clients when going to
defines the Nurse Practice Act (NPA). lunch
B. Regulatory law includes prevention of harm B. Nurse following an order that is incomplete
for the public and punishment for those laws or incorrect
that are broken. C. Nurse documenting blame on the physician
C. Common law protects the rights of the when a mistake is made
individual within society for fair and equal D. Supervisor watching a new employee check
treatment. his or her skills level
D. Criminal law creates boards that pass rules
and regulations to control society. 18. The nurse places an aquathermia pad on a
client with a muscle sprain. The nurse informs
12. Besides the Joint Commission on the client the pad should be removed in 30
Accreditation of Healthcare Organizations minutes. Why will the nurse return in 30
(JACHO), which governing agency regulates minutes to remove the pad?
hospitals to allow continued safe services to be A. Reflex vasoconstriction occurs.
provided, funding to be received from the B. Reflex vasodilation occurs.
government and penalties if guidelines are not C. Systemic response occurs.
followed? D. Local response occurs.
A. Board of Nursing (BON)
B. Nurse Practice Act (NPA) 19. A client has recently been told he has
C. Philippine Nurses Association (PNA) terminal cancer. As the nurse enters the room,
D. Department of Health he yells, “My eggs are cold, and I’m tired of
having my sleep interrupted by noisy nurses!”
13. When a client is confused, left alone with The nurse may interpret the client’s behavior as:
the side rails down, and the bed in a high A. An expression of the anger stage of dying
position, the client falls and breaks a hip. What B. An expression of disenfranchised grief
law has been broken? C. The result of maturational loss
A. Assault D. The result of previous losses
B. Battery
C. Negligence 20. When helping a person through grief work,
D. Civil tort the nurse knows:
A. Coping mechanisms that were effective in the
14. When signing a form as a witness, your past are often disregarded in response to the
signature shows that the client: pain of a loss
A. Is fully informed and is aware of all B. A person’s perception of a loss has little to do
consequences. with the grieving process.
B. Was awake and fully alert and not medicated C. The sequencing of stages of grief may occur
with narcotics. in order, they may be skipped, or they may
C. Was free to sign without pressure recur.
D. Has signed that form and the witness saw it D. Most clients want to be left alone.
being done
21. A client is hospitalized in the end stage of
15. Which criterion is needed for someone to terminal cancer. His family members are sitting
give consent to a procedure? at his bedside. What can the nurse do to best
A. An appointed guardianship aid the family at this time?
B. Unemancipated minor A. Limit the time visitors may stay so they do
C. Minimum of 21 years or older not become overwhelmed by the situation.
D. An advocate for a child B. Avoid telling family members about the
client’s actual condition so they will not lose
16. Which statement is correct? hope.
C. Discourage spiritual practices because this D. “Palliative care means the client and family
will have little connection to the client at this take a more passive role and the doctor focuses
time. on the physiological needs of the client. The
D. Find simple and appropriate care activities for location of death will most likely occur in the
the family to perform. hospital setting.”

22. When caring for a terminally ill client, it is 27. Which of the following is not included in
important for the nurse maintain the client’s evaluating the degree of heritage consistency in
dignity. This can be facilitated by: a client?
A. Spending time to let clients share their life A. Gender
experiences B. Culture
B. Decreasing emphasis on attending to the C. Ethnicity
client’s appearance because it only increases D. Religion
their fatigue
C. Making decisions for clients so they do not 28. When providing care to clients with varied
have to make them cultural backgrounds, it is imperative for the
D. Placing the client in a private room to provide nurse to recognize that:
privacy at all times A. Cultural considerations must be put aside if
basic needs are in jeopardy.
23. What are the stages of dying according to B. Generalizations about the behavior of a
Elizabeth Kubler-Ross? particular group may be inaccurate.
A. Numbing; yearning and searching; C. Current health standards should determine
disorganization and despair; and reorganization. the acceptability of cultural practices.
B. Accepting the reality of loss, working through D. Similar reactions to stress will occur when
the pain of grief, adjusting to the environment individuals have the same cultural background.
without the deceased, and emotionally
relocating the deceased and moving on with 29. To respect a client’s personal space and
life. territoriality, the nurse:
C. Anticipatory grief, perceived loss, actual loss, A. Avoids the use of touch
and renewal. B. Explains nursing care and procedures
D. Denial, anger, bargaining, depression, and C. Keeps the curtains pulled around the clients
acceptance. bed
D. Stands 8 feet away from the bed, if possible.
24. Bereavement may be defined as:
A. The emotional response to loss. 30. To be effective in meeting various ethnic
B. The outward, social expression of loss. needs, the nurse should:
C. Postponing the awareness of the reality of A. Treat all clients alike.
the loss. B. Be aware of client’s cultural differences.
D. The inner feeling and outward reactions of C. Act as if he or she is comfortable with the
the survivor. client’s behavior.
D. Avoid asking questions about the client’s
25. A client who had a “Do Not Resuscitate” cultural background.
order passed away. After verifying there is no
pulse or respirations, the nurse should next: 31. The most important factor in providing
A. Have family members say goodbye to the nursing care to clients in a specific ethnic group
deceased. is:
B. Call the transplant team to retrieve vital A. Communication
organs. B. Time orientation
C. Remove all tubes and equipment (unless C. Biological variation
organ donation is to take place), clean the body, D. Environmental control
and position appropriately.
D. Call the funeral director to come and get the 32. A health care issue often becomes an ethical
body. dilemma because:
A. A client’s legal rights coexist with a health
26. A client’s family member says to the nurse, professional’s obligation.
“The doctor said he will provide palliative care. B. Decisions must be made quickly, often under
What does that mean?” The nurse’s best stressful conditions.
response is: C. Decisions must be made based on value
A. “Palliative care is given to those who have systems.
less than 6 months to live.” D. The choices involved do not appear to be
B. “Palliative care aims to relieve or reduce the clearly right or wrong.
symptoms of a disease.” 33. A document that lists the medical treatment
C. “The goal of palliative care is to affect a cure a person chooses to refuse if unable to make
of a serious illness or disease.” decisions is the:
A. Durable power of attorney C. Battery
B. Informed consent D. Negligence
C. Living will
D. Advance directives 40. The nurse puts a restraint jacket on a client
without the client’s permission and without the
34. Which statement about an institutional physicians order. The nurse may be guilty of:
ethics committee is correct? A. Assault
A. The ethics committee is an additional B. Battery
resource for clients and healthcare C. Invasion of privacy
professionals. D. Neglect
B. The ethics committee relieves health care
professionals from dealing with ethical issues. 41. In a situation in which there is insufficient
C. The ethics committee would be the first staff to implement competent care, a nurse
option in addressing an ethical dilemma. should:
D. The ethics committee replaces decision A. Organize a strike
making by the client and health care providers. B. Inform the clients of the situation
C. Refuse the assignment
35. The nurse is working with parents of a D. Accept the assignment but make a protest in
seriously ill newborn. Surgery has been writing to the administration.
proposed for the infant, but the chances of
success are unclear. In helping the parents 42. Which statement about loss is accurate?
resolve this ethical conflict, the nurse knows A. Loss is only experienced when there is an
that the first step is: actual absence of something valued.
A. Exploring reasonable courses of action B. The more the individual has invested in what
B. Collecting all available information about the is lost, the less the feeling of loss.
situation C. Loss may be maturational, situational, or
C. Clarifying values related to the cause of the both.
dilemma. D. The degree of stress experienced is unrelated
D. Identifying people who can solve the to the type of loss.
difficulty.
43. Trying questionable and experimental forms
36. Miss Mary, an 88-year old woman, believes of therapy is a behavior that is characterized of
that life should not be prolonged when hope is which stage of dying?
gone. She has decided that she does not want A. Anger
extraordinary measures taken when her life is at B. Depression
its end. Because she feels this way, she has C. Bargaining
talked with her daughter about her desires, D. Acceptance
completing a living will and left directions with
her physician. This is an example of: 44. All of the following are crucial needs of the
A. Affirming a value dying client except:
B. Choosing a value A. Control of pain
C. Prizing a value B. Preservation of dignity and self-worth
D. Reflecting a value C. Love and belonging
D. Freedom from decision making
37. The scope of Nursing practice is legally
defined by: 45. Cultural awareness is an in-depth self-
A. State nurses practice acts examination of one’s:
B. Professional nursing organizations A. Background, recognizing biases and
C. Hospital policy and procedure manuals prejudices.
D. Physicians in the employing institutions B. Social, cultural, and biophysical factors
C. Engagement in cross-cultural interactions
38. A student nurse who is employed as a D. Motivation and commitment to caring.
nursing assistant may perform any functions
that: 46. Cultural competence is the process of:
A. Have been learned about in school A. Learning about vast cultures
B. Are expected of a nurse at that level B. Acquiring specific knowledge, skills, and
C. Are identified in the positions job description attitudes
D. Require technical rather than professional C. Influencing treatment and care of clients
skill. D. Motivation and commitment to caring.
39. A confused client who fell out of bed 47. Ethnocentrism is the root of:
because side rails were not used is an example A. Biases and prejudices
of which type of liability? B. Meanings by which people make sense of
A. Felony their experiences.
B. Assault C. Cultural beliefs
D. Individualism and self-reliance in achieving nurse could provide this patient is resources for
and maintaining health. a liver transplant.
D. Justice, because the first and greatest
48. When action is taken on one’s prejudices: question in this situation is how to determine
A. Discrimination occurs the just distribution of resources.
B. Sufficient comparative knowledge of diverse
groups is obtained. 54. The code of ethics for nurses is promulgated
C. Delivery of culturally congruent care is by:
ensured. A. Philippine Nurses Association
D. People think/know you are a dumbass for B. Board of Nursing
being prejudiced. C. The Medical American Association
D. The National Institutes of Health, Nursing
49. This is not a value orientation in the division.
Philippines:
A. Use of rituals symbolizing the supernatural. 55. Nurses agree to be advocates for their
B. Group reliance and interdependence patients. Practice of advocacy calls for the nurse
C. Healing emphasizing naturalistic modalities to:
D. Individualism and self-reliance in achieving A. Seek out the nursing supervisor in conflicting
and maintaining health. situations
B. Work to understand the law as it applies to
50. Disparities in health outcomes between the the client’s clinical condition.
rich and the poor illustrates: a (an) C. Assess the client’s point of view and prepare
A. Illness attributed to natural, impersonal, and to articulate this point of view.
biological forces. D. Document all clinical changes in the medical
B. Creation of own interpretation and record in a timely manner.
descriptions of biological and psychological
malfunctions. 56. Successful ethical discussion depends on
C. Influence of socioeconomic factors in people who have a clear sense of personal
morbidity and mortality. values. When many people share the same
D. Combination of naturalistic, religious, and values it may be possible to identify a
supernatural modalities. philosophy of utilitarianism, with proposes that:
A. The value of people is determined solely by
51. Culture strongly influences pain expression leaders in the Unitarian church.
and need for pain medication. However, cultural B. The decision to perform a liver transplant
pain: depends on a measure of the moral life that the
A. May be suffered by a client whose valued client has led so far.
way of life is disregarded by practitioners. C. The best way to determine the solution to an
B. Is more intense, thus necessitating more ethical dilemma is to refer the case to the
medication. attending physician.
C. Is not expressed verbally or physically D. The value of something is determined by its
D. Is expressed only to others of like culture. usefulness to society.

52. The dominant values in Philippine society on 57. The philosophy sometimes called the code
individual autonomy and self-determination: of ethics of care suggests that ethical dilemmas
A. Rarely have an effect on other cultures can best be solved by attention to:
B. Do not have an effect on health care A. Relationships
C. Hinders hospice care program. B. Ethical principles
D. May be in direct conflict with diverse groups. C. Clients
D. Code of ethics for nurses.
53. In the United States, access to health care
usually depends on a client’s ability to pay for 58. In most ethical dilemmas, the solution to
health care, either through insurance or by the dilemma requires negotiation among
paying cash. The client the nurse is caring for members of the health care team. The nurse’s
needs a liver transplant to survive. This client point of view is valuable because:
has been out of work for several months and A. Nurses have a legal license that encourages
does not have insurance or enough cash. A their presence during ethical discussions.
discussion about the ethics of this situation B. The principle of autonomy guides all
would involve predominantly the principle of: participants to respect their own self-worth.
A. Accountability, because you as the nurse are C. Nurses develop a relationship to the client
accountable for the well being of this client. that is unique among all professional health
B. Respect of autonomy, because this client’s care providers.
autonomy will be violated if he does not receive D. The nurse’s code of ethics recommends that
the liver transplant. a nurse be present at any ethical discussion
C. Ethics of care, because the caring thing that a about client care.
59. Ethical dilemmas often arise over a conflict 62. The client’s right to refuse treatment is an
of opinion. Once the nurse has determined that example of:
the dilemma is ethical, a critical first step in A. Statutory law
negotiating the difference of opinion would be B. Common law
to: C. Civil laws
A. Consult a professional ethicist to ensure that D. Nurse practice acts
the steps of the process occur in full.
B. Gather all relevant information regarding the 63. Even though the nurse may obtain
clinical, social, and spiritual aspects of the the client’s signature on a form,
dilemma. obtaining informed consent is the responsibility
C. List the ethical principles that inform the of the:
dilemma so that negotiations agree on the A. Client
language of the discussion. B. Physician
D. Ensure that the attending physician has C. Student nurse
written an order for an ethics consultation to D. Supervising nurse.
support the ethics process.
64. The nurse is obligated to follow a physician’s
60. The nurse practice acts are an example of: order unless:
A. Statutory law A. The order is a verbal order
B. Common law B. The physician’s order is illegible
C. Civil law C. The order has not been transcribed
D. Criminal law D. The order is an error, violates hospital policy,
or would be detrimental to the client.
61. The scope of Nursing Practice, the
established educational requirements for 65. The nursing theorist who developed
nurses, and the distinction between nursing and transcultural nursing theory is
medical practice is defined by: A. Dorothea Orem
A. Statutory law B. Madeleine Leininger
B. Common law C. Betty Newman
C. Civil law D. Sr. Callista Roy
D. Nurse practice acts