A nurse is caring for four patients in the emergency department during a mass casualty event.Hospital resources, including available personnel and lifesaving equipment, are limited. The following patients have just arrived: Patient A is a 27-year-old with an open femur fracture and stable vital signs; Patient B is an 82-year-old with advanced dementia and severe internal bleeding; Patient C is a 34-year-old with a head injury and a Glasgow Coma Scale score of 4; Patient D is a 12-year-old with superficial lacerations and mild respiratory distress. The nurse must apply the ethical principle of justice when making triage decisions.
Based on the ethical principle of justice, which actions by the nurse are appropriate? Select all that apply.
Defer to the physician's judgment to avoid personal bias.
Provide equal attention and resources to each patient regardless of condition.
Use a standardized triage protocol to guide treatment decisions.
Prioritize care for the patient most likely to recover with timely intervention.
Allocate resources to the patient who has lived the longest.
Advocate for equitable access to care based on severity and potential outcomes.
Correct Answer : C,D,E,F
Choice A rationale
Deferring entirely to a physician is not an application of the ethical principle of justice but rather a delegation of professional responsibility. Nurses are ethically obligated to use their own clinical judgment and adhere to established triage frameworks. Justice requires that the nurse actively participate in ensuring resources are distributed fairly. Simply following another person's lead does not ensure that the distribution of care is equitable or principled.
Choice B rationale
Providing equal attention to every patient in a mass casualty event is actually a violation of distributive justice. When resources are scarce, giving the same amount of time to a person with minor cuts as to someone with a life-threatening but treatable injury is inefficient and unethical. Justice in this context means treating people based on their needs and the potential for a positive outcome, rather than providing identical care to all.
Choice C rationale
Using a standardized triage protocol ensures that every patient is evaluated using the same objective criteria, which is a core component of formal justice. Protocols like START or SAVE prevent favoritism or emotional bias from influencing care. By applying the same rules to everyone, the nurse ensures that the distribution of limited medical resources is handled in a fair, predictable, and transparent manner during a high-stress crisis.
Choice D rationale
Prioritizing patients who are most likely to recover with intervention is an application of distributive justice and utilitarianism. In a mass casualty situation, the goal is to do the greatest good for the greatest number of people. Justice involves allocating limited lifesaving equipment to those who can actually benefit from it, rather than exhausting those resources on patients whose prognosis is terminal despite any medical efforts or interventions provided.
Choice E rationale
While age is a sensitive factor, distributive justice sometimes considers the concept of a fair innings, where resources are prioritized for those who have not yet lived a full life. However, in traditional triage, allocating resources strictly to the oldest patient, who also has advanced dementia and internal bleeding, would be an inefficient use of limited supplies. Justice often shifts toward those with the highest probability of survival and many years ahead.
Choice F rationale
Advocating for equitable access based on severity and potential outcomes aligns with the principle of justice. This ensures that care is not diverted due to social status or age but is instead focused on clinical need and the likelihood of successful recovery. The nurse acts as a gatekeeper of fairness, ensuring that the triage process remains focused on objective clinical data and the survival of the largest possible group.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
This scenario describes an ethical dilemma rather than moral distress. An ethical dilemma occurs when there is a conflict between two moral imperatives, such as the patient's right to know and the family's desire to protect them. The nurse may feel conflicted about the best course of action, but they are not necessarily prevented from acting by an external constraint. Resolving this requires ethical consultation and communication rather than coping with systemic failures.
Choice B rationale
Moral distress occurs when a healthcare professional knows the ethically correct action to take but is prevented from doing so by institutional or environmental constraints. A heavy workload that prevents a nurse from providing necessary, high-quality care creates a gap between professional values and actual practice. This disconnect leads to feelings of frustration, anger, and burnout because the nurse is forced to provide suboptimal care that contradicts their clinical and ethical training and standards.
Choice C rationale
Witnessing a colleague use a racial slur is a violation of professional conduct and human rights. This situation requires a disciplinary or interpersonal response based on workplace policy and civil rights protections. While it is emotionally upsetting and morally wrong, it does not fit the specific definition of moral distress, which centers on the inability to provide proper patient care due to institutional barriers. This is a matter of professional ethics and workplace culture.
Choice D rationale
A colleague lying about an illness to attend a social event is a breach of integrity and professional responsibility. It impacts the team's workload and trust but does not constitute moral distress for the nurse who discovers it. This is a behavioral and administrative issue. Moral distress is specifically tied to the internal struggle of being unable to fulfill one's perceived moral obligations to patients due to factors beyond one's immediate control.
Correct Answer is C
Explanation
Choice A rationale
Increasing the irrigation rate is a secondary intervention used to prevent clot formation or to clear existing obstructions. However, if the catheter is already obstructed or kinked, increasing the flow will lead to rapid bladder distention and severe pain. The nurse must first determine if the tubing is patent before adding more fluid into a potentially closed system to avoid causing trauma or bladder rupture.
Choice B rationale
Clamping an indwelling urinary catheter after a transurethral resection of the prostate is contraindicated. Continuous bladder irrigation is designed to keep the bladder clear of blood and clots. Clamping the tube would allow blood to accumulate and coagulate within the bladder, leading to painful distention and potential hemorrhage. This action does not address the lack of output and actually increases the risk of serious postoperative complications.
Choice C rationale
Assessment is the first step of the nursing process and is critical when a sudden cessation of urinary output occurs. The nurse should check the tubing for kinks, loops, or clots that might be obstructing the flow. In the immediate postoperative period of a prostatectomy, maintaining a patent drainage system is the priority to prevent bladder spasms and ensure the surgical site remains stable and free from pressure.
Choice D rationale
Notifying the provider is an appropriate action but only after the nurse has performed a thorough assessment and tried simple bedside troubleshooting. If the nurse calls the provider without first checking for kinks or attempting to irrigate the catheter according to standing orders, they lack the necessary information to give a concise report. Assessment must precede notification to ensure the provider can make an informed clinical decision.
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