Davis Advantage Chapter 44, 45 Nursing Ethics and Legal Issues

Which are elements of the Good Samaritan law? Select all that apply. 1. Care was provided in an emergency situation. 2. A person was harmed as a result of care provided. 3. Care was voluntary and payment was not provided. 4. A health-care provider is required to provide care in an emergency situation. 5. Care is provided in a reasonably competent manner.

1. Care was provided in an emergency situation. Rationale: Good Samaritan laws apply to care given in emergencies. 3. Care was voluntary and payment was not provided. Rationale: If payment is given for care provided, Good Samaritan laws are nullified. 5. Care is provided in a reasonably competent manner. Rationale: Good Samaritan laws state that emergency care should be provided in a reasonably competent manner. INCORRECT ANSWERS WITH RATIONALE 2. A person was harmed as a result of care provided. Rationale: Good Samaritan laws do not apply to a person harmed as a result of the care provided. 4. A health-care provider is required to provide care in an emergency situation. Rationale: Good Samaritan laws do not require that a health-care provider respond to an emergency. Test-Taking Tip Good Samaritan laws are designed to protect from liability those who provide emergency care to someone in need of medical services. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1200

What would be an appropriate nursing diagnosis for a client who is uncertain about which course of action to take in his or her treatment? 1. Decisional Conflict 2. Moral Distress 3. Values Clarification 4. Value/Belief/Action Congruence

1. Decisional Conflict Rationale: With Decisional Conflict, the client may verbalize distress and uncertainty, may delay decision making, and may be unable to make a definitive decision. INCORRECT ANSWERS WITH RATIONALE 2. Moral Distress Rationale: Moral Distress is used when the client has made a moral decision but is unable to carry out the chosen action. 3. Values Clarification Rationale: Values Clarification refers to the process of becoming conscious of and naming one's values, which enables sound decision making. 4. Value/Belief/Action Congruence Rationale: Value/Belief/Action Congruence is a class of diagnoses in the NANDA-I classification list. Test-Taking Tip Patients may not know what course of action to take regarding their illness and may look to the nurse for guidance. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1186

Fair access to care and allocation of resources are examples of what type of justice? 1. Distributive 2. Procedural 3. Compensatory 4. General

1. Distributive Rationale: Distributive justice requires fair distribution of both benefits and burdens and includes allocation of health-care resources and available care for all. INCORRECT ANSWERS WITHRATIONALE 2. Procedural Rationale: Procedural justice is important in processes that require ranking or ordering, such as visiting hours, sick leave, holiday schedules, and other institutional policies. 3. Compensatory Rationale: Malpractice is an example of compensatory justice, which focuses on making amends for wrongs that have been done to individuals or groups. 4. General Rationale: General justice is an overall term for the obligation to be fair and implies equal treatment of all clients. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1182 - 1183

What are steps to help avoid malpractice? Select all that apply. 1. Don't blame or criticize other health-care providers. 2. Recognize "problem" clients. 3. Recognize significant assessment cues. 4. Know and follow standards of care. 5. Be sure medical equipment has been properly inspected.

1. Don't blame or criticize other health-care providers. Rationale: It is never wise to blame or criticize other health-care professionals in the presence of clients, as it demeans the whole system and is unprofessional. 2. Recognize "problem" clients. Rationale: Clients who have unresolved issues and are angry may more often feel mistreated, which can lead to a lawsuit. 3. Recognize significant assessment cues. Rationale: It is important to report all changes in client status, as well as any concerns expressed by the client, to the provider. 4. Know and follow standards of care. Rationale: Adhering to local, state, and professional agency policies will help eliminate the risk for malpractice. INCORRECT ANSWERS WITH RATIONALE 5. Be sure medical equipment has been properly inspected. Rationale: Ensuring equipment has been inspected and is working properly is a smart nursing activity, but it is not one particular to avoiding malpractice. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1210

A 49-year-old uninsured and unemployed client arrives at the emergency department of the local private hospital closest to home complaining of chest pain radiating between the shoulder blades, tightness in the neck, and nausea. The triage nurse calls the on-call provider, who instructs the nurse to send the client to the county hospital several blocks away. What federal law protects this client against refusal of care at the private hospital? 1. EMTALA 2. PSDA 3. HITECH 4. DPOA

1. EMTALA Rationale: The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates health-care facilities provide emergency medical treatment to clients seeking emergency health care regardless of their ability to pay, legal status, or citizenship status. INCORRECT ANSWERS WITH RATIONALE 2. PSDA Rationale: The Patient Self-Determination Act (PSDA) identifies a client's right to make informed decisions regarding his or her health care. 3. HITECH Rationale: Under the HITECH Act, health-care agencies are required to notify clients of any breach of information without unreasonable delay and by no longer than 60 days. 4. DPOA Rationale: Durable power of attorney (DPOA) identifies a surrogate decision maker who is able to make decisions regarding health in the event the client is unable to do so. Test-Taking Tip Patients are entitled to health care regardless of their insurance or social standing. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1197

Which are examples of beliefs? Select all that apply. 1. Elderly people cannot provide a good medical history. 2. A family should be told if a medical error occurs. 3. A nurse should not be allowed to work while impaired. 4. A person should not accept blood or blood products from another person. 5. Arriving 15 minutes before shift will give the appearance of dedication.

1. Elderly people cannot provide a good medical history. Rationale: Beliefs are not necessarily facts. These are particular to an individual and personal. 4. A person should not accept blood or blood products from another person. Rationale: The rightness of accepting certain medical treatment is based on beliefs, which may be based on faith. 5. Arriving 15 minutes before shift will give the appearance of dedication. Rationale: There is no legal or ethical basis to arrive early for work, and the appearance of this practice is a belief. INCORRECT ANSWERS WITH RATIONALE 2. A family should be told if a medical error occurs. Rationale: There is an ethical and legal basis for this statement, so it goes further than a belief. 3. A nurse should not be allowed to work while impaired. Rationale: Nurses working while impaired presents ethical and safety concerns, and therefore is more than a belief. Test-Taking Tip A belief is something that one accepts as true—it may or may not be factual or based on faith. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1177

Which is a description of nurses being able to apply standards of ethical conduct to professional practice and participate in ethical decision making? 1. Ethical agency 2. Moral judgment 3. Whistleblowing 4. Ethical distress

1. Ethical agency Rationale: Ethical agency is the application of ethical principles to professional practice. INCORRECT ANSWERS WITH RATIONALE 2. Moral judgment Rationale: Moral judgment is a person's own standard of right and wrong. 3. Whistleblowing Rationale: Whistleblowing is a type of ethical distress signal in which a nurse observes an immoral or unethical behavior. 4. Ethical distress Rationale: Ethical distress is a situation in which a nurse observes or even participates in a violation of ethics. Test-Taking Tip Nurses must move their ethics into professional practice. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1171

A nurse discharges a client without answering any questions or teaching her how to treat a wound at home. What type of malpractice claim could be brought against this nurse? 1. Failure to implement a plan of care 2. Failure to assess and diagnose 3. Failure to plan 4. Failure to evaluate

1. Failure to implement a plan of care Rationale: Not answering questions, failing to educate clients, and failing to provide care in a reasonable and timely manner are considered failure to implement a plan of care, which is considered a form of malpractice. INCORRECT ANSWERS WITH RATIONALE 2. Failure to assess and diagnose Rationale: Failure to complete an assessment as well as analyze the data to make correct nursing diagnoses can lead to inappropriate action(s) or improper delegation. 3. Failure to plan Rationale: ANA standards require the nurse to complete a care plan that is individualized for the client; therefore, failure to do so is considered malpractice. 4. Failure to evaluate Rationale: Failing to observe for changes in treatment and interventions is in direct violation of the ADA nursing standards and can be considered malpractice. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1210

A client has called the nurse to the room several times over the course of the past hour because he or she keeps getting up and wandering and is having difficulty getting back into bed. On the last visit to the client, the nurse gives the client a sedative to cause drowsiness. What can this treatment be considered? 1. False imprisonment 2. Assault 3. Battery 4. Quasi-intentional tort

1. False imprisonment Rationale: Any attempts to restrain a client, either physically or medically, without his or her permission or justification is considered false imprisonment. INCORRECT ANSWERS WITH RATIONALE 2. Assault Rationale: Assault occurs when a nurse intentionally places a client in immediate fear of personal violence, such as threatening to slap the client or withhold food. 3. Battery Rationale: Battery occurs when there is offensive or harmful physical contact made toward a client without consent or unauthorized touching of a person's body by another person. 4. Quasi-intentional tort Rationale: A quasi-intentional tort results in defamation of character and involves actions that injure a person's reputation. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1206

Which expectations are covered by the American Hospital Association Patient Care Partnership? Select all that apply. 1. High-quality care 2. No unexpected costs 3. Explanation of a diagnosis 4. Involvement in care 5. A clean and safe environment

1. High-quality care Rationale: High-quality care is an expectation of clients that is provided in the Patient Care Partnership. 4. Involvement in care Rationale: Involvement in care is addressed in the Patient Care Partnership. 5. A clean and safe environment Rationale: A clean and safe environment is an expectation that is addressed in the Patient Care Partnership. INCORRECT ANSWERS WITH RATIONALE 2. No unexpected costs Rationale: The Patient Care Partnership does not stipulate no unexpected costs. 3. Explanation of a diagnosis Rationale: The Patient Care Partnership does not cover explanation of diagnoses. Test-Taking Tip The American Hospital Association Patient Care Partnership is a client bill of rights that has been published in eight languages. It explains in detail what clients should expect when they are hospitalized. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1201

What is the mission of the Patient Care Partnership? 1. It encourages health-care providers to be more aware of the need to treat clients in an ethical manner and to protect their rights. 2. A client's values, preferences, need for information, and other factors that promote autonomy must be considered in the plan of care. 3. It states that ethical behavior in care, treatment, services, and business practices should be maintained at all times. 4. It addresses the nurse's responsibilities to clients and directs nurses to contribute to the establishment and maintenance of an ethical environment.

1. It encourages health-care providers to be more aware of the need to treat clients in an ethical manner and to protect their rights. Rationale: When clients are admitted to hospitals or extended care facilities, they are entitled to specific rights in terms of their treatment, which vary from culture to culture, so awareness of client needs is important. INCORRECT ANSWERS WITH RATIONALE 2. A client's values, preferences, need for information, and other factors that promote autonomy must be considered in the plan of care. Rationale: The Joint Commission standards state that a client's values as well as factors that facilitate autonomy are important aspects of ethical care. 3. It states that ethical behavior in care, treatment, services, and business practices should be maintained at all times. Rationale: The Joint Commission standards contain sections on organizational ethics and individual rights, including requiring ethical behavior in care, treatment, services, and business practices. 4. It addresses the nurse's responsibilities to clients and directs nurses to contribute to the establishment and maintenance of an ethical environment. Rationale: Standard 7 of the ANA Standards of Care speaks to the nursing responsibilities to clients and focus on maintaining an ethical environment. Test-Taking Tip Clients have the right to have a say in their care and partnerships. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1185 - 1186

What is one major drawback of applying the Golden Rule way of thinking when addressing a client's wishes? 1. It is presumptuous in that nursing actions may not really be what the client wants. 2. It removes all grounds for client autonomy. 3. It removes the family from decision making. 4. It blurs the role of nurse, advocate, and ethical decision making.

1. It is presumptuous in that nursing actions may not really be what the client wants. Rationale: Presuming the client would want to be treated the same way the nurse does can have significant clinical and ethical implications, as it causes health-care professionals and families to make decisions for the client that are, in reality, not what the client would want. INCORRECT ANSWERS WITH RATIONALE 2. It removes all grounds for client autonomy. Rationale: Client autonomy may be removed if the client has not already stated wishes and is unable to determine for himself or herself, but this is not the major problem. 3. It removes the family from decision making. Rationale: Applying the Golden Rule way of thinking does not mean removing the family from any decision making. 4. It blurs the role of nurse, advocate, and ethical decision making. Rationale: Blurring the lines between nurse and advocate is difficult because both are ethical duties of the nurse. Test-Taking Tip Most important to keep in mind is the wishes of the patient. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1169

When using the MORAL model for ethical decision making, what principles will help the nurse to function effectively as an advocate? 1. Know and document facts. 2. Know the argument. 3. Avoid getting into a power struggle. 4. Be aware of client vulnerability. 5. Assess the group's willingness.

1. Know and document facts. Rationale: By having a complete understanding of the data, the nurse can best serve in an advocacy position for clients. 2. Know the argument. Rationale: Understanding the components of the argument, being unbiased, and understanding the opposition of the client will best suit the client's needs. 3. Avoid getting into a power struggle. Rationale: Decide how far is appropriate and enlist those with more power to help facilitate the change. 4. Be aware of client vulnerability. Rationale: Avoid confrontation and be sure the client is aware of possible risks. INCORRECT ANSWERS WITH RATIONALE 5. Assess the group's willingness. Rationale: Assessing a group's willingness is not particular to the model for ethical decision making. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1188 - 1189

A nurse has been caring for a client and appears to make excessive visits to the client's room. The nurse states he or she has the best understanding of the client's needs while behaving as if no one else can care for the client. When asked about this behavior, the nurse becomes defensive. What could possibly be the issue in this scenario? 1. Potential boundary issues 2. Possible substance abuse issues 3. Infraction of statutory law 4. Unclear scope of practice

1. Potential boundary issues Rationale: Nurses exhibiting secretive behaviors or excessive visits to a client's room could be demonstrating behavior that is consistent with boundary issues. INCORRECT ANSWERS WITH RATIONALE 2. Possible substance abuse issues Rationale: Substance abuse issues can be seen in the behaviors of nurses who have excessive absences or take long breaks. 3. Infraction of statutory law Rationale: Infractions regarding the scope of practice can be considered statutory law issues. 4. Unclear scope of practice Rationale: The scope of practice is clearly defined and is not the issue in this scenario. Test-Taking Tip It is important for the nurse to consider the ramifications of her actions, both ethically and legally. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1215

After assessing a client who has just been weaned from the ventilator, the nurse determines the client is not yet able to ambulate and does not follow the physician's order. What protects the nurse from being terminated or disciplined for not following orders? 1. Safe harbor laws 2. Good Samaritan laws 3. Professional liability 4. Nurse practice acts

1. Safe harbor laws Rationale: Safe harbor laws protect nurses from being suspended, terminated, disciplined, or discriminated against for refusing to do (or not do) something they believe would be harmful to a client. INCORRECT ANSWER WITH RATIONALE 2. Good Samaritan laws Rationale: Good Samaritan laws protect those who provide emergency care to individuals in need of medical services. 3. Professional liability Rationale: Professional liability insurance covers the nurse if sued for malpractice. 4. Nurse practice acts Rationale: Nurse practice acts (NPAs) are statutory laws within each state that define the practice of nursing, including regulations and scope of practice. Test-Taking Tip Nurses must use critical thinking when caring for patients. Safety of the patient is always the priority. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1216

What is an appropriate nursing intervention for moral distress? 1. Self-manage emotions; discuss moral distress with a mentor if you are having difficulty 2. Decreased anxiety level 3. Assess nature of the action and likelihood of immediate harm 4. Self-determination; to choose and act on that choice

1. Self-manage emotions; discuss moral distress with a mentor if you are having difficulty Rationale: An intervention of self-management and working with a mentor is appropriate for a client who is experiencing moral distress. INCORRECT ANSWERS WITH RATIONALE 2. Decreased anxiety level Rationale: Decreased anxiety level is an outcome or goal but not an intervention. 3. Assess nature of the action and likelihood of immediate harm Rationale: When working with immediate harm and nature of actions, this is involving a whistleblower intervention. 4. Self-determination; to choose and act on that choice Rationale: Self-determination is autonomy that is only a small component of working with a client in moral distress. Test-Taking Tip Patients may become unable to take action on their decision, which creates moral distress. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1186

Which questions are examples of bioethics considerations? Select all that apply. 1. Should a client be allowed to die? 2. Should a nurse practice outside of scope? 3. Should a nurse question an order? 4. Should a nurse sign with "RN" following her name? 5. Should a client be told about a medical error?

1. Should a client be allowed to die? Rationale: End-of-life decisions apply principles of bioethics. 3. Should a nurse question an order? Rationale: Questioning a physician's order applies principles of bioethics. 5. Should a client be told about a medical error? Rationale: Informing a client and the family about a medical error is an application of bioethics. INCORRECT ANSWERS WITH RATIONALE 2. Should a nurse practice outside of scope? Rationale: A nurse practicing outside of scope is more an issue of a legal nature. 4. Should a nurse sign with "RN" following her name? Rationale: It is a legal responsibility to sign with "RN" after the signature. Test-Taking Tip Bioethics refers to the application of ethical principles in health care. It applies to many situations in nursing. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1169 - 1170

Nurse practice acts are an example of what type of law? 1. Statutory 2. Administrative 3. Common 4. Constitutional

1. Statutory Rationale: Nurse practice acts (NPAs) passed by the legislative body of each state are regulations that govern the profession of nursing. INCORRECT ANSWERS WITH RATIONALE 2. Administrative Rationale: Administrative law refers to the laws that govern the activities of administrative agencies. 3. Common Rationale: Common law, also called case law, is based on common customs and traditions and comes from legal principles used by judges. 4. Constitutional Rationale: Constitutional law is a system of basic and foundational laws and principles that sets the nature, functions, and limits of a government. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1196

What important step could be called into question when reporting this incident? The provider prescribed Demerol 50 mg at 1400 as an initial dose for a postoperative client to be monitored for reactions and titrate accordingly every 3 to 4 hours PRN for pain. The nurse documented the following: 1200 Demerol 150 mg given intramuscularly. 1530R: 10 breaths/min; BP 98/62; skin pale. 1600 Called provider. Prescription for naloxone (Narcan) 1 mg IV STAT 1605 Narcan given as prescribed. R:14 breaths/min, BP 112/68 1. The 30-minute delay in contacting the provider 2. The difference in what was given and what was prescribed 3. The delay in administering the initial dosage 4. The 30-minute delay in assessing the client for side effects

1. The 30-minute delay in contacting the provider Rationale: The standard of care would require that the provider be notified immediately, and a 30-minute delay could be detrimental to this client. INCORRECT ANSWERS WITH RATIONALE 2. The difference in what was given and what was prescribed Rationale: While the nurse should be prepared to address this issue, it is not the issue with this client after the initial dose was administered and the issue has been reported. 3. The delay in administering the initial dosage Rationale: Delaying of initial administration could be due to pharmacy delays or other assessment issues taking place. 4. The 30-minute delay in assessing the client for side effects Rationale: 30 minutes is not particularly a delay but an appropriate time frame to monitor for side effects. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1207

How can a nurse recognize a client is struggling with an ethical issue? 1. The client experiences conflict in some form. 2. There is incongruent behavior between the client and the family. 3. Vitals signs are abnormal and the client appears to be in distress. 4. The physician and the client do not agree on the method of treatment.

1. The client experiences conflict in some form. Rationale: Conflict in decisions that need to be made about care, needs, interests, and duties and obligations are the foundation of ethical distress and confusion. INCORRECT ANSWERS WITH RATIONALE 2. There is incongruent behavior between the client and the family. Rationale: Incongruent behavior could be related to a variety of issues not related to health care and ethics. 3. Vitals signs are abnormal and the client appears to be in distress. Rationale: Stress may be an effect of indecisiveness, fear, or disease and not particular to ethical issues. 4. The physician and the client do not agree on the method of treatment. Rationale: The client has a right to choose his or her care, and disagreements between the physician and the client do not particularly create an ethical issue. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1191

Which civil laws deal with wrongs done by one person to another without a contract involved? 1. Tort laws 2. Criminal laws 3. Assault 4. Misdemeanor

1. Tort laws Rationale: Tort laws are a wrong done by one person to another without a contract being involved. INCORRECT ANSWERS WITH RATIONALE 2. Criminal laws Rationale: Criminal laws involve breaking the law and committing a crime. 3. Assault Rationale: Assault is a criminal law. 4. Misdemeanor Rationale: A misdemeanor is a lesser criminal offense. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1205

Which describes an ethical dilemma? 1. A client refuses treatment for cancer, stating that his or her religious beliefs forbid it. 2. A pregnant woman may miscarry if she takes a strong chemotherapy agent, but if she doesn't, her cancer will progress quickly. 3. A nurse catches a coworker diverting drugs, and the coworker asks him or her not to tell anyone. 4. A charge nurse asks a staff nurse to stay and work late, but the nurse has plans that evening.

2. A pregnant woman may miscarry if she takes a strong chemotherapy agent, but if she doesn't, her cancer will progress quickly. Rationale: Both choices are undesirable. The client must be allowed to make the decision based on ethical principles. INCORRECT ANSWERS WITH RATIONALE 1. A client refuses treatment for cancer, stating that his or her religious beliefs forbid it. Rationale: The client's beliefs must be respected. Although the nurse may disagree with the choice, this is not an ethical dilemma. 3. A nurse catches a coworker diverting drugs, and the coworker asks him or her not to tell anyone. Rationale: This is a moral issue—the nurse has a duty to report this matter. 4. A charge nurse asks a staff nurse to stay and work late, but the nurse has plans that evening. Rationale: The nurse should not have an ethical dilemma in making a choice. This could be a workplace issue, but it is not an ethical dilemma. Test-Taking Tip An ethical dilemma is one in which a choice must be made between two equally undesirable outcomes. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1187

Which nursing value describes the right to self-determination and to choose and act on that choice? 1. Altruism 2. Autonomy 3. Human dignity 4. Integrity

2. Autonomy Rationale: Autonomy refers to the right to self-determination—to choose and act upon one's own decisions. INCORRECT ANSWERS WITH RATIONALE 1. Altruism Rationale: Altruism refers to client advocacy and concern for the welfare of clients, other nurses, and other health-care providers. 3. Human dignity Rationale: Human dignity refers to respect for the inherent worth and uniqueness of individuals and populations. 4. Integrity Rationale: Integrity refers to honesty and acting within a certain code of ethics. Test-Taking Tip All people have the right to choose and act on their choices. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1189 - 1190

A nurse taking care of a client who has been involved in a motor vehicle accident while intoxicated is an example of which principle? 1. Morals 2. Ethics 3. Legal 4. Policy

2. Ethics Rationale: Nursing ethics would require the nurse to care for the client regardless of the cause of the injuries. INCORRECT ANSWERS WITH RATIONALE 1. Morals Rationale: A moral judgement on the client has nothing to do with the care provided by the nurse. 3. Legal Rationale: Legality is not the principle represented in this scenario. 4. Policy Rationale: Policy is not a principle that relates to not judging an individual when providing care. Test-Taking Tip Doing the right thing is part of being a nurse. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1169

Which are the purposes of the Health Insurance Portability and Accountability Act of 1996? Select all that apply. 1. Mandate the informed consent process before procedures. 2. Protect health insurance benefits for workers who change jobs. 3. Establish standards to protect client privacy and confidentiality. 4. Protect coverage for individuals with preexisting conditions. 5. Guarantee payment to health-care facilities by Medicare.

2. Protect health insurance benefits for workers who change jobs. Rationale: HIPAA provides for portability of insurance coverage if a person changes jobs. 3. Establish standards to protect client privacy and confidentiality. Rationale: The HIPAA Privacy Rule has stipulations for how and when client information is shared. 4. Protect coverage for individuals with preexisting conditions. Rationale: HIPAA prevents denial of coverage for those with preexisting conditions. INCORRECT ANSWERS WITH RATIONALE 1. Mandate the informed consent process before procedures. Rationale: HIPAA does not address informed consent. 5. Guarantee payment to health-care facilities by Medicare. Rationale: HIPAA does not provide a guarantee of payment by Medicare. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1197

Which consequentialist theory requires a risk-benefit analysis? 1. Deontology 2. Utilitarianism 3. Whistleblowing 4. Conflict of universal principles

2. Utilitarianism Rationale: Utilitarianism asserts that the value of an action is determined by its usefulness. INCORRECT ANSWERS WITH RATIONALE 1. Deontology Rationale: Deontology involves applying principles of right and wrong to a decision. 3. Whistleblowing Rationale: Whistleblowing can be an ethical action, but it is not a consequentialist theory. 4. Conflict of universal principles Rationale: Conflict of universal principles involves deciding between two actions. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1179

Which are examples of negligence? Select all that apply. 1. A nurse inadvertently giving a wrong dose of a medication 2. A nurse documenting vital signs in a medical record when they have not been taken 3. A nurse not turning and repositioning a bedridden client, resulting in the development of bedsores 4. A nurse not administering pain medications as needed for a hospice client 5. A client falling after the client has called for assistance in getting up, for which nobody responded after 25 minutes

3. A nurse not turning and repositioning a bedridden client, resulting in the development of bedsores Rationale: A nurse failing to provide basic care that a reasonable person with similar credentials should provide is negligent. 4. A nurse not administering pain medications as needed for a hospice client Rationale: Not administering pain medications to a client who is in severe pain is negligent. 5. A client falling after the client has called for assistance in getting up, for which nobody responded after 25 minutes Rationale: If a client has a need and the nurse does not respond, this is negligence. INCORRECT ANSWERS WITH RATIONALE 1. A nurse inadvertently giving a wrong dose of a medication Rationale: A medication error is not an example of negligence. 2. A nurse documenting vital signs in a medical record when they have not been taken Rationale: This is an example of falsification of records. Test-Taking Tip Negligence is failure to use ordinary and reasonable care or to act in a responsible manner. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1206

Which represents an Americans with Disabilities Act (ADA) accommodation? 1. A nurse has chronic back pain and is terminated from his or her position. 2. A nursing mother returns to work and is given a lactation area for pumping breast milk. 3. A nurse who has had a stroke is not physically able to perform client care and is given a position in scheduling, with an associated pay cut. 4. A nurse adopts a baby and is given maternity leave.

3. A nurse who has had a stroke is not physically able to perform client care and is given a position in scheduling, with an associated pay cut. Rationale: A nurse who has physical limitations and is given a job he or she can perform has had a reasonable accommodation made. INCORRECT ANSWERS WITH RATIONALE 1. A nurse has chronic back pain and is terminated from his or her position. Rationale: This is not a reasonable accommodation of a disability. 2. A nursing mother returns to work and is given a lactation area for pumping breast milk. Rationale: There are legal protections for nursing mothers, but this is not an ADA accommodation. 4. A nurse adopts a baby and is given maternity leave. Rationale: FMLA is a maternity leave that is applicable when giving birth or adopting a baby. Test-Taking Tip The Americans with Disabilities Act provides protection against discrimination of individuals with disabilities. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1199

Which describes the ethical concept of fidelity? 1. Doing no harm and preventing harm 2. Duty to do or promote good 3. Duty to keep promises 4. Duty to tell the truth

3. Duty to keep promises Rationale: This is fidelity. INCORRECT ANSWERS WITH RATIONALE 1. Doing no harm and preventing harm Rationale: This is nonmaleficence. 2. Duty to do or promote good Rationale: This is beneficence. 4. Duty to tell the truth Rationale: This is veracity. Test-Taking Tip Fidelity is essential to the nurse client relationship because trust hinges on this concept. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1183

A nurse suspects a colleague is taking a client's narcotics. The colleague has been behaving erratically at work and his or her clients complain of uncontrolled pain. The nurse reports this concern to the colleague's supervisor. Which is this an example of? 1. Mandated reporting 2. Bioethics 3. Whistleblowing 4. Morals

3. Whistleblowing Rationale: Whistleblowing is done in response to moral outrage and recognizing an unsafe situation. INCORRECT ANSWERS WITH RATIONALE 1. Mandated reporting Rationale: Mandated reporting is a legal requirement to report suspected abuse or neglect. 2. Bioethics Rationale: Bioethics is ethical principles applied to nursing practice. 4. Morals Rationale: Morals is the application of right and wrong. Chapter:Chapter 44, Ethics & Values Page Reference:Vol 1, 1171 - 1174

Which regulation requires health-care facilities to provide emergency care to clients who seek health care regardless of ability to pay? 1. Health Insurance Portability and Accountability Act 2. Client Self-Determination Act 3. Durable power of attorney for health care 4. Emergency Medical Treatment and Active Labor Act

4. Emergency Medical Treatment and Active Labor Act Rationale: EMTALA requires health-care facilities to provide emergency care to clients who present for health care without regard for ability to pay. INCORRECT ANSWERS WITH RATIONALE 1. Health Insurance Portability and Accountability Act Rationale: HIPAA does not address emergency treatment without regard to payment. 2. Client Self-Determination Act Rationale: The Client Self-Determination Act recognizes the client's right to make decisions regarding his or her own health care. 3. Durable power of attorney for health care Rationale: Durable power of attorney for health care addresses clients determining a decision maker if they are no longer able to make decisions. Test-Taking Tip Patients cannot be turned away for lack of insurance. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1197

A client is placed under involuntary confinement for suicidal ideation. During this time, the nurse applies restraints to insert a urinary catheter. Which situation has occurred? 1. Neglect 2. Fraud 3. Assault 4. False imprisonment

4. False imprisonment Rationale: False imprisonment is the application of restraints without proper legal authorization. INCORRECT ANSWERS WITH RATIONALE 1. Neglect Rationale: This situation does not describe neglectful actions. 2. Fraud Rationale: No fraudulent activity is taking place. 3. Assault Rationale: Although this is a threat of violence, this is not an assault. Chapter:Chapter 45, Legal Accountability Page Reference:Vol 1, 1206