Ethical and Legal Issues Chapter 6

15. The nurse enters a client's room and notes that the client's lawyer is present and that the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which is the appropriate nursing action? 1. Decline to sign the will. 2. Sign the will as a witness to the signature only. 3. Call the hospital lawyer before signing the will. 4. Sign the will, clearly identifying credentials and employment agency.

15. 1 Rationale: Living wills are required to be in writing and signed by the client. The client's signature either must be witnessed by specified individuals or notarized. Many states prohibit any employee from being a witness, including the nurse in a facility in which the client is receiving care. Test-Taking Strategy: Options 2 and 4 are comparable or alike and should be eliminated first. From the remaining options, option 1 is the appropriate action. Review: the legal implications associated with living wills.

18. A client has died, and the nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. Which is the appropriate nursing action?1. Show acceptance of feelings.2. Provide information needed for decision making.3. Suggest a referral to a mental health professional.4. Remain with the family member without discussing funeral arrangements.

18. 4 Rationale: The family member is exhibiting the first stage of grief (denial), and the nurse should remain with the family member. Option 1 is an appropriate intervention for the acceptance or reorganization and restitution stage. Option 2 may be an appropriate intervention for the bargaining stage. Option 3 may be an appropriate intervention for depression. Test-Taking Strategy: Use therapeutic communication techniques to direct you to option 4. Remember to address client and family feelings first. Review: the grief process and therapeutic communication techniques.

11. Which identifies accurate nursing documentation notations? Select all that apply. 1. The client slept through the night. 2. Abdominal wound dressing is dry and intact without drainage. 3. The client seemed angry when awakened for vital sign measurement. 4. The client appears to become anxious when it is time for respiratory treatments. 5. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema.

11. 1, 2, 5 Rationale: Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. The use of vague terms, such as seems or appears, is not acceptable because these words suggest the nurse is stating an opinion. Test-Taking Strategy: Focus on the subject, accurate documentation notations. Eliminate options 3 and 4 because they are comparable or alike and include vague terms (seemed, appears). Review: the guidelines for documentation.

12. The licensed practical nurse (LPN) enters a client's room and finds the client lying on the bathroom floor. The LPN calls the registered nurse, who checks the client thoroughly and then assists the client back into bed. The LPN completes an incident report, and the nursing supervisor and primary health care provider (PHCP) are notified of the incident. Which is the next nursing action regarding the incident? 1. Place the incident report in the client's chart. 2. Make a copy of the incident report for the PHCP. 3. Document a complete entry in the client's record concerning the incident. 4. Document in the client's record that an incident report has been completed.

12. 3 Rationale: The incident report is confidential and privileged information, and it should not be copied, placed in the chart, or have any reference made to it in the client's record. The incident report is not a substitute for a complete entry in the client's record concerning the incident. Test-Taking Strategy: Note the strategic word, next. Eliminate options 1 and 4 first because they are comparable or alike. Recalling that incident reports should not be copied will direct you to the correct option. Review: the nursing responsibilities related to incident reports.

13. An unconscious client, bleeding profusely, is brought to the emergency department after a serious accident. Surgery is required immediately to save the client's life. With regard to informed consent for the surgical procedure, which is the best action? 1. Call the nursing supervisor to initiate a court order for the surgical procedure. 2. Try calling the client's spouse to obtain telephone consent before the surgical procedure. 3. Ask the friend who accompanied the client to the emergency department to sign the consent form. 4. Transport the client to the operating department immediately without obtaining an informed consent.

13. 4 Rationale: Generally there are only two instances in which the informed consent of an adult client is not needed. One instance is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second instance is when the client waives the right to give informed consent. Options 1, 2, and 3 are inappropriate. Test-Taking Strategy: Note the strategic word, best. Option 3 can easily be eliminated first. Note the subject, surgery is required immediately. Options 1 and 2 would delay treatment and should be eliminated. Review: the issues surrounding informed consent.

14. The nurse arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the pediatric unit. Which is the appropriate nursing action? 1. Call the hospital lawyer. 2. Call the nursing supervisor. 3. Refuse to float to the pediatric unit. 4. Report to the pediatric unit and identify tasks that can be safely performed.

14. 4 Rationale: Floating is an acceptable legal practice used by hospitals to solve their understaffing problems. Legally the nurse cannot refuse to float unless a union contract guarantees that the nurse can only work in a specified area or the nurse can prove a lack of knowledge for the performance of assigned tasks. When faced with this situation, the nurse should identify potential areas of harm to the client. Test-Taking Strategy: Options 1 and 2 can be eliminated first because they are comparable or alike. From the remaining options, eliminate option 3, because refusal is unacceptable behavior for a professional. Review: the nursing responsibilities related to accepting an assignment as a float nurse.

16. The nurse finds the client lying on the floor. The nurse calls the registered nurse, who checks the client and then calls the nursing supervisor and the primary health care provider to inform them of the occurrence. The nurse completes the incident report for which purpose? 1. Providing clients with necessary stabilizing treatments 2. A method of promoting quality care and risk management 3. Determining the effectiveness of interventions in relation to outcomes 4. The appropriate method of reporting to local, state, and federal agencies

16. 2 Rationale: Proper documentation of unusual occurrences, incidents, accidents, and the nursing actions taken as a result of the occurrence are internal to the institution or agency. Documentation on the incident report allows the nurse and administration to review the quality of care and determine any potential risks present. Options 1, 3, and 4 are incorrect. Test-Taking Strategy: Focus on the subject, the purpose of completing incident reports. Eliminate options 1 and 3, because incident reports are not routinely filled out for interventions or treatment measures. Eliminate option 4, because incident reports are not used to report occurrences to other agencies; medical records are used for this purpose. Review: the purpose of incident reports.

17. The nurse observes that a client received pain medication 1 hour ago from another nurse, but the client still has severe pain. The nurse has previously observed this same occurrence several times. Based on the nurse practice act, the observing nurse should plan to take which action? 1. Report the information to the police. 2. Call the impaired nurse organization. 3. Talk with the nurse who gave the medication. 4. Report the information to a nursing supervisor.

17. 4 Rationale: Nurse practice acts require reporting the suspicion of impaired nurses. The state board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the board of nursing. Options 1 and 2 are inappropriate. Option 3 may cause a conflict. Test-Taking Strategy: Focus on the subject, following the channels of communication in a health care agency. By reporting the information, the nurse alerts the institution to the potential problem and sets the stage for further investigation and appropriate action. Review: the actions to take regarding reporting the suspicion of an impaired nurse.

19. A nurse lawyer provides an education session to the nursing staff regarding client rights with emphasis on invasion of client rights. The nurse lawyer asks a staff nurse to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right? 1. Threatening to place a client in restraints 2. Performing a surgical procedure without consent 3. Taking photographs of the client without consent 4. Telling the client that he or she cannot leave the hospital

19. 3 Rationale: Invasion of privacy takes place when an individual's private affairs are intruded on unreasonably. Threatening to place a client in restraints constitutes assault. Performing a surgical procedure without consent is an example of battery. Not allowing a client to leave the hospital constitutes false imprisonment. Test-Taking Strategy: Note the subject, invasion of client privacy. These words should direct you to the correct option. Also reading each option carefully will direct you to the correct option. Review: the situations that constitute the invasion of client privacy.

20. An older woman is brought to the emergency department. When caring for the client, the nurse notes old and new ecchymotic areas on both of the client's arms and buttocks. The nurse asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her daughter frequently hits her if she gets in the way. Which is the appropriate nursing response? 1. "I have a legal obligation to report this type of abuse." 2. "I promise I won't tell anyone, but let's see what we can do about this." 3. "Let's talk about ways that will prevent your daughter from hitting you." 4. "This should not be happening. If it happens again, you must call the emergency department."

20. 1 Rationale: Confidential issues are not to be discussed with nonmedical personnel or with the client's family or friends without the client's permission. Clients should be assured that information is kept confidential unless it places the nurse under a legal obligation. The nurse must report situations related to child, older adult abuse, and other types of abuse, depending on state laws; gunshot wounds; stabbings; and certain infectious diseases. Test-Taking Strategy: Focus on the subject, elderly abuse. Option 4 can be eliminated first because this action does not protect the client from injury. Options 2 and 3 are comparable or alike and should be eliminated next. Review: the nursing responsibilities related to reporting obligations for abuse.