Ethics EAQ
The nurse manager of the unit comes to work obviously intoxicated. The staff nurse's ethical obligation is to: 1 Call the security guard 2 Tell the nurse manager to go home Correct3 Have the supervisor validate the observation 4 Offer the nurse manager a large cup of coffee
3 Have the supervisor validate the observation The staff nurse should call the supervisor to confirm and deal with the problem. The security guard has no authority in this situation. Although sending the nurse manager home removes the nurse manager from the clinical setting, it does not provide for documentation of the situation; also, the nurse manager may be in no condition to go home independently. Drinking coffee does not make a person less intoxicated.
After speaking with the parents of a child dying of leukemia, the practitioner gives a verbal do-not-resuscitate order but refuses to put it in writing. What should the nurse do? 1 Follow the order as given by the practitioner 2 Refuse to follow the practitioner's order unless the nursing supervisor approves it 3 Ask the practitioner to write the order in pencil on the child's chart before leaving the room Correct4 Determine whether the family is in accord with the practitioner while following hospital policy
Correct4 Determine whether the family is in accord with the practitioner while following hospital policy Determining whether the family is in accord with the practitioner while following hospital policy verifies family and practitioner agreement and uses institutional policy developed by the ethics committee. Neither the nurse nor the nursing supervisor should accept this inappropriate order. The order must be present in ink on the written record.
A visitor says to the nurse, "Can I read my client's progress record? I am the sponsor from an alcohol recovery program." How should the nurse respond? 1 Allow the visitor to review the record; sponsors have access to privileged information 2 Ask the primary health care provider about granting permission to the sponsor Correct3 Do not allow the sponsor to review the record 4 Allow the visitor to review the record; clients with alcoholism need reassurance from sponsors
Correct3 Do not allow the sponsor to review the record The Health Insurance Portability and Accountability Act (HIPAA) stipulates that clients' records are confidential and may be seen by only those who are associated with the direct care of the client. Although the sponsor can receive permission from the client to review the record, only those who have direct care responsibilities for the client can see it. Viewing a client's records is not allowed according to the privacy laws, despite the health care provider's approval. Although clients with a diagnosis of alcoholism need reassurance from their sponsors, it can be offered without reviewing the client's progress report.
The nurse is preparing a client for epidural anesthesia. Which client statement would cause the nurse to stop the placement of the epidural catheter? Correct1 "I'm not exactly sure how an epidural works." 2 "I understand that the epidural might or might not take my pain away." 3 "I signed the consent form for an epidural at my last clinic appointment." 4 "I'm aware that the epidural could cause my contractions to slow down."
Correct1 "I'm not exactly sure how an epidural works." A description of the various anesthetic techniques and what they entail is essential to informed consent , even if the woman received information about analgesia and anesthesia earlier in her pregnancy. Nurses play a part in the informed consent by clarifying and describing procedures or by acting as the woman's advocate and asking the primary health care provider for further explanation. There are three essential components of an informed consent. First, the procedure and its advantages and disadvantages must be thoroughly explained. Second, the woman must agree with the plan of labor pain care as explained to her. Third, her consent must be given freely without coercion or manipulation from her health care provider.
A visitor from a room adjacent to a client asks the nurse what disease the client has. The nurse responds, "I will not discuss any client's illness with you. Are you concerned about it?" This response is based on the nurse's knowledge that to discuss a client's condition with someone not directly involved with that client is an example of: 1 Libel 2 Negligence Correct3 Breach of confidentiality 4 Defamation of character
Correct3 Breach of confidentiality The release of information to an unauthorized person or gossiping about a client's activities constitutes a breach of confidentiality and an invasion of privacy. Libel occurs when a person writes false statements about another that may injure the individual's reputation. Negligence is a careless act of omission or commission that results in injury to another. Defamation of character is the publication of false statements that injure a person's reputation.
A spouse of a client, while visiting at the hospital, slips and falls on a recently washed floor in the hallway leading to the client's room. To meet the criteria of ethical practice, what action should the nurse that witnessed the occurrence take? Correct1 Initiate an agency incident report. 2 Report the fall to the state health department. 3 Write a brief description of the incident to be kept by the nurse manager. 4 Determine that no documentation is needed because the visitor is not a client in the hospital.
Health care agencies document the occurrence of any event out of the ordinary that results in or has the potential to harm a client, employee, or visitor. Falls by visitors are not required to be reported to state health departments. However, incident reports are required to be presented to accrediting agencies for review when an agency is in the process of being accredited. Writing a brief description of the incident to be kept by the nurse manager is not a requirement of ethical practice. However, a nurse who is involved in an incident or is a witness to an incident should write an accurate description of the event along with the names of individuals involved. This documentation should be kept by the nurse at home. Lawsuits may take several years before they come to trial and personal notes may help the nurse recall the event. The documentation must accurately contain the same elements included in the formal incident report. Taking no action is irresponsible. All events out of the ordinary that result in or have the potential to harm a visitor should be documented in an agency incident report.
A nurse on the medical-surgical unit tells other staff members, "That client can just wait for the lorazepam (Ativan); I get so annoyed when people drink too much." What does this nurse's comment reflect? Correct1 Demonstration of a personal bias. 2 Problem solving based on assessment. 3 Determination of client acuity to set priorities. 4 Consideration of the complexity of client care.
Correct1 Demonstration of a personal bias. When nurses make judgmental remarks and client needs are not placed first, the standards of care are violated and quality of care is compromised. Assessments should be objective, not subjective and biased. There is no information about the client's acuity to come to this conclusion. The statement does not reflect information about complexity of care.
The count of hydrocodone (Vicodin) is incorrect. After several minutes of searching the medication cart and Physiological Aspects of Care records, no explanation is found. Who should the primary nurse notify about the discrepancy? Correct1 Nursing unit manager 2 Hospital administrator 3 Quality control manager 4 Health care provider prescribing the medication
Correct1 Nursing unit manager Controlled substance issues for a particular nursing unit are the responsibility of that unit's nurse manager. Responsibility flows directly from the staff of a nursing unit to the nurse manager; the nurse manager reports to a nurse administrator. There is no direct flow of accountability from the primary nurse to the quality control manager. Health care providers are responsible for medical management issues, not issues associated with management of a nursing unit.
A client is scheduled for surgery. Legally, the client may not sign the operative consent if: 1 Ambivalent feelings are present and acknowledged Correct2 Any sedative type of medication has been given recently 3 A discussion of alternatives with two health care providers has not occurred 4 A complete history and physical has not been performed and recorded
Correct2 Any sedative type of medication has been given recently Sedation may interfere with the client's knowledge of the consent form. Many clients face contradictory feelings regarding their impending surgery, but their consent is legal unless they withdraw the consent. A second opinion is not required for a consent to be legal. A complete history and physical examination are needed before surgery, but they do not affect the legality of consent.
A client expresses concern about the surgical consent that the client signed. How should the nurse respond? 1 Share the client's concern with the family Correct2 Inform the health care provider of the client's concern 3 Reassure the client that the surgery will be successful 4 Cancel the surgery until the client feels more comfortable with the decision
Correct2 Inform the health care provider of the client's concern The client's concern indicates that there is a need to explore informed consent further. Discussing the client's concern is a privacy issue; the nurse must obtain the client's consent to talk with the family. Reassuring the client that the surgery will be successful is false reassurance that does not address the client's concerns. The decision to cancel surgery is not within the scope of nursing practice.
The hospital's policy requires two nurses to supervise the wasting of excess opioid solutions. The nurse draws up the prescribed dose and then requests that another nurse witness wasting of the remaining medication. The second nurse states that there is no time to observe the wasting of the medication, enters the identification to serve as the witness, and leaves the area. What is the appropriate action for the first nurse to take? 1 Waste the appropriate amount of medication and administer the appropriate dose to the client. 2 Accept the second nurse's identification as the witness but ask another nurse to observe the actual wasting. Correct3 Cancel the process and ask another nurse to serve as the witness and to observe the wasting of the medication. 4 Insist that the second nurse re-enter the area to actually observe the wasting of the medication.
Correct3 Cancel the process and ask another nurse to serve as the witness and to observe the wasting of the medication. According to hospital policy the wasting of the excess opioid solution must be monitored by two nurses. This provides for client safety and protects the nurse legally. It is unsafe for the first nurse to proceed without a second nurse performing observation and documentation . Asking another nurse to observe the wasting of the excess solution but not to serve as the documented witness is a violation of the policy. Documenting something that was not performed is unethical. Insisting that the second nurse interrupt another pressing responsibility may result in jeopardizing another client.
A nursing team leader identifies that a nurse is coming to work after drinking alcohol. What is the most appropriate way for the team leader to approach this ethical situation? 1 Counsel the nurse about the problem. 2 Ignore the problem until it happens again. Correct3 Notify the nurse manager about the problem. 4 Resolve the problem by sending the nurse home.
Correct3 Notify the nurse manager about the problem. The assessment phase of problem solving consists of collecting data. The next step involves exploring options to address the problem; this is best accomplished in collaboration with the nurse manager. Counseling the nurse about the problem is not the role of a nurse; the nurse who has been drinking needs professional counseling. Ignoring the problem until it happens again is unsafe; clients may be placed in jeopardy. Resolving the problem by sending the nurse home delays addressing the problem.
A client who has a hemoglobin of 6 gm/dL is refusing blood because of religious reasons. What is the most appropriate action by the nurse? 1 Call the chaplain to convince the client to receive the blood transfusion. 2 Discuss the case with coworkers. Correct3 Notify the primary health care provider of the client's refusal of blood products. 4 Explain to the client that they will die without the blood transfusion.
Correct3 Notify the primary health care provider of the client's refusal of blood products. The nurse serves as an advocate for clients to uphold their wishes. Synthetic blood products are available but must be prescribed by the primary health care provider. Therefore, the primary health care provider needs to be notified of the client's refusal for blood so alternatives can be considered. The chaplain's role is to offer support, not to convince the client to go against their beliefs. It is an HIPAA violation to discuss the case with coworkers unless they are involved in the care of the client. The nurse should not use threats or fear to coerce the client.
Which nursing action is confidential and protected from legal action? 1 Providing health teaching regarding family planning. 2 Offering first aid at the scene of an automobile collision. Correct3 Reporting incidents of suspected child abuse to the appropriate authorities. 4 Administering resuscitative measures to an unconscious child pulled from a swimming pool.
Correct3 Reporting incidents of suspected child abuse to the appropriate authorities. The reporting of possible child abuse is required by law, and the nurse's identity can remain confidential. The nurse is functioning in a professional capacity and therefore can be held accountable. Although the Good Samaritan Act protects health professionals, the nurse is still responsible for acting as any reasonably prudent nurse would in a similar situation.
Which of the following legal defenses is the most important for a nurse to develop? 1 Dedication 2 Certification 3 Assertiveness Correct4 Accountability
Correct4 Accountability The concept of accountability is of high priority in nursing practice. As a licensed professional, the nurse is always accountable, which means liable and answerable for his or her actions. Dedication means to be committed, and assertiveness means to be confident. These are desired characteristics in a nurse but not legal defenses. Certification relates to achieving a higher level of knowledge or proficiency in one's area of specialization and is also not a legal defense.
