Saunder's Comprehensive Review Ethical and Legal Issues
The nurse has just assisted a client back to bed after a fall. The nurse and primary health care provider have assessed the client and have determined that the client is not injured. After completing the occurrence report, the nurse should implement which action next? A. Reassess the client. B. Conduct a staff meeting to describe the fall. C. Contact the nursing supervision to update information regarding the fall. D. Document in the nurse's notes that an occurrence report was completed.
Answer: A Rationale: After a client's fall, the nurse must frequently reassess the client, because potential complications do not always appear immediately after the fall. The client's fall should be treated as private information and shared on a "need to know" basis. Communication regarding the event should involve only the individuals participating in the client's care. An occurrence report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nursing supervisor has been made away of the occurrence, the supervisor will contact the nurse if status update is necessary.
Which identifies accurate nursing documentation notation(s)? (Select all that apply.) A. The client slept through the night. B. Abdominal wound dressing is dry and intact without drainage. C. The client seemed angry when awakened for vital sign measurement. D. The client appears to become anxious when it is time for respiratory treatments. E. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema.
Answer: A, B, E 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 seemed or appears, is not acceptable because these words suggest that the nurse is stating an opinion.
The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate initial nursing action? A. Call the police. B. Cut up the photograph and throw it away. C. Call the nursing supervisor and report the occurrence. D. Call the laboratory and ask for the name of the individual who sent the photograph.
Answer: C Rationale: Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. Sexually suggestive jokes, touching, pressuring a coworker for a date, and open displays of or transmitting sexually oriented photographs or posters are examples of conduct that could be considered sexual harassment by another worker and is an abusive behavior. If the nurse believes that he or she is being subjected to unwelcome sexual conduct, these concerns should be reported to the nursing supervisor immediately. Option A is unnecessary at this time. Options B and D are inappropriate initial actions.
A hospitalized client tells the nurses that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client? A. "I will sign as a witness to your signature." B. "You will need to find a witness on your own." C. "Whoever is available at the time will sign as a witness for you." D. "I will call the nursing supervisor to seek assistance regarding your request."
Answer: D Rationale: Instructional directives (living wills) are required to be in writing and signed by the client. The client's signature must be witnessed by specific individuals or notarized. Laws and guidelines regarding instructional directives vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option B is nontherapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.
A nursing instructor delivers a lecture to nursing students regarding the issue of clients' rights and asks a nursing student 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? A. Performing a procedure without consent B. Threatening to give a client a medication C. Telling the client that he or she cannot leave the hospital D. Observing care provided to the client without the client's permission
Answer: D Rationale: Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure without consent is an example of battery. Threatening to give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.
An older woman is brought to the emergency department for treatment of a fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. Which is the most appropriate nursing response? A. "Oh, really? I will discuss this situation with your son." B. "Let's talk about the ways you can manage your time to prevent this from happening." C. "Do you have any friends who can help you out until you resolve these important issues with your son?" D. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay."
Answer: D Rationale: The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with nonmedical personnel or 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. Options A, B, and C do not address the legal implications of the situation and do not ensure a safe environment for the client.
The nurse calls the primary health care provider (PHCP) regarding a new medication prescription, because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the PHCP, and the medication is due to be administered. Which action should the nurse take? A. Contact the nursing supervisor. B. Administer the dosage prescribed. C. Hold the medication until the PHCP can be contacted. D. Administer the recommended dosage until the PHCP can be located.
Answer: A Rationale: If the PHCP writes a prescription that requires clarification, the nurse's responsibility is to contact the PHCP. If there is no resolution regarding the prescription because the PHCP cannot be located or because the prescription remains as it was written after talking with the PHCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.
Nursing staff members are sitting in the lounge taking their morning break. An assistive personnel (AP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. The registered nurse should inform the AP that making this accusation has violated which legal tort? A. Libel B. Slander C. Assault D. Negligence
Answer: B Rationale: Defamation is a false communication or a carless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or offensive contact. Negligence involves the actions of professionals that fall below the standard of care for a specific professional group.
The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first? A. Refuse to float to the ICU based on lack of unit orientation. B. Clarify the ICU client assigned with the team leader to ensure that it is a safe assignment. C. Ask the nursing supervisor to review the hospital policy on floating. D. Submit a written protest to nursing administration, and then call the hospital lawyer.
Answer: B Rationale: Floating is an acceptable practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify the client assignment with the team leader to ensure that it is a safe one is the best option. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Submitting a written protest and calling the hospital lawyer is a premature action.
The nurse has made an error in documentation of the dose administered of an opioid pain medication in the client's record. The nurse draws 1 mg from the vial and another registered nurse (RN) witnesses wasting of the remaining 1 mg. When scanning the medication, the nurse entered into the medication administration record (MAR) that 2 mg of hydromorphone was administered instead of the actual dose administered, which was 1 mg. The nurse should take which action(s) to correct the error in the MAR? (Select all that apply) A. Complete and file an occurrence report. B. Right-click on the entry and modify it to reflect the correct information. C. Document the correct information and end with the nurse's signature and title. D. Obtain a cosignature from the RN who witnessed the waste of the remaining 1 mg. E. Document in a nurse's note in the client's record detailing the corrected information.
Answer: B, C, D, E Rationale: Electronic health records (EHR) will have a time date stamp that indicates an amendment has been entered. If the nurse makes an error in the MAR, the nurse should follow agency policies to correct the error. In the MAR, the nurse can click on the entry (usually right-click) and modify it to reflect the corrected information. Since this is an opioid medication, the nurse should obtain a cosignature from the RN who witnessed the wasting of the excess medication, to validate that 1 mg, rather than 2 mg, was given. A nurse's note should be used to detail the event and the corrections made, and the nurse's name and title will be stamped on the entry in the EHR. An occurrence report is not necessary in this situation.
A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? A. Obtain a court order for the surgical procedure. B. Ask the EMS team to sign the informed consent. C. Transport the victim to the operating room for surgery. D. Call the police to identify the client and locate the family.
Answer: C Rationale: In general, there are two situations in which informed consent of an adult client is not needed. One 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 is when the client waives the right to give informed consent. Option A will delay emergency treatment, and option B is inappropriate. Although option D may be pursued, it is not the best action because it delays necessary emergency treatment.
The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? A. Call security B. Call the police C. Call the nursing supervisor D. Lock the coworker in the medication room until help is obtained
Answer: C Rationale: Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This occurrence needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option D is an inappropriate and unsafe action.
The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the primary health care provider, and completes an occurrence report. Which statement should the nurse document on the occurrence report? A. The client fell out of bed. B. The client climbed over the side rails. C. The client was found lying on the floor. D. The client became restless and tried to get out of bed.
Answer: C Rationale: The occurrence report should contain a factual description of the occurrence, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options A, B, and D are interpretations of the situation and are not factual information as observed by the nurse.
