Advocacy - questions
A patient is asked to participate in a medical research study. The nurse describes to the patient and family members how the patient is protected by the: 1. Code of Ethics 2. Informed Consent 3. Nurse Practice Act 4. Constitution of the United States
1. A code of ethics is the official statement of a group's ideals and values. It includes broad statements that provide a basis for professional actions. 2. CORRECT: Informed consent is an agreement by a client to accept a course of treatment or a procedure after receiving complete information necessary to make a knowledgeable decision. 3. Nurse Practice Acts define the scope of nursing practice; they are unrelated to informed consent. 4. The Constitution of the United States addresses broad individual rights and responsibilities. The rights related to nursing practice and patients include the rights of privacy, freedom of speech, and due process.
The client who requires a co-signature for a valid consent for surgery is a: 1. 15-year-old mother whose infant requires exploratory surgery 2. 40-year-old resident in a home for developmentally disabled adults 3. 90-year-old adult who wants more information about the risks of surgery 4. 50-year-old unconscious trauma victim who needs insertion of a chest tube
1. A mother may legally make medical decisions for her children even if the mother is younger than 18 years of age. 2. CORRECT: A client living in a protected environment such as a home for developmentally disabled adults may not have the mental capacity to make medical decisions and requires the signature of a court-appointed legal representative. This person could be a parent, sibling, relative, or unrelated individual. 3. Older adults can make decisions for themselves as long as they understand the risks and benefits of the surgery and are not receiving medication that may interfere with cognitive ability. 4. The insertion of a chest tube to inflate a lung is an emergency intervention to facilitate respiration and oxygenation. This emergency procedure is implemented to sustain life and does not require a signed consent if the client is incapacitated.
The nurse administers an incorrect dose of a medication to a patient. What is the primary purpose of documenting this event in an Incident Report? 1. Record the event for future litigation 2. Provide a basis for designing new policies 3. Prevent similar situations from happening again 4. Ensure accountability for the cause of the accident
1. Although documentation of an incident may be used in a court of law, it is not the primary reason for an Incident Report. 2. This is not the primary reason for Incident Reports. New policies may or may not have to be written and implemented. 3. CORRECT: Risk-management committees use statistical data about accidents and incidents to identify patterns of risk and prevent future accidents and incidents. 4. Although nurses are always accountable for their actions, accountability for the cause of an incidence is the role of the courts.
When considering legal issues the word contract is to liable as standard is to: 1. Rights 2. Negligence 3. Malpractice 4. Accountability
1. Although patients have a right to receive care that meets appropriate standards, the word right does not have the same relationship to the word standard as the relationship between the words contract and liable. 2. The words standards and negligence do not have the same relationship as contract and liable. Negligence involves an act of commission or omission that a reasonably prudent person would not do. 3. The words standards and malpractice do not have the same relationship as contract and liable. Malpractice is negligence by a professional person. 4. CORRECT: Liable means a person is responsible (accountable) for fulfilling a contract that is enforceable by law. Accountable means a person is responsible (liable) for meeting standards, which are expectations established for making judgments or comparisons.
The nurse must administer a medication. What should the nurse do first? 1. Check the patient's identification armband 2. Ensure the medication is in the medication cart 3. Verify the practitioner's prescription for accuracy 4. Determine the appropriateness of the prescribed medication
1. Although this action is essential for the safe administration of a medication to a patient, it is not the first step of this procedure. 2. Although this may be done as a timemanagement practice, it is not the first step when preparing to administer a medication to a patient. 3. CORRECT: The administration of medications is a dependent function of the nurse. The practitioner's prescription should be verified for accuracy. The prescription must include the name of the patient, the name of the drug, the size of the dose, the route of administration, the number of times per day to be administered, and any related parameters. 4. A nurse is legally responsible for the safe administration of medications; therefore, the nurse should assess if a medication prescription is reasonable. However, this is not the first step when preparing to administer a medication to a patient.
The nurse is implementing an ordered bowel preparation for a patient who is scheduled for a colonoscopy. Which is the most serious consequence that is prevented by an effective bowel preparation? 1. Discomfort 2. Misdiagnosis 3. Wasted expense 4. Psychological stress
1. Although this may occur, it is not the most serious outcome of an inappropriate preparation for a colonoscopy. 2. CORRECT: Fecal material in the intestines can interfere with the visualization, collection, and analysis of data obtained through a colonoscopy, resulting in diagnostic errors. 3. A test may have to be cancelled or performed a second time if the patient has an ineffective bowel preparation. Although this is a serious consequence, it is not life threatening. 4. Although this is a serious consequence, it is not life threatening.
The practitioner orders OOB for a patient. How is the nurse functioning when moving this patient out of bed to a chair? 1. Dependently 2. Independently 3. Collaboratively 4. Interdependently
1. CORRECT: Determining the extent of activity desirable for a patient is within the practitioner's, not a nurse's, scope of practice. Following activity orders is a dependent function of the nurse. 2. The responsibility to determine a patient's activity level is not within the legal scope of nursing practice. 3. A practitioner works independently when determining a patient's desired activity level. 4. The nurse is following the practitioner's order to get the patient OOB. There are no restrictions or parameters in relation to the order. However, the nurse must use judgment before, during, and after a transfer if a patient's condition changes
When caring for a terminally ill patient a family member says, "I need your help to hasten my mother's death so that she is no longer suffering." What should the nurse do based on the position of the American Nurses Association in relation to assisted suicide? 1. Not participate in active euthanasia 2. Participate based on personal values and beliefs 3. Participate when the patient is experiencing severe pain 4. Not participate unless two practitioners are consulted and the patient has had counseling
1. CORRECT: Nursing actions must comply with the law, and the law states that euthanasia is legally wrong. Euthanasia can lead to criminal charges of homicide or civil lawsuits for providing an unacceptable standard of care. 2. A nurse's beliefs, values, or moral convictions should not be imposed on patients. 3. Compassion and good intentions are not an acceptable basis for actions beyond the scope of nursing practice. 4. These factors do not permit a nurse to be involved with euthanasia.
A student nurse is about to graduate from an accredited nursing program. The student nurse understands that an action unrelated to a state Nurse Practice Act is: 1. Setting guidelines for nurses' salaries in the state 2. Establishing reciprocity for licensure between states 3. Determining minimum requirements for nursing education 4. Maintaining a list of nurses who can legally practice in the state
1. CORRECT: State Nurse Practice Acts define and regulate the practice of nursing within the state. The salary of nurses is determined through negotiations between nurses or their representatives, such as a union or a professional nursing organization, and the representatives of the agency for which they work. 2. A state's Nurse Practice Act determines the criteria for reciprocity for licensure. 3. A state's Nurse Practice Act stipulates minimum requirements for nursing education. 4. A state's Nurse Practice Act defines the criteria for licensure within the state. The actual functions, such as maintaining a list of nurses who can legally practice in the state, may be delegated to another official body such as a State Board of Nursing or State Education Department.
What is the primary purpose of the American Nurses Association Standards of Clinical Nursing Practice? 1. Establish criteria for quality practice 2. Define the philosophy of nursing practice 3. Identify the legal definition of nursing practice 4. Determine educational standards for nursing practice
1. CORRECT: The ANA Standards of Clinical Nursing Practice describe the nature and scope of nursing practice and the responsibilities for which nurses are accountable. 2. A philosophy incorporates the values and beliefs about the phenomena of concern to a discipline. The ANA Standards of Clinical Nursing Practice reflect, not define, a philosophy of nursing. Each nurse and nursing organization should define its own philosophy of nursing. 3. The laws of each state define the practice of nursing within the state. 4. Educational standards are established by accrediting bodies, such as the National League for Nursing Accrediting Commission, the Commission on Collegiate Nursing Education, and state education departments.
A nurse expert is called to testify in a lawsuit regarding professional nursing malpractice primarily to testify: 1. About standards of nursing care as they apply to the facts in the case 2. With regard to laws governing the practice of nursing 3. For the prosecution 4. For the defense
1. CORRECT: The American Nurses Association Standards of Clinical Nursing Practice are authoritative statements by which the national organization for nursing describes the responsibilities for which its practitioners are accountable. An expert nurse is capable of explaining these standards as they apply to the situation under litigation. These professional standards are one criterion that helps a judge or jury determine if a nurse committed malpractice or negligence. 2. An expert nurse is not an expert in the law. The expert nurse's role is not to make judgments about the laws as they apply to the practice of nursing. 3. A nurse expert can testify for either the prosecution or the defense. 4. A nurse expert can testify for either the defense or the prosecution.
What is the main purpose of the American Nurses Association? 1. Establish standards of nursing practice 2. Recognize academic achievement in nursing 3. Monitor educational institutions granting degrees in nursing 4. Prepare nurses to become members of the nursing profession
1. CORRECT: The American Nurses Association has established Standards of Care and Standards of Professional Performance. These standards reflect the values of the nursing profession, provide expectations for nursing practice, facilitate the evaluation of nursing practice, and define the profession's accountability to the public. 2. Sigma Theta Tau, the international honor society of nursing, recognizes academic achievement. 3. The National League for Nursing Accrediting Commission, the Commission on Collegiate Nursing Education, and state education departments monitor educational institutions granting degrees in nursing. 4. Schools of nursing (diploma, associate degree, and baccalaureate) educate individuals for entry into the practice of nursing.
The nurse is informed that a credentialing team has arrived and is in the process of assessing quality of care delivered at the hospital. What is the organization associated with the credentialing of hospitals? 1. Joint Commission 2. National League for Nursing 3. American Nurses Association 4. National Council Licensure Examination
1. CORRECT: The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) evaluates health-care organizations' compliance with Joint Commission standards. Accreditation indicates that the organization has the capabilities to provide quality care. In addition, federal and state regulatory agencies and insurance companies require Joint Commission accreditation. 2. The National League for Nursing (NLN) fosters the development and improvement of nursing education and nursing service. 3. The American Nurses Association (ANA) is the national professional organization for nursing in the United States. Its purposes are to promote high standards of nursing practice and to support the educational and professional advancement of nurses. 4. In the United States, graduates of educational programs that prepare students to become Licensed Practical Nurses or Registered Professional Nurses must successfully complete the National Council Licensure Examination-PN (NCLEX-PN) and the National Council Licensure Examination- RN (NCLEX-RN), respectively, as part of the criteria for licensure.
When choosing a nursing school in the United States that awards an associate degree, a future student nurse should consider schools that have met the standards of nursing education established by which organization? 1. National League for Nursing Accrediting Commission 2. North American Nursing Diagnosis Association 3. American Nurses Association 4. Sigma Theta Tau
1. CORRECT: The National League for Nursing Accrediting Commission (NLNAC) is an organization that appraises and grants accreditation status to nursing programs that meet predetermined structure, process, and outcome criteria. 2. The North American Nursing Diagnosis Association (NANDA) developed a constantly evolving taxonomy of nursing diagnoses to provide a standardized language that focuses on the patient and related nursing care. 3. The American Nurses Association (ANA) is the national professional organization for nursing in the United States. It does not accredit schools of nursing. 4. Sigma Theta Tau, the international honor society of nursing, recognizes academic achievement. It does not accredit schools of nursing.
When the nurse attempts to administer a medication to a patient, the patient refuses to take the medication because it causes diarrhea. The nurse provides teaching about the medication, but the patient continues to adamantly refuse the medication. What should the nurse do first? 1. Document the patient's refusal to take the medication 2. Notify the practitioner of the patient's refusal to take the medication 3. Discuss with a family member the need for the patient to take the medication 4. Explain again to the patient the consequences of refusing to take the medication
1. CORRECT: Withholding the medication and documenting the patient's refusal are the appropriate interventions. Patient's have a right to refuse care. 2. Notifying the practitioner eventually should be done, but it is not the priority at this time. 3. Discussing the situation with a family member without the patient's consent is a violation of confidentiality. 4. The patient has been taught about the medication and adamantly refuses the medication. Further teaching at this time may be viewed by the patient as badgering.
How is the nurse functioning when administering a drug that has PRN as part of the prescription? 1. Collegially 2. Dependently 3. Independently 4. Interdependently
1. Collegial or collaborative interventions are actions the nurse performs in conjunction with other health-care team members. 2. Dependent interventions are those activities performed under a practitioner's direction and supervision. 3. Independent interventions are those activities the nurse is licensed to initiate based on knowledge and expertise. 4. CORRECT: An interdependent intervention requires a practitioner's order associated with a set parameter. The parameter, whenever necessary, requires that the nurse use judgment in implementing the order
A Registered Nurse witnesses an accident and assists the victim who has a life-threatening injury. What should the nurse do to meet the most important standard when acting as a Good Samaritan at the scene of an accident? 1. Seek consent from the injured party before rendering assistance 2. Implement every critical-care intervention necessary to sustain life 3. Stay at the scene until another qualified person takes over responsibility 4. Insist on helping because a nurse is the best-qualified person to provide care
1. Depending on the injured person's physical and emotional status, the person may or may not be able to consent to care. 2. When a nurse helps in an emergency, the nurse is required to render care that is consistent with care that any reasonably prudent nurse would provide under similar circumstances. The nurse should not attempt interventions that are beyond the scope of nursing practice. 3. CORRECT: When a nurse renders emergency care, the nurse has an ethical responsibility not to abandon the injured person. The nurse should not leave the scene until the injured person leaves or another qualified person assumes responsibility. 4. A nurse should offer assistance, not insist on assisting, at the scene of an emergency.
A practitioner writes a prescription for a medication that is larger than the standard dose. What should the nurse do? 1. Inform the supervisor 2. Give the drug as prescribed 3. Give the average dose of the medication 4. Discuss the prescription with the practitioner
1. It is unnecessary to call the supervisor in this situation. 2. This is unsafe for the patient and may result in malpractice. 3. Changing a medication prescription is not within the scope of nursing practice. 4. CORRECT: Nurses have a professional responsibility to know or investigate the standard dose for medications being administered. In addition, nurses are responsible for their own actions regardless of whether there is a written prescription. The nurse has a responsibility to question and/or refuse to administer a prescription that appears unreasonable.
A practitioner asks the nurse to witness an informed consent. Which patient does the nurse identify is unable to give an informed consent for surgery? 1. 16-year-old boy who is married 2. 35-year-old woman who is depressed 3. 50-year-old woman who does not speak English 4. 65-year-old man who has received a narcotic for pain
1. Legally, individuals younger than 18 years old can provide informed consent if they are married, pregnant, parents, members of the military, or emancipated. 2. A depressed person is capable of making health-care decisions until proven to be mentally incompetent. 3. This person can provide informed consent after interventions ensure that the person understands the facts and risks concerning the treatment. 4. CORRECT: Narcotics depress the central nervous system, including decision-making abilities. This person is considered functionally incompetent.
Licensure of Registered Professional Nurses is required primarily to protect: 1. Nurses 2. Patients 3. Common law 4. Health-care agencies
1. Licensure does not protect the nurse. Licensure grants an individual the legal right to practice as a Registered Nurse. 2. CORRECT: Licensure indicates that a person has met minimal standards of competency, thus protecting the public's safety. 3. Licensure does not protect common law. Common law comprises standards and rules based on the principles established in prior judicial decisions. 4. Licensure does not protect health-care agencies. The Joint Commission determines if agencies meet minimal standards of health-care delivery, thus protecting the public.
State legislatures are responsible for: 1. Standardized care plans 2. Enactment of Nurse Practice Acts 3. Accreditation of educational nursing programs 4. Certification in specialty areas of nursing practice
1. Nursing team members or an interdisciplinary team of health-care providers write standardized care plans. 2. CORRECT: Every state has its own Nurse Practice Act that describes and defines the legal boundaries of nursing practice within the state. 3. The National League for Nursing Accrediting Commission, the Commission on Collegiate Nursing Education, and state education departments are the major organizations accrediting nursing education programs in the United States. 4. The American Nurses Association and other specialty organizations offer certification in specialty areas in nursing practice.
Which organization is responsible for ensuring that Registered Nurses are minimally qualified to practice nursing? 1. Sigma Theta Tau 2. State Boards of Nursing 3. American Nurses Association 4. Constituent Leagues of the National League for Nursing
1. Sigma Theta Tau, the international honor society of nursing, recognizes academic achievement and leadership qualities, encourages high professional standards, fosters creative endeavors, and supports excellence in the profession of nursing. This organization does not grant licensure. 2. CORRECT: The National Council of State Boards of Nursing is responsible for the NCLEX examinations; however, the licensing authority in the jurisdiction in which the graduate takes the examination verifies the acceptable score on the examination. 3. The American Nurses Association (ANA) is the national professional organization for nursing in the United States. It fosters high standards of nursing practice; it does not grant licensure. 4. The National League for Nursing (NLN) is committed to promoting and improving nursing service and nursing education; it does not grant licensure.
A faculty member of a nursing program is conducting an informational session for potential nursing students. The faculty member includes the information that at the completion of the program licensure to practice is: 1. A responsibility of the American Nurses Association 2. Granted on graduation from a nursing program 3. Approved by the National League for Nursing 4. Required by state law
1. The ANA Standards of Clinical Nursing Practice do not address licensure. 2. When a person graduates from a school of nursing, the individual receives a diploma that indicates completion of a course of study; the diploma is not a license to practice nursing. 3. The National League for Nursing (NLN) promotes nursing service and nursing education; it is not involved with licensure. 4. CORRECT: The Nurse Practice Act in a state stipulates the requirements for licensure within the state.
The nurse changes a patient's dry sterile dressing. How is the nurse functioning when performing this task? 1. Interdependently 2. Collaboratively 3. Independently 4. Dependently
1. The changing of a dry sterile dressing is an interdependent action by the nurse when the practitioner's order for wound care states: Dry Sterile Dressing PRN. 2. In this situation, the nurse is not working with other health-care professionals to implement a practitioner's order. 3. This intervention is not within the scope of nursing practice without a practitioner's order. 4. CORRECT: A nurse is not permitted legally to prescribe wound care. The nurse needs a practitioner's order to provide wound care.
The nurse initiates a visit from a member of the clergy for a patient. How is the nurse functioning when initiating this visit? 1. Interdependently 2. Independently 3. Dependently 4. Collegially
1. The nurse does not need a practitioner's order to make a referral to a member of the clergy. An interdependent intervention requires a practitioner's order associated with a parameter. 2. CORRECT: The nurse is initiating the referral to the member of the clergy and is therefore working independently. Nurses are legally permitted to diagnose and treat human responses to actual or potential health problems. 3. This action is within the scope of nursing practice. The nurse does not need a practitioner's order to make a referral to a member of the clergy. 4. The nurse can make a referral to a member of the clergy without collaborating with another professional health-care team member.
The nurse completes an Incident Report after a patient falls while getting out of bed unassisted. What is the main purpose of this report? 1. Ensure that all parties have an opportunity to document what happened 2. Help establish who is responsible for the incident 3. Make data available for quality-control analysis 4. Document the incident on the patient's chart
1. The nurse who identified or created the potential or actual harm completes the Incident Report. The report identifies the people involved in the incident, describes the incident, and records the date, time, location, actions taken, and other relevant information. 2. Documentation should be as factual as possible and avoid accusations. Questions of liability are the responsibility of the courts. 3. CORRECT: Incident Reports help to identify patterns of risk so that corrective action plans can take place. 4. The report is not part of the patient's medical record, and reference to the report should not be made in the patient's medical record.
Which factor is unique to malpractice when comparing negligence and malpractice? 1. The action did not meet standards of care 2. The inappropriate care is an act of commission 3. There is harm to the patient as a result of the care 4. There is a contractual relationship between the nurse and patient
1. There is a violation of standards of care with both negligence and malpractice. 2. Negligence and malpractice both involve acts of either commission or omission. 3. The patient must have sustained injury, damage, or harm with both negligence and malpractice. 4. CORRECT: Only malpractice is misconduct performed in professional practice, where there is a contractual relationship between the patient and nurse, which results in harm to the patient.
When the nurse is administering a medication to a confused patient, the patient says, "This pill looks different from the one I had before." What should the nurse do? 1. Ask what the other pill looked like 2. Explain the purpose of the medication 3. Check the original medication prescription 4. Encourage the patient to take the medication
1. This action by itself is unsafe because the patient is confused and the information obtained may be inaccurate. 2. This intervention ignores the patient's concern. Although this ultimately may be done, it is not the priority action. 3. CORRECT: This is the safest intervention because it goes to the original source of the prescription. 4. This action ignores the patient's statement and is unsafe without first obtaining additional information
The patient's diet order is "clear liquids to regular as tolerated." How is the nurse functioning when progressing the patient's diet to full liquid? 1. Dependently 2. Independently 3. Collaboratively 4. Interdependently
1. This dietary order has parameters that exceed a simple dependent function of the nurse. 2. Prescribing a dietary order for a patient is outside the scope of nursing practice. 3. Collaborative or collegial interventions are actions the nurse carries out in conjunction with other health-care team members. 4. CORRECT: The practitioner's order implies a progression in the diet as tolerated. The nurse uses judgment to determine the time of this progression, which is an interdependent action.
Identify the actions that are examples of slander. Select all that apply. 1. _____ Volunteer telling another volunteer a patient's age 2. _____ Nurse explaining to a patient that another nurse is incompetent 3. _____ Personal care assistant sharing information about a patient with another patient 4. _____ Unit manager documenting a nurse's medication error in a performance appraisal 5. _____ Housekeeper who is angry at a nurse erroneously telling another staff member that the nurse uses cocaine
1. This is a violation of the patient's right to confidentiality, not slander. 2. CORRECT: This is an example of slander. Slander is a false spoken statement resulting in damage to a person's character or reputation. 3. This is a violation of the patient's right to confidentiality, not slander. 4. This is not slander because it is a written, not spoken, statement and it documents true, not false, information. 5. CORRECT: This is an example of slander. It is a malicious, false statement that may damage the nurse's reputation.
When attempting to administer a 10:00 PM sleeping medication, the nurse assesses that the patient appears to be asleep. What should the nurse do? 1. Withhold the drug 2. Notify the practitioner 3. Awaken the patient to administer the drug 4. Administer it later if the patient awakens during the night
1. This is a violation of the practitioner's order. Drug administration is a dependent nursing function. 2. This is unnecessary. 3. CORRECT: Administering a medication is a dependent function of the nurse. The prescription should be followed as written if the prescription is reasonable and prudent. This medication was not a PRN medication but rather a standing order. 4. The drug should be administered as prescribed not at a later time.
The nurse says, "If you do not let me do this dressing change, I will not let you eat dinner with the other residents in the dining room." What legal term is related to this statement? 1. Battery 2. Assault 3. Negligence 4. Malpractice
1. This is not an example of battery. Battery is the actual willful touching of another person that may or may not cause harm. 2. CORRECT: This statement is an unjust threat. Assault is the threat to harm another person without cause. 3. This is not an example of negligence. Negligence occurs when harm or injury is caused by an act of either commission or omission. 4. This is not an example of malpractice. Malpractice is negligence by a professional person as compared with the actions of another professional person in a similar circumstance when a contract exists between the patient and nurse.
An anxious patient repeatedly uses the call bell to get the nurse to come to the room. Finally the nurse says to the patient, "If you keep ringing, there will come a time I won't answer your bell." What legal term is related to this statement? 1. Slander 2. Battery 3. Assault 4. Libel
1. This is not an example of slander, which is a false spoken statement resulting in damage to a person's character or reputation. 2. This is not an example of battery, which is the unlawful touching of a person's body without consent. 3. CORRECT: This is an example of assault. Assault is a verbal attack or unlawful threat causing a fear of harm. No actual contact is necessary for a threat to be an assault. 4. This is not an example of libel, which is a false printed statement resulting in damage to a person's character or reputation.
Nursing practice is influenced by the doctrine of respondeat superior. What is the basic concept related to this theory of liability? 1. Nurses must respond to the Supreme Court when they commit acts of malpractice 2. Health-care facilities are responsible for the negligent actions of the nurses whom they employ 3. Nurses are responsible for their actions when they have contractual relationships with patients 4. The laws absolve nurses from being sued for negligence if they provide inappropriate care at the scene of an accident
1. This is unrelated to respondeat superior. Negligence and malpractice, which are unintentional torts, are litigated in local courts by civil actions between individuals. 2. CORRECT: The ancient legal doctrine respondeat superior means "let the master answer." By virtue of the employer-employee relationship, the employer is responsible for the conduct of its employees. 3. Individual responsibility is unrelated to respondeat superior. A nurse can have an independent contractual relationship with a patient. When a nurse works for an agency, the contract between the nurse and patient is implied. In both instances the nurse is responsible for the care provided. 4. This is unrelated to respondeat superior. Good Samaritan laws do not provide absolute immunity.
A client who insists on leaving the hospital against medical advice (AMA) after being properly advised signs the necessary form. In order to avoid legal consequences regarding the client's decision, the nurse should: A. objectively document all the details of the situation thoroughly but concisely in the client's medical record. B. notify the nursing supervisor of the client's decision and that all reasonable efforts were made to dissuade the client from leaving. C. have a member of the security staff escort the client off the facility's property and into their private vehicle or public transportation D. with the client's permission notify a contact person that the client is leaving the hospital against medical advice.
A Almost all health care facilities have an AMA form that patients are asked to sign when they decide to refuse or discontinue ordered therapy or intend to leave the facility. The value of the document in countering a claim of negligence should the patient or family later sue will depend in great part on the quality of the nurse's charting. Although the other options may be correct procedures, they are not directed towards protecting the nurse legally.
In order to best ensure client safety, which of the following questions should a staff nurse ask first when determining whether to accept a client assignment that is made when several staff members have reported off sick? A. "Do I have the experience and knowledge to care for these patients?" B. "Is this a staffing crisis or a result of typical staffing patterns?" C. "Can I expect to be mandated to stay an additional shift?" D. "How long will it be before I get additional help?"
A Although all these questions can help the staff nurse think critically about accepting the assignment, initially the important question is whether the nurse possesses the experience, skills, and knowledge necessary to safely provide appropriate care for the clients she is asked to care for.
Based on current trends, which nursing care environment has the greatest employment potential for new nurses? A. Long-term care facilities B. Hospital emergency departments C. Pre- and postsurgical departments D. Primary health care provider practices
A Employment will not grow at the same rate in every setting—hospital employment will grow more slowly because many procedures and care are shifting to outpatient and home health settings, more sophisticated procedures can safely be done outside the hospital, and home health and long-term care facilities will see employment growth due to the aging population. The other options are more traditional environments and so are not as likely to show increased employment growth.
Which hospital-wide policy would best address the nurse's negative view of job satisfaction? A. Making it possible to earn additional personal leave time based on their absentee records B. Providing a dedicated parking area close to the hospital for nursing staff C. Instituting biannual staff recognition days that include a free meal in the cafeteria D. Providing security backup when there is a perceived sense of workplace violence
A RNs are generally satisfied with their jobs when hospital administrators emphasize quality of patient care; recognize the importance of their personal and family lives; and provide nurses with satisfying salary and benefits, high job security, and positive relationships with other nurses and with management. The other policies may appeal to groups of nurses, but they are not directed towards any of the major job satisfaction indicators.
Ethical dilemmas often arise over a conflict of opinions. Each of the following steps constitutes a correct step to take toward resolution of an ethical dilemma. What order should these steps be taken? 1. Clarify your own values about the issue. 2. Call a meeting in which those involved in the dilemma can discuss (negotiate) the possible solutions to the dilemma. 3. State the problem clearly in a way that all involved can understand. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. A. 4, 1, 3, 2 B. 4, 3, 1, 2 C. 1, 4, 2, 3 D. 1, 4, 3, 2
A The first step to the resolution of any ethical dilemma entails the gathering of all relevant information. In some cases this step may uncover valuable information that resolves the dilemma without further processing. Clarifying values helps you distinguish between your own values and opinions and those of others and the difference between value and fact. Stating the problem clearly ensures efficient discussion as you negotiate possible solutions.
A patient's daughter is speaking to the nurse caring for her father. The daughter has presented the nurse with a document identifying her as the spokesperson for the patient when he is no longer capable of speaking for himself. Which of the following best characterizes the daughter's legal relationship with her ailing father? A. Health care proxy B. Legal Samaritan C. Guardian ad litem D. Attorney
A The health care proxy is a surrogate decision maker chosen by the patient and documented in a legal form dated and signed by the patient and notarized by an impartial notary (in many states). Formally this document is known as a durable power of attorney for health care. There is no such characterization known as a legal Samaritan. A guardian ad litem is a person chosen by a court of law with written documentation describing the guardian status. A guardian ad litem is not limited to health care decisions. An attorney may or may not be a health care proxy. A health care proxy does not have to be an attorney.
Utilitarianism is a term commonly found in ethical discourse, but it stands for only one of several different approaches to ethical discourse. Which is a true statement about the ethical philosophy of utilitarianism? A. The value of an intervention is determined primarily by its usefulness to society. B. The value of an intervention is culturally established based on predetermined measures. C. The decision to provide medical care depends on a measure of the moral life of the patient. D. Attention to relationships provides resolution to ethical dilemmas.
A Utilitarianism is based on the notion of "usefulness." "The value of an intervention is culturally established based on predetermined measures" and "Attention to relationships provides resolution to ethical dilemmas" describe other philosophical approaches to ethical discourse but not utilitarianism. "The decision to provide medical care depends on a measure of the moral life of the patient" is a false statement.
At the hospital where you work, you care for a child admitted frequently for management of cystic fibrosis. The child's family has initiated a Cystic Fibrosis Support Group page on Facebook, and they invite you to "friend" their page. Which of the following justifications would you use to explain your decision to accept or not accept the invitation? (Select all that apply.) A. Nurse-patient boundaries may be violated, harming possibility for therapeutic relationship. B. By accepting you could share nursing information online about the patient as a way to educate the support group. C. Postings can easily spread to a wider audience with the potential for HIPAA violations. D. The law prohibits your use of social networking with patients.
A, C Participation in online social media such as Facebook entails hazards, such as nurse-patient boundaries being violated or postings being viewed by a much wider audience with potential for HIPAA violations. These justify declining an invitation to "friend" a patient's support group online. Laws do not yet exist prohibiting nurse-patient social networking, although most health care facilities have established policies that guide participation in social media. The hazards involved in a nurse's participation in social media may not be obvious. Hazards include the interruption of relationships of trust and therefore therapeutic relationships. Postings can be shared with others outside the privacy limits established by the original user. Images and information posted innocently may violate privacy when an unintended audience views the page.
Which of the following actions is/are required of the nurse practicing advocacy? (Select all that apply.) A. Speak up for patient care issues even when others may disagree. B. Contribute money toward the patient's health care costs if the patient is indigent. C. Assess the patient's point of view and prepare to articulate it. D. Document all clinical changes in the medical record in a timely and legible way. E. Become an active member of professional nursing organizations.
A, C, D Advocacy involves speaking up for the patient from the nurse's point of view, even when others may disagree and the advocacy is awkward or uncomfortable. To advocate well, the nurse needs to be sensitive to the patient's point of view by listening well and articulating accurately. Documentation about acts of advocacy helps others on the health care provider team to support your advocacy. Although providing charitable contributions can be praiseworthy, that act is not necessarily a nursing act based on nursing knowledge.
One of the elements of professional negligence is the failure to act according to the standard of care or breach of duty. Standard of care may best be defined as which of the following? (Select all that apply.) A. Nursing competence as defined by the State Nurse Practice Act B. Giving nursing care in the most expedient and timely way possible C. The degree of nursing judgment and skill given by a reasonably prudent nurse under similar circumstances D. Providing health services according to community expectations and ordinances
A, C, D Duty under any standard of care is the degree of nursing judgment and skill given by a reasonably prudent professional in the same or similar circumstance. A standard of care is defined by the State Board of Nursing Practice Act and current community standards. Expedient care, although timely, may not necessarily meet the standard of care.
Ethics in nursing practice includes an embrace of accountability or the ability to justify your actions. Even though your practice is defined in part by orders written by health care providers and policies enforced by administrators, you remain ethically accountable for your actions. Which of the following actions illustrates accountability? (Select all that apply.) A. Your patient receives a surgical procedure that is new to your facility. You ask your manager to provide an in-service about the procedure. B. A health care provider writes orders for pain-management medication even though the patient has been free of pain for 3 days. Out of respect for the health care provider's legal responsibilities, you administer the medications. C. During annual budget preparation at your facility, you advocate for annual pay increases for you and your peers. D. Your patient confides in you that she has recently lost her job and is anxious about her medical bills, including her ability to pay for medications after discharge. Health care coverage is not your area of expertise, but you know that the social worker might be able to help. You initiate a consultation request.
A, D Taking accountability for actions involves acting independently and taking initiative to remain competent and in taking initiative to act in the patient's best interest. Declining to question a health care provider's orders represents a lack of personal accountability. Asking for a pay raise is more about advocacy than accountability.
A nurse is instructing a group of students about how to know and what to expect when ethical dilemmas arise. Which of the following situations should the students identify as an ethical dilemma? A. A nurse on a medical-surgical unit demonstrates signs of chemical impairment. B. A nurse overhears another nurse telling an older adult client that if he doesn't stay in the bed, she will have to apply restraints. C. A family has conflicting feelings about the initiation of enteral tube feedings for their father, who is terminally ill. D. A client who is terminally ill hesitates to name her spouse on her durable power of attorney form.
A. INCORRECT: Delivering client care while showing signs of a substance use disorder is a legal issue, not an ethical dilemma. B. INCORRECT: A nurse who threatens to restrain a client has committed assault. This is a legal issue, not an ethical dilemma. C. CORRECT: Making the decision about initiating enteral tube feedings is an example of an ethical dilemma. A review of scientific data cannot resolve the issue, and it is not easy to resolve. The decision will have a profound effect on the situation and on the client. D. INCORRECT: The selection of a person to make healthcare decisions on a client's behalf is a legal decision, not an ethical dilemma.
A nurse questions a medication prescription as too extreme in light of the client's advanced age and unstable statue. The nurse understands that this action is an example of which of the following ethical principles? A. fidelity B. autonomy C. justice D. nonmaleficence
A. INCORRECT: Fidelity is an agreement to keep promises. The nurse is not addressing a specific promise when she determines the appropriateness of a prescription for the client. Thus, this principle does not apply. B. INCORRECT: Autonomy is the right to make personal decisions, even when they are not necessarily in the person's best interest. No personal decision is involved when the nurse questions the client's prescription. C. INCORRECT: Justice is fairness in care delivery and in the use of resources. In this situation, the nurse is delivering responsible client care and not assessing available resources. This principle does not apply. D. CORRECT: Nonmaleficence is the avoidance of harm or injury. In this situation, administering the medication could harm the client. By questioning it, the nurse is demonstrating this ethical principle.
A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells him she will put a diaper on him if he does not use the urinal more carefully next time. Which of the following torts is the AP committing? A: Assault B: Battery C: False imprisonment D: Invasion of privacy
A: CORRECT: By threatening the client, the AP is committing assault. Her threats could make the client become fearful and apprehensive. B: INCORRECT: Battery is actual physical contact without the client's consent. Because the AP has only verbally threatened the client, battery has not occurred. C: INCORRECT: Unless the AP restrains the client, there is no false imprisonment involved. D: INCORRECT: Invasion of privacy most often involves disclosing information about a client to an unauthorized individual.
A client is about to undergo an elective surgical procedure. Which of the following actions are appropriate for the nurse who is providing preoperative care regarding informed consent? (Select all that apply.) A: Make sure the surgeon obtained the client's consent. B: Witness the client's signature on the consent form. C: Explain the risks and benefits of the procedure. D: Describe the consequences of choosing not to have the surgery. E. Tell the client about alternatives to having the surgery.
A: CORRECT: It is the nurse's responsibility to verify that the surgeon obtained the client's consent and that he understands the information the surgeon gave him. B: CORRECT: It is the nurse's responsibility to witness the client's signing of the consent form, and to verify that he is consenting voluntarily and appears to be competent to do so. The nurse also should verify that he understands the information the surgeon gave him. C: INCORRECT: It is the surgeon's responsibility, not the nurse's, to explain the risks and benefits of the procedure. D: INCORRECT: It is the surgeon's responsibility, not the nurse's, to describe the consequences of choosing not to have the surgery. E. INCORRECT: It is the surgeon's responsibility, not the nurse's, to tell the client about any available alternatives to having the surgery.
An adult client who is competent tells the nurse that he is thinking about leaving the hospital against medical advice. The nurse believes that this is not in the client's best interest, so she administers a PRN sedative medication the client has not requested along with his usual medication. Which of the following types of tort has the nurse committed? A: Assault B: False imprisonment C: Negligence D: Breach of confidentiality
A: INCORRECT: Assault is an action that threatens harmful contact without the client's consent. The nurse has made no threats in this situation. B: CORRECT: The nurse gave the medication as a chemical restraint to keep the client from leaving the facility against medical advice. C: INCORRECT: Negligence is a breach of duty that results in harm to the client. It is unlikely that medication that the nurse administered without his consent actually harmed the client. D: INCORRECT: The nurse has not disclosed any protected health information, so there is no breach of confidentiality involved in this situation.
A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, she found the nurse asleep in her chair in the break room when she was not on a break. Which of the following actions should the nurse take? A: Remind the nurse that safe client care is a priority on the unit. B: Ask others on the team whether they have observed the same behavior. C: Report her observations to the nurse manager on the unit. D: Conclude that her coworker's fatigue is not her problem to solve.
A: INCORRECT: Confronting the coworker might cause her to respond defensively and does nothing to resolve the problem. B: INCORRECT: Finding out whether others have noticed the problem is immaterial and should not affect the nurse's course of action. C: CORRECT: Any nurse who notices behavior that could jeopardize client care or could indicate a substance use disorder has a duty to report the situation immediately to the nurse manager. D: INCORRECT: The nurse may not be responsible for solving the problem, but she does have a duty to take action since she has observed the problem.
A nurse is instructing a group of nursing students about the responsibilities involved with organ donation and procurement. When the nurse explains that all clients waiting for a kidney transplant have to meet the same qualifications, the students should understand that this aspect of care delivery is and example of which of the following ethical principles? A. Fidelity B. Autonomy C. Justice D. Nonmaleficence
A: INCORRECT: Fidelity is an agreement to keep promises. Because donor organs are a scarce resource compared with the numbers of potential recipients who need them, no one can promise anyone an organ. Thus, this principle does not apply. B: INCORRECT: Autonomy is the right to make personal decisions, even when they are not necessarily in the person's best interest. No personal decision is involved with the qualifications of organ recipients. C: CORRECT: Justice is fairness in care delivery and in the use of resources. By applying the same qualifications to all potential kidney transplant recipients, organ procurement organizations demonstrate this ethical principle in determining the allocation of these scarce resources. D: INCORRECT: Nonmaleficence is the avoidance of harm or injury. In this situation, harm can occur to organ donors and to recipients. The requirements of the organ procurement organizations are standard procedures and do not address avoidance of harm or injury.
A nurse is caring for a client who decides not to have surgery despite significant blockages in his coronary arteries. The nurse understands that this client's choice is an example of which of the following: A. Fidelity B. Autonomy C. Justice D. nonmaleficence
A: INCORRECT: Fidelity is an agreement to keep promises. The nurse has not made any promises; this is the client's decision. B: CORRECT: In this situation, the client is exercising his right to make his own personal decision about surgery, regardless of others' opinions of what is "best" for him. This is an example of autonomy. C: INCORRECT: Justice is fairness in care delivery and in the use of resources. Because the client has chosen not to use them, this principle does not apply. D: INCORRECT: Nonmaleficence is the avoidance of harm or injury. In this situation, harm can offur whether ot not the client has surgery. However, because he chooses not to, this principle does not apply.
A nurse offers pain medication to a client who is postoperative prior to ambulation. The nurse understands that this aspect of care delivery is an example of which of the following ethical principles: A. Fidelity B. Autonomy C. Justice D. Beneficence
A: INCORRECT: Fidelity is an agreement to keep promises. Unless the nurse has specifically promised the client a pain-free recovery, which is unlikely, this principle does not apply to this action. B: INCORRECT: Autonomy is the right to make personal decisions, even when they are not necessarily in the person's best interest. In this situation, the nurse is delivering responsible client care. This principle does not apply. C: INCORRECT: Justice is fairness in care delivery and in the use of resources. Pain management is available for all client's who are postoperative, so this principle does not apply. D: CORRECT: Beneficence is taking positive actions to help others. By administering pain medication before the client attempts a potentially painful exercise like ambulation, the nurse is taking a specific and positive action to help the patient.
A client who will undergo neurosurgery the following week tells the nurse in the surgeons's office that he will prepare his advance directives before he goes to the hospital. Which of the following statements by the client indicates to the nurse that he understands advance directives? A: "I'd rather have my brother make decisions for me, but I know it has to be my wife." B. "I know they won't go ahead with surgery unless I prepare these forms." C. "I plan to write that I don't want them to keep me on a breathing machine." D. "I will get my regular doctor to approve my plan before I hand it in at the hospital."
A: INCORRECT: The client may designate any competent adult to be his health care proxy. It does not have to be my spouse. B: INCORRECT: Although the hospital staff must ask the client whether he has prepared advance directives and provide written information about them if he hasn't, they may not refuse care based on the lack of advance directives. C: CORRECT: The client has the right to decide and specify which medical procedures he wants when a life-threatening situation arises. D: INCORRECT: The client does not need his provider's approval to submit his advance directives. However, he should give his primary care provider a copy of the document for his records.
A patient is scheduled to have surgery, and informed consent is to be obtained. Place these steps in the order in which they should performed. 1. The patient is willing to sign the consent voluntarily 2. The patient signs the consent in the presence of the nurse 3. The nurse determines that the patient is alert and competent to give consent 4. The practitioner informs the patient of the risks and benefits of the procedure
Answer: 4, 3, 1, 2 4. It is the responsibility of the practitioner to provide all the information necessary to make a knowledgeable decision. Patients have a legal right to have adequate and accurate information to make informed decisions. 3. Patients must be competent to sign a consent form. The patient must be alert, competent, and in touch with reality. Confused, sedated, unconscious, or minor patients may not give consent. Minor patients who are married, parents, emancipated, or serving in the United States military can provide a legal consent. 1. Patients must give their consent voluntarily and without coercion. 2. The health-care provider witnessing the signing of the consent must ensure that the signature is genuine.
In order to best address workplace satisfaction among its nursing staff, a hospital's administration provides: A. a yearly salary raise. B. tuition reimbursement. C. additional vacation time. D. an extra 15-minute break per shift.
B Areas that have been identified as affecting nursing satisfaction include: 1) opportunities to influence decisions about workplace organization; 2) recognition of accomplishments and work well done; 3) opportunities for professional development and advancement; and 4) opportunities to influence decisions about patient care. Tuition reimbursement would meet the interest in professional development of many nurses. Although the other options are considered favorable gestures, they do not address the identified factors.
The public's right to expect to receive treatment that meets the standards of nursing care is protected by: A. state law. B. federal law. C. reporting law. D. common law.
B Federal laws have a major effect on nursing practice, mandating a minimal standard of care in all health care settings that receive federal funds. Nursing practice is governed by state laws that delineate the conduct of licensed nurses and define behaviors of all health care professionals in promoting public health and welfare. Some states have enacted statutes that mandate nurses to report unsafe, illegal, or unethical practices of nursing colleagues or physicians. Common law is created through cases heard and decided in federal and state appellate courts. Throughout the years, judge-made law regarding nursing practice has accumulated in the form of written opinions.
Which of the following is the best example of a situation where a nurse could demonstrate workforce advocacy? A. A client wishes to become an organ donor in spite of family opposition. B. A client feels pressured by a health care provider into agreeing to a specific medical procedure. C. A nurse volunteers time to participate in a fund raiser to provide toys for a hospital's pediatric unit. D. Staff on a particular unit feel that the nurse manager is showing favoritism when granting vacation time.
B Nurses' strong concern and commitment to patient care and their role as patient advocates often place them in direct conflict with those who have more control, such as physicians and health care administrators. How a nurse reacts to such conflicts within the workplace and continues to advocate to improve patient care is a necessary focus for the profession—a focus called workforce advocacy. Volunteering time to provide funds for toys shows an interest in the client's welfare but is not as strongly related to client care. Advocacy for a client wishing to become an organ donor is an example of patient advocacy. The issue of fair management in this situation does not involve client care.
You have agreed to serve on a Policy and Procedure committee at your hospital, representing the voice of bedside nurses from your unit. The committee is discussing a revision to the staffing ratio policy at your hospital by discussing these questions: How many patients can a nurse safely and effectively care for on your unit? Does the ANA professional code of ethics support your concerns about staffing ratios? Indicate the best answer. A. No, the code describes philosophical principles that are important to ethical discourse but unrelated to staffing ratios. B. Yes, the code supports nurses' participation in conditions of employment, including the promotion of quality health care using both individual and collective action. C. No, to support staffing ratio discussions the ANA publishes journals containing research about best practices in a variety of health care settings D. No, the code is not necessary for this discussion since historical foundations of nursing as defined by Florence Nightingale established staffing ratios before the ANA code of ethics.
B The code of ethics clearly and convincingly establishes guidelines to shape nursing practice by promoting ethical behaviors, including the promotion of nursing involvement in issues that shape nursing practice beyond individual behaviors.
A nurse has received a letter from the State Board of Nursing in which he practices that he has been placed on probation and that his license is suspended. The nurse has received no other information about this action. What, if any, claims does this nurse have? A. The nurse has a claim against the State Board of Nursing for a violation of his right to privacy. B. The nurse has a claim against the State Board of Nursing for violating his rights to due process. C. The nurse has a claim against the hospital where he works for failing to represent him in a civil law suit. D. The nurse has no claim against the State Board of Nursing and the hospital.
B The nurse has a claim against the State Board of Nursing. He has a right of due process, which includes the right to timely and sufficient notice of the charges against him. He has a right to a hearing regarding the charge, the right to review evidence against him or her, and the right to question those who bring evidence against him. There is no violation of the nurse's privacy in the current fact pattern. The nurse's hospital may or may not be required to represent the nurse, depending on the nature of the charge and whether it related to the scope of the nurse's employment.
A patient's visitor has fallen in the patient's room. Which of the following is the most appropriate action for the nurse to take? A. Call the nursing supervisor. B. Assist the visitor and document with an occurrence report. C. Assist the visitor and, if there is no injury, document nothing. D. Assist the visitor and document the occurrence in the patient's chart.
B The nurse's first action would be to assist the visitor to make sure that he or she is safe and then complete an occurrence report. An occurrence report is completed for any unanticipated event, whether it occurs to a patient or visitor. It is completed even though there is no apparent injury. An occurrence report is never referred to in the patient's chart. Calling the nursing supervisor is a proper action but only after the visitor has been made safe and the occurrence documented in an appropriate form.
Ethics of care suggests that you resolve an ethical dilemma by attention to relationships. As Madeleine Leininger described it, caring is the "central and unifying domain for the body of knowledge and practices in nursing." How does it differ from other approaches to ethical dilemmas? (Select all that apply.) A. Ethics of care applies exclusively to nursing practice. B. Ethics of care pays special attention to the stories of the people involved in an ethical issue. C. Ethics of care uses logic and intellectual analysis based on universal philosophical principles. D. Ethics of care depends less on universal principles than other approaches to analyze ethical dilemmas. E. Stories about relationships can be distracting when trying to resolve an ethical dilemma.
B, C Ethics of care focuses on relationships, logic, and narrative as a way to understand the source of ethical dilemma and the resolution of dilemmas. It is not exclusive to nursing but applies to all areas of health care. It specifically depends more on storytelling and examination of relationships than on an analysis of universal principles.
You are caring for a patient who will undergo a bone marrow aspiration, a difficult and painful procedure necessary to monitor the progress of recuperation after bone marrow transplantation. You are eager to minimize pain for this patient. You review the medical record for previous successful pain-management plans. You discuss the procedure with the patient. You advocate for the patient when the health care provider arrives to prepare for the procedure. Which ethical principle best describes the reasons for your actions? A. Beneficence B. Accountability C. Nonmaleficence D. Respect for autonomy
C Although all these principles are important and valuable for nursing practice, the principle of nonmaleficence best describes efforts to minimize pain, particularly when at least some pain is unavoidable. The term is Latin and translates literally as "non" indicating "not" and "maleficence" indicating "harmful act."
Your adult patient is scheduled for an x-ray film of the head. He is refusing to go, despite the fact that the x-ray film will give vital information related to his chief complaint of a headache. The nurse learns of the patient's refusal and comes in to the patient's room saying, "If you don't go to this x-ray, I'll have to give you a shot to put you out." In your opinion, has the nurse committed a legal mistake? A. No, the nurse is acting in the best interests of the patient who needs the test to treat him. B. No, the nurse is merely trying to help the patient understand the necessity of cooperating with the ordered treatment regimen. C. Yes, the nurse may have committed an assault on the patient by verbally threatening him. D. Yes, the nurse may have committed malpractice by forcing the patient to do something against his will.
C An assault is any verbal or nonverbal threat that places the recipient in reasonable fear of imminent danger. Stating that the nurse will give the patient an injection to make him comply with a treatment is a verbal threat. If the patient is reasonably afraid of getting the x-ray film and the injection to sedate him if he continues to refuse, he may have a reasonable fear of imminent harm or danger. Although the x-ray film may be beneficial to the patient, the patient is an adult with apparent sufficient capacity to refuse a treatment. Therefore an argument related to his "best interest" has no relevance to his refusal. The issue of malpractice does not exist unless and until the nurse follows through on the threat, at which point the nurse will have breached her duty to the patient to respect his right to self-determination/autonomy.
Which nursing action best complies with the expectations for nursing care defined by the "never events" identified by the 2012 Rules of Participation for Hospitals? A. Requiring all unlicensed nursing personal to attend shift reports B. Providing care when convenient for the client whenever possible C. Attending an in-service on evidence-based practice on urinary catheter care D. Reporting suspected elder abuse to the nursing manager immediately
C Nurses are required to develop greater expertise in the provision of evidence-based patient care, case management, and discharge planning in order to avoid "never events." Although the other options are appropriate nursing actions, they are not related to "never events"; hospital-acquired conditions are considered reasonably preventable.
In what situation may a nurse deliver care that is not considered at the level of required standard of care? A. When directly ordered to do so by a physician B. When the nursing area is considered understaffed C. When the situation is determined to be an emergency D. When the client refuses care that would meet the standard of care.
C Nursing care rendered in a life-threatening emergency may breach the standard of care required under ordinary circumstances. The nurse may not knowingly provide substandard care even when ordered to do so by medical staff. Understaffing is not an acceptable reason for substandard care nor is a client's refusal to consent.
Which of the following situations fails to meet the criteria for establishing nursing negligence or malpractice? A. A nurse comes to work under the influence of alcohol. B. The nurse leaves a client's bed in the raised position, resulting in a fall. C. The nurse fails repeatedly to document a client's response to pain medication. D. A nurse assigns first-time ambulation of a postop client to an aide and the client falls.
C The criteria require that the nurse-client contract be broken such as the alcohol scenario or preventable injury to the client as a result of the failure to follow good nursing practice. While failing to document is not acceptable practice, it would not be considered either malpractice or negligence unless the omission resulted in patient injury.
A health care provider has written an order for a patient to receive a medication every 6 hours for 7 days. You note that the patient has indicated that she is allergic to this medication (rash, shortness of breath). Which of the following should you do first? A. Contact the health care provider. B. Contact the pharmacist. C. Place a "hold" note on the medication administration record (MAR). D. Contact the nursing supervisor.
C You must stop any possible administration of the medication that will cause an allergic response in the patient. Placing a hold order on the MAR stops anyone from inadvertently administering the medication. You should then contact the pharmacy and the health care provider. The nursing supervisor should be contacted if the health care provider does not act to rescind the order.
Although you normally work in a hospital setting, you have volunteered at a homeless shelter at a blood pressure clinic. If an incident occurs at the blood pressure clinic, what is your most likely liability protection provider? A. Your employer hospital malpractice insurance B. Your home insurance C. Your professional liability insurance D. No one (There is a small likelihood that a nurse will be sued in this type of situation.)
C Your employer is only obligated to defend your actions as an agent of the employer when you are working within the scope of your employment. Your home insurance does not cover your actions in this situation unless you also have professional liability attached to your homeowner's policy.
You are working in an intensive care unit on the night shift. You have been caring for the same patient for three nights in a row. The patient's mother sleeps at the patient's bedside. Over time the mother has come to trust you, as evidenced by her long conversations with you while her child sleeps. Earlier in the week, in the presence of health care providers during morning rounds, she consented to an experimental surgical intervention for her child. But in conversation with you, she shares her doubts and confusions about the intervention. In the morning you ask the health care provider to consider an ethical consultation. What is the value of this nurse participating in discussions about ethical dilemmas? (Select all that apply.) A. Most state laws require that ethics committees include a nurse representative. B. The principal of beneficence promotes kindness in nurses. C. Nurses provide unique insight about patients that can be critical to the resolution of ethical dilemmas. D. Nurses can help articulate a patient's point of view based on specific nursing knowledge. E. Health care providers generally do not participate in ethical discourse.
C, D Nurses assess patients in ways that are unique to nursing. Furthermore they often find opportunity for communication with patients that differs in quantity and quality from other health care providers. As a result, nurses obtain information that other professionals may not notice or appreciate
According to annual assessments performed by the Federal Government, certain groups of people in the United States have poor or no access to health care. You decide to write an editorial to your local newspaper expressing your opinion about this situation. Which ethical principle would you incorporate into your editorial? A. Accountability because as the nurse you are accountable for the well-being of all patient groups B. Respect for autonomy because autonomy is violated if care is not accessible C. Ethics of care because the caring action would be to provide resource access for all D. Justice since this concept addresses questions about the fair distribution of health care resources
D Accountability, respect for autonomy, and ethics of care are valuable and could be incorporated into a discussion about access, but the fundamental principle that shapes thinking about access to care is the principle of justice.
A patient is discussing her surgery with her surgeon. The physician leaves and asks you to have the patient sign the consent form in a few hours. Which statement made by the patient indicates that informed consent has likely been achieved? A. The patient states that the doctor has told her there is nothing more they can do and she is going home. B. The patient states that she has not spoken with her surgeon at all today. C. The patient states that her surgeon has told her that she doesn't need surgery. D. The patient states that she is having surgery on her leg in the morning and that she will have some pain and bleeding for a few days.
D By stating that she is having surgery in the morning and that she understands some pain and bleeding will occur, the patient reflects a reasonable understanding about the plan for her surgery and the likely outcomes. Stating the doctor has nothing more to do so she is being released, stating that her surgeon indicated surgery is not necessary, and stating that she hasn't spoken to her surgeon all day indicate that the patient may be in denial and needs further explanation, instruction, and support before undergoing surgery.
You are the night shift nurse for a hospital nursing division of 40 acutely ill postoperative patients. The staffing for the night shift is you plus two patient care technicians. Based on the end-of-shift report, the current staffing, and your assessment of the patients, you have determined that there is insufficient staff to safely take care of the patients on this nursing division. What is the best action for you to take? A. Leave the nursing division immediately and go home. B. Contact the nursing supervisor, inform him or her of the situation, and leave the nursing division. C. Contact the chief of medicine and inform her or him of the situation and document it. D. Contact the nursing supervisor, inform him or her of the situation, and document it.
D Leaving the nursing division, even with documentation and notice of the situation to your nursing supervisor, may be seen as patient abandonment. Contacting the chief of medicine is insufficient notice to the nursing employer of the unsafe situation.
A nurse believes that a pediatric patient has been the victim of abuse based on verbal statements and scarring noted on the patient's abdomen and legs. Which of the following is the best action for the nurse to take? A. Do nothing but document the patient's condition. B. Contact the patient's family. C. Contact the patient's teacher. D. Contact the Child Abuse Hotline.
D Nurses are mandatory reporters for suspected child abuse. Although documenting the patient's condition is important, it is insufficient to meet the mandatory reporting requirement. Contacting the patient's teacher and/or family does not meet the mandatory reporting requirement.
