Chapter 3: Ethics, Law, and Delegation in Nursing

An adult child brings an older adult patient to a clinic. The patient is in soiled clothing, has a body odor of urine, and is unable to answer questions. Which additional assessment is most important for the nurse to perform?

Evaluate the patient for signs of current or past physical injuries.

The nurse works in a hospital that uses electronic health records (EHRs). Which situation violates the Security Rule?

Failing to report a breach in the use of one's password

A patient is angry and is insisting on going home even though multiple therapies are in place. The nurse calls the health-care provider and requests a sedative to help calm the patient. Which tort may the nurse be guilty of if the patient is medicated under these conditions?

False imprisonment

The nurse is assigned to care for a patient who was injured during an arrest for a violent crime. The nurse states, "I will not take care of this terrible person." The nurse then leaves the unit and goes home. Which disciplinary action is the charge nurse most likely to initiate against the nurse?

Filing charges of abandonment

The nurse notices that a coworker changes the work schedule so that they both work on the same days. Lately, the coworker has followed the nurse into the medicine and supply rooms, and then blocks the nurse from leaving. The nurse has told the coworker, to no avail, that the behavior is disturbing. The nurse needs to file which report with the personnel office?

Harassment

The LPN/LVN works in the emergency department (ED) and is caring for a preschool-age patient with a head laceration and bruising on the body. The patient also refuses to sit down because "it hurts." The patient's medical record indicates multiple visits to the ED and several broken bones. Which action is taken by the LPN/LVN?

Notify the RN in charge of suspected child abuse.

The nurse manager suspects that a breach has occurred involving patient electronic health records (EHRs). Which action will the nurse manager take?

Notify the technical department about the possibility of a computer breach.

The nurse enters a public elevator in the hospital and overhears two other employees talking about a patient's condition. The nurse looks directly at the two employees, but they continue talking. Which action will the nurse take next?

Speak directly to the two employees and tell them they are violating confidentiality.

Which specific type of law has the greatest impact on the profession of nursing?

Statutory

A patient was recently diagnosed with HIV. The patient's spouse asks the nurse about the patient's diagnosis. Which action must the nurse take?

Tell the spouse that medical information cannot be shared without the patient's permission.

The nurse finds a visitor lying in the hallway. The visitor states, "The floor was wet, and I fell." The patient has no apparent injuries and refuses medical attention. The nurse fills out an incident report. Which entry by the nurse is incorrect?

"A visitor fell in the hallway after slipping because of a wet floor."

The nurse tells the unit manager, "I am not sure where to get my mandatory continuing education hours." Which sources can the nurse manager suggest to the nurse?

"Attend the programs offered by the hospital."

The nurse is providing in-home private duty care for an elderly patient. The patient's family member, who is often in the home during care, asks the nurse to go out on a dinner date after work. Which comment by the nurse will establish professional boundaries?

"I appreciate your offer, but I cannot accept personal or social invitations from patients and family members."

The nurse is providing care for a patient with a terminal illness. The patient states, "I am finished with feeling so sick. I just want to die." Which comment indicates the nurse is experiencing an ethical struggle?

"You need faith that something may come along to make you better."

The community where the nurse works is experiencing severe weather that is preventing some nurses from reporting for the next shift. Which statement by the nurse whose shift is ending shows professional accountability? Select all that apply.

- "I will give report to the nurse who is taking charge of my patients." - "I would like to stay for the upcoming shift, but I am exhausted and need some sleep." - "I will stay and help until enough staff arrives to cover the next shift."

The nurse works in a pediatric surgical unit. The health-care provider is acquiring a consent form for surgery on an underage patient. As a witness, the nurse must make certain which person signs for the patient? Select all that apply.

- A parent of the patient - A grandparent with custody

The licensed practical nurse/licensed vocational nurse (LPN/LVN) is responsible for which legal documents when working in an extended care facility?

- Client record -Incident report - Advance directives - Informed consent

The student nurse is preparing for clinical by reviewing the medical records for an assigned patient. What information is the student nurse likely to find in the current medical record? Select all that apply.

- Communication among health-care personnel - Health-care provider's admitting diagnosis - Nursing plan of patient care - Ordered tests and the results of tests

The nurse is aware that it is important to remain current and up-to-date in order to be a safe practitioner. Which sources are best for the nurse to select to obtain and review clinical information? Select all that apply

- Reading current nursing journals on a regular basis - Joining and participating in professional nursing organizations - Researching nursing topics and health-care issues on professional web sites - Staying up-to-date with published Board of Nursing meeting reports.

The nurse works in an extended care facility. Which action by the nurse is identified as assault? Select all that apply.

- Telling an ambulatory patient to stay in a chair or they will not get lunch - Warning a patient that misbehavior may result in discipline - Informing a patient that they will get an injection if medication is not swallowed

The registered nurse (RN) is making a patient assignment to the licensed practical nurse/licensed vocational nurse (LPN/LVN). What information will the RN keep in mind when making the assignment? Select all that apply.

- The LPN/LVN has been checked off for competency of the task. - The facility's policies and procedures designate tasks the LPN/LVN can perform. - The LPN/LVN is able to verbalize to the RN an understanding of directions. - The LPN/LVN is responsible for communicating with the RN regarding the task and patient.

The nurse feels that a health-care provider is committing sexual harassment. Which behaviors will the nurse include when filing a complaint? Select all that apply

- The health-care provider looks at the nurse from head to toe whenever they come in contact. - The health-care provider tells the nurse jokes containing sexual content and references to body parts. - The health-care provider continually touches the nurse during conversations and patient rounds.

The first year LPN/LVN student is called to assist with a patient in cardiopulmonary arrest in the unit. The registered nurse (RN) has drawn up an intravenous push medication and asks the student nurse to administer the medication. The student nurse states, "I can't. I have not learned how to do that." Which behavior is the student nurse demonstrating?

Accountability

When a patient below the age of _________________ is permitted to sign a consent form, the nurse determines the patient is likely an emancipated minor.

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The nurse works in a facility using electronic health records (EHR). Which document for the patient would the nurse least expect to be in either the patient's health record or EHR?

A copy of the patient's will

A meeting is called with the hospital's ethics committee. Which situation does the nurse identify as an ethical dilemma?

A family requests life support for a brain-dead patient who is six months pregnant until the fetus is viable.

The nurse is caring for a patient who would like to leave the emergency department. The health-care provider has ordered that the patient receive stitches for an open wound on the arm and antibiotics; however, the patient claims to feel fine and does not want to receive either of those treatments. Which occurrence category should the nurse circle?

AMA *pic

The nurse is providing care for a patient who signed an informed consent form for surgery. The nurse overhears the patient state a change of mind regarding the surgery. A family member states, "You need the surgery and I will not let you back out." Which action should the nurse take as a patient advocate?

Ask the patient about thoughts and feelings regarding the surgery.

The nurse provides care for a patient who just received a diagnosis of advanced cancer. The patient's family member states, "We can beat this, we will just need to do whatever it takes." Which action by the nurse demonstrates advocacy for the patient?

Ask the patient to share how they feel about the newly received diagnosis.

The nurse is caring for a patient scheduled for surgery. The nurse overhears an unlicensed nursing assistant personnel (UAP) tell the patient, "My mother suffered terribly and died after this same surgery. You better think about it." Which is the nurse's first action?

Ask the patient to share questions and concerns

The nurse lives in a state that requires a specific number of continuing education (CE) hours for license renewal. Which guideline regarding continuing education is incorrect?

CEs are offered at no charge to nurses because of the importance.

A patient tells the nurse, "I am leaving the hospital and firing my doctor. I have been here three days and no one knows what's wrong with me." The nurse presents the form below. Which purpose does the form fulfill?

Documents that leaving is against medical advice.

The LPN/LVN is assisting the RN in caring for a patient who is very combative. While trying to serve the patient dinner and administer medications, the patient begins to yell obscenities and verbally threaten to kill the nurses. The patient also begins to throw items in the room and grabs the LPN/LVN by the arm, which leaves a bruise. After the incident, the patient is placed in restraints. Which occurrence category should the nurse circle?

Employee injury *pic

The registered nurse (RN) assigns a licensed practical nurse/licensed vocational nurse (LPN/LVN) the task of inserting a nasogastric (NG) tube. The LPN/LVN has only performed this task once in nursing school on a mannequin. Which behavior by the LPN/LVN is best?

Inform the RN and ask for guidance and assistance.

The registered nurse (RN) is preparing a patient assignment for the licensed practical nurse/licensed vocational nurse (LPN/LVN). Which assignment does the RN recognize as being within the LPN/LVN's scope of practice?

Maintain input and output for a patient admitted for dehydration.

The nurse admits a patient to the hospital for injuries related to domestic abuse. The patient fears harm from the abusing spouse while the patient is in the hospital. Which precaution shared by the nurse will provide the patient with the greatest sense of safety?

No one in the hospital can give information about the patient or even confirm that the patient is there.

A patient experienced a brainstem stroke and has no active brain waves. The family wants the patient removed from life support. Which action by the nurse is ethical?

Provide the family with care and support.

The nurse in a hospital emergency department (ED) is caring for a patient diagnosed with Ebola. The hospital director does not want news of the disease to become public and requests the illness not be reported to any outside sources. Which decision should the nurse make?

Report the disease to the CDC in compliance with the statute that requires mandatory reporting.

The nurse is providing care for a patient who is terminal and experiencing severe levels of pain. The patient has been asking for additional narcotic medication to "end my suffering." Which action will the nurse take?

Report the patient's distress to the health-care provider.

The nurse is on an airplane when another passenger becomes short of breath. The flight attendant asks for assistance from anyone with medical training. When the nurse's traveling companion suggests that the nurse assist, the nurse states, "I am not risking legal repercussions in this setting." Which should the nurse consider?

The Good Samaritan Law will protect the nurse.

The registered nurse (RN) assigns patient care to a licensed practice nurse/licensed vocational nurse (LPN/LVN) and an unlicensed assistive personnel (UAP). Which patient need would require the RN to reassume total responsibility for a patient?

The LPN/LVN's patient with pneumonia develops uncontrollable coughing.

A nurse educator is preparing a presentation for the staff nurses about liability. Which part of the presentation will the nurse educator plan to emphasize the most?

The necessity for the nurse to develop a trusting relationship with each patient

The nurse on night shift is noted to be spending an unusually long time in a specific patient's room. Which observed behavior by the nursing supervisor would indicate that the nurse has crossed professional boundaries?

The nurse makes a note of the patient's home phone.

The nurse manager cites which nursing behavior as demonstrating empathy?

The nurse who holds a patient's hand if loneliness is voiced.

A patient who requires emergency surgery after a serious accident is unconscious and has no identification. Which action should the nurse expect to occur first?

The patient will be prepared for surgery because of an immediate need.

The nurse is in court as a defendant in a case regarding negligence. The nurse knows that the deciding factor will be based on standards of care that will be presented by the testimony of another nurse. Which factor will assure the defendant of fair consideration?

The testifying nurse will outline performance in the same situation.

The newly hired nurse is working on an oncology unit. The nurse states, "Most of these patients are so sick, I just don't know how to interact with them." Which suggestion by the new nurse's mentor is most helpful?

Treat your patients as you would want to be treated."