Legal and Ethical Issues in Leadership and Management

Dr. Famm tells Lynn Ann that a biopsy of the pancreatic mass should be performed. After discussing this recommendation with Dianne, Lynn Ann decides that she would like a second opinion about the biopsy. She calls the nurse at Dr. Famm's office to discuss her decision. Which response by the nurse is appropriate? "A second opinion may be helpful in helping you make your decision." "Time is of the essence, and you should not waste time getting a second opinion." "A second opinion is really not necessary because Dr. Famm is one of the best primary health care providers for this type of problem." "Most people think about getting a second opinion but don't end up doing so because it takes a while to get an appointment with another primary health care provider."

"A second opinion may be helpful in helping you make your decision." RATIONALE: The client has a right to make decisions about his or her plan of care before and during the course of treatment, to refuse a recommended treatment or plan of care, and to be informed of the consequences of such action. It is the client's right to request and receive a second opinion from another primary health care provider. Telling the client that of time is the essence or that getting a second opinion is not really necessary is inappropriate and can induce fear in the client. The nurse should not make generalized statements such as telling the client that it takes too long to get an appointment with another primary health care provider.

A client with polycystic kidney disease requires a kidney transplant. After several tests, it is determined that the client's brother is a histologically compatible donor. The client is told about the findings and informed that kidney transplant surgery will be scheduled. The client tells the nurse that he does not want the kidney transplant and asks to speak to his primary health care provider about other treatment options. Which statement by the nurse is appropriate? "Can we talk about the reasons that you do not want the kidney transplant?" "You're probably just nervous about the surgery. Sleep on it, and then we'll talk about it tomorrow." "Your brother was so excited about being able to help you. What a disappointment it's going to be for him to hear this." "Are you kidding? Do you know how lucky you are to have a compatible donor? Not too many people get a second chance at life."

"Can we talk about the reasons that you do not want the kidney transplant?" RATIONALE: The client has the right to accept or refuse a treatment. This includes the right to decide to become an organ donor and the right to refuse an organ transplant as a treatment option. The appropriate nursing response is to focus on the client's feelings and provide an opportunity for the client to verbalize his thoughts and concerns. Placing the client's feelings on hold, instilling guilt in the client, and showing disapproval are all inappropriate and nontherapeutic responses.

Lynn Ann decides to have the surgery to remove the pancreatic mass, and the surgery is performed by Dr. Donlon. Lynn Ann is told that the mass was malignant but that it was encapsulated, there was no evidence of local invasion or metastasis, and that she will not need to undergo chemotherapy. Dianne comes to the hospital to visit, approaches Lynn Ann's nurse, and asks about the outcome of the surgery. How should the nurse respond to Lynn Ann's sister? "Everything went great. Lynn Ann has a very good prognosis." "Let's go into the conference room. I don't want to talk about Lynn Ann here in the hallway." "You're a nurse! You know the rules! I can't discuss Lynn Ann's condition with you!" "Dr. Donlon has explained everything to Lynn Ann. You'll need to talk to Lynn Ann about her status

"Dr. Donlon has explained everything to Lynn Ann. You'll need to talk to Lynn Ann about her status RATIONALE: The client has the right to privacy, and the nurse must protect the client's privacy as much as possible. The nurse should not discuss any information with anyone but Lynn Ann herself about Lynn Ann's diagnosis. Doing otherwise would violate the client's right to privacy. Therefore, the correct response is to explain that any information about Lynn Ann's condition will have to be obtained from Lynn Ann

One of Madeleine's daughters comes in for a visit and talks to Madeleine about her wishes. She is willing to call an attorney for assistance but asks the nurse, "What's the difference between a durable power of attorney for health care and an instructional living will? I'm so confused!" Which of these responses by the nurse is correct? Select all that apply. "They're the same thing, actually." "With a durable power of attorney for health care, the family decides who will serve as the client's representative." "The client specifies who will hold the client's durable power of attorney for health care, and that person does not have to be a family member." "With either of these documents you are telling your primary health care provider that you no longer want any medical care and that you want to die." "The living will is a legal document that tells the primary health care providers and family members what your wishes are about life-sustaining treatments if you can no longer make decisions." "The durable power of attorney for health care is a legal document in which you name someone else to make decisions about your health care if you are no longer able to make these decisions."

"The client specifies who will hold the client's durable power of attorney for health care, and that person does not have to be a family member." "The living will is a legal document that tells the primary health care providers and family members what your wishes are about life-sustaining treatments if you can no longer make decisions." "The durable power of attorney for health care is a legal document in which you name someone else to make decisions about your health care if you are no longer able to make these decisions." RATIONALE: Both the living will and durable power of attorney for health care are legal documents in which a person specifies his or her wishes about health care decisions in the event that the person cannot make these decisions on his or her own. The instructional living will is a document that provides instructions for health care providers and family members. The durable power of attorney for health care is a legal document in which a person designates another person, such as a family member or a friend, to make health care decisions when the person becomes unable to do so. The client selects the proxy, not the family members.

Just before her discharge, Lynn Ann decides that she wants to review her medical record. She calls the nurse and says, "I'd like to read my chart before I leave. I want to see the pathology report for myself." Which responses by the nurse are appropriate? Select all that apply. "Sure! Let me go make a copy for you." "Well, that's not really allowed. Why don't you believe what your doctor told you?" "The nursing supervisor will be glad to review your record with you in case you have questions." "We can't let you look at it now, but you can ask your doctor about reviewing it when you see her." "Yes, you'll be able to review your record. Let me go and check on the correct procedure for doing that first, though."

"The nursing supervisor will be glad to review your record with you in case you have questions." "Yes, you'll be able to review your record. Let me go and check on the correct procedure for doing that first, though." RATIONALE: Per HIPAA regulations, the client has the right to inspect and have a copy of his or her medical record. Lynn Ann just wants to review her record; she is not asking for a copy at this time. However, clients may have questions about what is in the chart, and the institution's policies for client review of medical records must be followed. Asking a client why he or she wants to read the record is challenging the client and not therapeutic; it is not necessary to delay the review by asking the primary health care provider, although the primary health care provider should be informed of the client's request.

Lynn Ann schedules an appointment with another primary health care provider, Dr. Anna Donlon, to obtain a second opinion. Dr. Donlon tells Lynn Ann that biopsy is unnecessary at this time because she will need extensive abdominal surgery to remove the mass, regardless of whether it is benign or malignant. After Dr. Donlon leaves the examining room, Lynn Ann says to the nurse, "I can't believe that I need surgery; I feel fine! Lately I've read quite a bit about herbal products and alternative therapies, and I think I should give that a try before I have the surgery. What do you think?" Which response by the nurse is appropriate? "I have so many people ask me about alternative therapy. Personally, I don't think that it works." "You'd better not try that stuff if you plan to have Dr. Donlon treat you. She's totally against using that stuff." "How much have you read? Did you read about the adverse effects of these herbal products? If you had, you wouldn't use them." "We have an alternative therapy department here at the clinic. It is important to be well informed about the available therapies and how they are believed to work. Would you like the phone number so that you can schedule an appointment?"

"We have an alternative therapy department here at the clinic. It is important to be well informed about the available therapies and how they are believed to work. Would you like the phone number so that you can schedule an appointment?" RATIONALE: The client has the right to be informed about treatment options. If the client requests information about a treatment option, the nurse must help the client obtain that information. The nurse should not give his or her opinion to the client. The incorrect options are nontherapeutic responses.

A primary health care provider asks a client to participate in a cardiac research study, and the client agrees. After the primary health care provider leaves the client's room, the client says to the nurse, "I don't really want to participate in the study, but I didn't want to say no to my doctor. He's done so much for me; I guess this is the least I can do for him." How should the nurse respond to the client? "Well, you've signed the consent form, so you're committed to participating." "Yes, he has done a lot for you, hasn't he? But all that you need to do is tell him that you changed your mind." "You have the right to consent to or decline participation in a research study. Even though you have agreed to participate, you have the right to change your mind." "I know other clients who have participated in this study, and they didn't mind it at all. You might as well participate; before you know it, the study will be over with."

"You have the right to consent to or decline participation in a research study. Even though you have agreed to participate, you have the right to change your mind." RATIONALE: A client has the right to consent or decline to participate in research and the right to change his or her mind about the treatment plan. Even though the client has signed the consent form, he or she is not committed to participating. Telling the client that he or she is committed to participating because the consent form has been signed violates the client's rights. The primary health care provider may or may not have done a lot for the client; regardless, agreeing with the client is a nontherapeutic communication technique. Telling the client that other clients who participated in the study did not mind participating at all is generalizing, which is nontherapeutic.

The nurse is reviewing Angela's laboratory results and discovers that her pregnancy test result is positive. The nurse asks Angela, "When was your last menstrual period?" Angela answers, "I'm not sure. Am I pregnant?" The nurse tells Angela that the pregnancy test result was positive, and Angela starts sobbing: "That's all I need right now!" Who else should the nurse notify? Select all that apply. Angela's mother Angela's husband Angela's primary health care provider The nurse's co-workers on the same shift The nurse on the oncoming shift, during report The radiology technician who comes in to perform a chest x-ray

Angela's primary health care provider The nurse on the oncoming shift, during report The radiology technician who comes in to perform a chest x-ray

A 16-year-old girl arrives at the women's health center and tells the nurse that she thinks she is pregnant. The nurse obtains subjective data from the client and informs her about the laboratory procedures used to test for pregnancy. Which action should the nurse take in obtaining informed consent to treat the client? Asking the 16-year-old girl to sign the informed consent Asking the 16-year-old girl for permission to call one of her parents Giving the 16-year-old girl permission forms to take home for her parents to sign Telling the 16-year-old girl that her boyfriend will need to provide consent for her pregnancy te

Asking the 16-year-old girl to sign the informed consent RATIONALE: A minor is a client under the age of legality (usually 18 years) as defined by state statute. Parental or guardian consent should be obtained before treatment is initiated for a minor except in the case of an emergency, in situations in which the consent of the minor is sufficient (e.g., treatment related to substance abuse or a sexually transmitted infection, testing for HIV and AIDS, birth control services, pregnancy, or psychiatric services, or if a court order or other legal authorization has been obtained). Asking anyone other than the client to sign the informed consent would be incorrect

A student nurse who has been assigned to care for a client on a medical unit arrives at the unit and asks the nurse in charge for the client's medical record so that she may review it. Which action should the charge nurse take? Making a copy of the record for the student Giving the student the client's medical record Sitting with the student while the student reviews the record Asking the client for permission for the student to review the medical record

Asking the client for permission for the student to review the medical record RATIONALE: A client's medical record is confidential. Only staff members directly involved in a client's care have legitimate access to a client's record. Any other individual must obtain permission from the client to review the record. Medical records should not be copied. If it is necessary to copy a record, the client must give permission.

A nurse, who is working in the Neonatal Intensive Care Unit, is caring for a preterm infant (delivered at 28 weeks) who has multiple congenital anomalies making survival beyond a few days of life highly unlikely. The parents are very distraught about the infant's condition; and, in addition, they are in disagreement as to whether life supporting measures should be continued or not. The nurse has listened to both parents and knows they have very conflicting thoughts about what is best for the child. What should the nurse do to best support the parents A. Continue to listen to both parents in a non-judgmental manner. B. Tell the parents you know what would be best for the child because of your six years working in the NICU. C. Consult with members of the ethics committee for advice and guidance in ways to support the parents. D. Ask other staff caring for the chil to take sides on the best course of action

C. Consult with members of the ethics committee for advice and guidance in ways to support the parents. (The ethics committees are multidisciplinary and should be consulted in cases which such conflict exists. Members can offer recommendations for parents in a manner that is not judgemental or coercive)

A client tells the nurse he wants to leave the hospital against medical advice (AMA). The client's son arrives for visiting hours and argues with the father, insisting that he stay. What is the best action of the nurse acting as an advocate for the client? A. Insist the father stay so that his health is not put at risk. B. Tell the client that he cannot leave the hospital unless his son is willing to take him home. C. Tell the client that he can leave and document comments made by the client, witnesses, and any follow-up information provided to the client. D. The nurse should call the physician and request the MD write an order for discharge.

C. Tell the client that he can leave and document comments made by the client, witnesses, and any follow-up information provided to the client. (A mentally competent adult client has the right to leave the hospital AMA. Trying to keep the him could result in false imprisonment charges against the nurse. The nurse should provide necessary information for follow-up care and the nurse should document comments made by the client. (D. While the nurse should notify the MD of client's desire to leave AMA, the MD should not be asked to write an order for discharge)

A nurse stops along the road to assist victims of a multi-car accident. Which of the following events would invalidate coverage under the Good Samaritan Act? Group of answer choices A. The nurse stops CPR on a non-responsive victim when she can no longer continue. B. The nurse has personal malpractice insurance that covers incidents outside of formal employment site. C. The nurse accepts a generous tip from the parents of a toddler with a fractured femur. D. One of the victims develops a wound infection at the site where the nurse placed a non-sterile dressing to stop active bleeding.

C. The nurse accepts a generous tip from the parents of a toddler with a fractured femur.

What is true about the action that may taken against a nurse who commits an act that does not violate a legal statute but is in violation of the ANA's Code of Ethics? A. Nurse can face legal charges for any ethical violation. B. No disciplinary or legal consequences can be brought against the nurse since Codes of Ethics are not binding. C. The nurse may face disciplinary actions from the agency and/or the state board of nursing. D. Snce the ANA does not have influence over individual State Practice Acts, so the SBON will never know about any ethical violations that occur.

C. The nurse may face disciplinary actions from the agency and/or the state board of nursing. (ALthough violations of the Code of Ethics may not rise to level of any criminal wrongdoing, both the agency (in policies) and State Board of Nursing May determine actions deemed unprofessional warrant disciplinary action, Such as imposing a temporary suspension or revoking the license to practice.)

A nurse is caring for a client who is scheduled for surgery at 11 a.m. A member of the operating room staff calls the nurse at 9:30 a.m. and informs her that the client must be premedicated and transported to the operating room by 10 a.m. The nurse immediately administers the sedative medications as prescribed. At 10 a.m., as the nurse is getting the client ready for transport, she notes that the informed consent for surgery has not been signed by the client. Which action should the nurse take? Contacting the client's surgeon Having the client sign the informed consent Calling the operating room and cancel the surgery Asking the client's significant other to sign the informed consent

Contacting the client's surgeon RATIONALE: Informed consent indicates the client's agreement to participate in the treatment or surgical procedure. Legally, the client must be mentally and emotionally competent to give consent. A client who has been administered sedative medications or any other medication that might affect his or her ability to make rational decisions should not be asked to sign a consent form. It is the primary health care provider's responsibility to obtain informed consent from the client or legal guardian; therefore, the nurse should contact the surgeon. It is inappropriate and illegal to ask a significant other to sign an informed consent for a client who is legally competent to do so. It is not within the realm of a nurse's role to cancel surgery.

1. A client has given written legal authorization for her husband to have access to her protected health information. After the physician tells the woman her breast cancer has spread extensively and she has a prognosis for survival of about 6 months, the woman begs the nurse not to tell her husband. The nurse promises the woman that she will not disclose any information to her husband. The husband arrives to the unit and tells the nurse he has feeling the prognosis is not good and he asks if the doctor has told his wife anything about the test results. The nurse knows she has promised the woman not to disclose the prognosis but she wants to tell the husband the truth because her own experience has taught her it will be better for both of them to know and the woman is not making the best judgment in this case. What ethical principles are the primary sources of this ethical conflict? A. Justice and veracity. B. Beneficence and fidelity. C. Fidelity and a HIPAA violation. D. Fidelity and paternalism.

D. Fidelity and paternalism. (fidelity is keeping one's promises, Paternalism - One individual assumes the right to make decisions for another - The nurse is torn between the decision to keep her promise to the woman, paternalism is that the nurse knows what is best for the woman, the woman is not making the best judgement in this case, even though it is against what the woman herself has requested) B. Beneficence and fidelity (incorrect, while fidelity is keeping one's promises, is involved in this conflict, beneficence deals with doing good. It is not posing conflict here)

A nurse witnesses another nurse signing out narcotics that are not administered to the patients. What should the nurse do? A. Confront the nurse with the fact it was observed that narcotics were taken and not given to patients. B. Tell the oncoming shift medication nurse that patients may be needing pain medication before time permits. C. Ask the nurse if the narcotics were given without saying anything about what action was observed. D. Speak to the nursing supervisor in private about the observed event.

D. Speak to the nursing supervisor in private about the observed event.

The nurse is demonstrating client advocacy in which of these situations? Select all that apply. Helping a client bathe Changing a client's abdominal dressing Including the client in the formulation of a nursing care plan Ensuring that the client has been informed of the treatment plan Sharing the client's viewpoint regarding treatment during an interdisciplinary health care conference

Including the client in the formulation of a nursing care plan Ensuring that the client has been informed of the treatment plan Sharing the client's viewpoint regarding treatment during an interdisciplinary health care conference RATIONALE: The nurse must act as a client advocate and speak up for or act on behalf of the client, protect the client's right to make his or her own decisions, and uphold the principle of fidelity. The nurse serves as an advocate by ensuring that the client has been informed of the treatment plan and including the client in developing the plan of care. The nurse should also share the client's viewpoint with others, such as the interdisciplinary health care team, involved in the client's care. Helping a client bathe and changing a client's abdominal dressing are nursing interventions but are not specifically associated with the role of advocacy.

A nurse employed in the emergency department (ED) cares for a male client who has sustained a gunshot wound, but the client dies in the ED. The client, who was having a romantic affair with a married woman, was shot by the woman's husband. The nurse tells a neighbor about the incident and the affair and also reports to the neighbor that the woman's husband was arrested by the police for murder. What offense has the nurse committed by sharing this information with the neighbor? Libel Fraud Assault Invasion of privacy

Invasion of privacy RATIONALE: The client has the right to be free of unwanted intrusion into his or her personal affairs. Invasion of privacy includes violation of confidentiality, intrusion on private client or family matters, and sharing of client information with unauthorized persons. Defamation (libel or slander) occurs when a person makes false statements that result in damage to an individual's reputation. Fraud is a deliberate deception intended to produce unlawful gain. Assault occurs when a person puts another person in fear of harmful or offensive contact.

A nurse manager is reviewing ethical principles with the nursing staff. Which example does the nurse manager provide to explain the concept of fidelity? Keeping a promise made to the client Supporting the client's right to informed consent Determining the order in which clients are cared for Avoiding harm to the client in the performance of nursing care

Keeping a promise made to the client RATIONALE: Ethical principles are codes that direct or govern nursing actions. Fidelity is the duty to do what one has promised. Autonomy refers to respect for an individual's right to self-determination. Justice is the equitable distribution of potential benefits and tasks and determining the order in which clients should be cared for. Nonmaleficence refers to the obligation to do or cause no harm to another.

Madeleine expresses concern to the nurse about the need for having one of her daughters act as a spokeswoman in the event of an emergency should additional decisions need to be made. What should the nurse tell Madeleine? Once the living will is in place, there is no need for a spokesperson. As long as she has shared her wishes with her daughter, there is no need for a spokesperson. The primary health care provider will keep Madeleine's family informed in the event of an emergency. Madeleine may appoint a person to carry out her wishes or to make decisions on her behalf if and when she is no longer able to do so.

Madeleine may appoint a person to carry out her wishes or to make decisions on her behalf if and when she is no longer able to do so. RATIONALE: A durable power of attorney for health care is a legal document that appoints a person (health care proxy) chosen by the client to carry out his or her wishes as expressed in the advance directive or to make decisions on the client's behalf if and when he or she is no longer able to do so. It is the primary health care provider's responsibility to keep the client's family informed about the client's condition in an emergency, but this option is unrelated to the subject of the question. A spokesperson may still be necessary even if a living will is in place.

The nurse prepares to transcribe the primary health care provider's medication prescriptions. Which of the prescriptions noted in this medication record should the nurse question? Select all that apply. Metoprolol 50 mg/day Atorvastatin 10 mg/day by mouth Ramipril 1 tablet/day by mouth Levothyroxine 137 mcg/day by mouth Metformin and sitagliptin 50 to 1000 mg twice daily

Metoprolol 50 mg/day Ramipril 1 tablet/day by mouth Metformin and sitagliptin 50 to 1000 mg twice daily RATIONALE: The components of a complete medication prescription are the date and time when the prescription was written; the medication's name, dosage, route of administration, and frequency of administration; and the prescribing primary health care providers or primary health care provider's signature. The ramipril prescription indicates that 1 tablet should be administered, but a specific dosage is required. The metoprolol and metformin/sitagliptin prescriptions do not indicate the route of administration. All of these prescriptions require clarification. The remaining prescriptions are complete.

The nurse treats the lacerations and prepares to interview Angela to gather additional subjective data about her injuries and medical history. Which action on the part of the nurse is appropriate? Moving Angela to a private room for the interview Calling Angela's husband and asking him to be present for the interview Asking another nurse to sit in and listen during the interview because Angela's injuries were the result of abuse Calling the police department and requesting that an officer be present to hear what Angela has to report about the abuse

Moving Angela to a private room for the interview RATIONALE: Confidentiality is a client's right to privacy regarding his or her health care information. The nurse is legally bound to protect the client from indiscriminate disclosure of health care information that may cause harm. Disclosure of confidential information exposes the nurse to liability for invasion of the client's privacy. The nurse would move the client to a private room for the interview so confidential information is not overheard by others. The nurse would not call the client's husband. Having the client's husband present might prevent the client from providing accurate information and could provoke additional conflict. The client's permission must be obtained before another nurse is asked to sit in and listen during the interview. Although cases of abuse must be reported, it is inappropriate to request that a police officer be present during the interview. These options are inappropriate.

The office nurse reviews the signed consent form and determines that which pieces are components of informed consent? Select all that apply. Cost of the procedure/surgery Name of the procedure/surgery Description of the procedure/surgery Person(s) performing the procedure/surgery Potential risks and adverse effects of procedure/surgery

Name of the procedure/surgery Description of the procedure/surgery Person(s) performing the procedure/surgery Potential risks and adverse effects of procedure/surgery RATIONALE: Information needed for informed consent includes the name and description of the procedure, the name of the person(s) performing the procedure, and risks and potential adverse effects of the procedure. Informed consent does not include the cost of the surgery. Other information includes the approximate length of recovery time needed and the consequences of refusing the proposed treatment.

A nurse employed in a medical unit arrives at work and is told that she will be floated to work in the delivery room for the day because several nurses who work there have called in sick with the flu. The nurse is reluctant to float because she has never worked in the delivery room. The nurse takes which actions? Select all that apply. Reporting to the delivery room Contacting the hospital legal department and reporting the situation Refusing to go to the delivery room because she has never worked in that unit Informing the supervisor of her lack of experience in caring for clients in the delivery room Requesting that she be allowed to go home because she is also experiencing signs/symptoms of the flu Reporting to the delivery room and asking that she spend the day reading the procedure manual for the unit.

Reporting to the delivery room Informing the supervisor of her lack of experience in caring for clients in the delivery room RATIONALE: Nurses are sometimes required to float from areas in which they normally practice to other nursing units. A nurse in a floating situation must not assume responsibility beyond his or her level of experience or qualification; he or she should inform the supervisor of any lack of experience in caring for the type of clients found on the new nursing unit. It is inappropriate and unnecessary to report the situation to the legal department. Asking to go home and refusing to go to the delivery room are both inappropriate actions that constitute abandonment. Although the nurse should request and be given orientation to the new unit, spending the day reading the procedure manual for the unit does not help alleviate the staffing situation in the delivery room.

The next morning, a nursing student walks into the room and awakens Lynn Ann. The student greets her and says, "Hi, I'm here to take care of you today. I hope you don't mind." The student then begins to ask Lynn Ann questions about her past health history and surgery. Lynn Ann is tired, needs some medication for pain, and does not really want to talk at the moment. She tries to tell the student that another time would be better. The student insists, "No, I need to do this now to finish my paperwork" and continues to ask questions. Which client rights did the student violate in this situation? Select all that apply. Right to privacy Right to consent or refuse a treatment Right to considerate and respectful care Right to expect that the hospital will provide necessary health services Right to know the names and roles of the persons who are involved in care

Right to privacy Right to considerate and respectful care Right to know the names and roles of the persons who are involved in care RATIONALE: The client has the right to know the names and roles of the persons involved in her care. In this situation, the student did not introduce herself. The right to privacy also means that a person must be left alone and remain anonymous if he or she chooses. The student has ignored Lynn Ann's request to talk at another time, another violation of the client's right to considerate and respectful care. This situation does not illustrate violation of the right to consent to or refuse treatment, because the student did not administer a treatment. The right to expect the hospital to provide necessary health services is also not an issue in this situation.

The emergency department nurse completes the interview with Angela, and with Angela's permission calls a social worker to speak to her. While the social worker is talking with Angela, Angela's husband arrives at the emergency department and requests information about Angela's physical status. Which action should the nurse take initially? Telling Angela's husband that this information cannot be shared with him Dialing 911 and letting the police know that Angela's husband is at the emergency department Telling Angela's husband that this information will be shared with him once the social worker has completed the interview Calling the security department and requesting that a security guard be sent to the emergency department to ask Angela's husband to leave hospital property

Telling Angela's husband that this information cannot be shared with him RATIONALE: Confidentiality is a client's right to privacy regarding his or her health care information. Health care information is not shared with others, including family members or friends of the client, without the client's consent. Therefore, the nurse would initially tell Angela's husband that the information cannot be shared with him. Contacting the police is not appropriate unless the client has formally filed charges against her husband. Calling the security department and requesting that a security guard ask the client's husband to leave hospital property is not appropriate initially and could cause agitation in a person who is believed to have violent tendencies.

A nurse is describing the situations that constitute invasion of client privacy to a group of staff members. The nurse knows that which situations violate the client's privacy? Select all that apply. Describing a treatment to a client in a secluded area Telling a family member about the client's condition Taking photographs of the client during the client's birthday party Asking the client for permission to allow a nursing student to observe a procedure Accessing a neighbor's medical record to find out about his or her health care status

Telling a family member about the client's condition Taking photographs of the client during the client's birthday party Accessing a neighbor's medical record to find out about his or her health care status RATIONALE: The client has a right to privacy and the right to protection against unreasonable and unwarranted interference in his or her private affairs. Some of the situations that violate this right include taking photographs of the client, releasing medical information to an unauthorized person, leaving the curtains or room door open while a treatment or procedure is being performed, allowing individuals unconnected to the client's care to observe a treatment or procedure without the client's consent, leaving a confused or agitated client sitting in the nursing unit hallway, interviewing a client in a room with only a curtain between clients or where conversation can be overheard, and accessing medical records when one is not unauthorized to do so. Describing a treatment to a client in a secluded area and asking the client for permission to allow a nursing student to observe a procedure are measures to protect the client's privacy.

A male primary health care provider who has been making sexual comments to a female nurse for some time asks the nurse to help him collect equipment with which to perform a procedure on a client. While in the supply closet, he places his hands on the nurse and tells her that he would like to take her to dinner. Which action should the nurse take first to best deal with the unwanted sexual advances? Calling the nursing supervisor and reporting the primary health care provider's behavior Telling the primary health care provider that she will be filing a report regarding his behavior Calling the American Medical Association (College of Nurses) and reporting the primary health care provider's behavior Telling the primary health care provider that his behavior is making her uncomfortable and that he needs to stop it immediately

Telling the primary health care provider that his behavior is making her uncomfortable and that he needs to stop it immediately RATIONALE: Sexual harassment is any unwelcome conduct of a sexual nature. A nurse who is being sexually harassed should first start with the most direct measure and tell the harasser that the behavior is making him or her uncomfortable and that it must be stopped immediately. If this measure is not effective in ending the harassment, the nurse may file a complaint against the perpetrator. Reporting the primary health care provider's behavior is not the best measure to take first. The initial goal is to stop the behavior, not punish the perpetrator, and to maintain some type of harmonious relationship.

The emergency department nurse is sitting in the conference room attached to the nurses' station, using the computer to update Angela's medical record. The nurse hears the two unit secretaries, who are in the nurses' station, talking about Angela. One secretary says to the other, "Gosh, that girl has been here so many times for injuries. I wouldn't stand for that abuse. I hope she'll finally do something about that big bully." Which action on the part of the nurse is appropriate? Ignoring the secretaries and continuing to work Telling the secretaries that Angela's information is confidential and should not be discussed Stopping what she is doing and letting the secretaries know that Angela is finally doing something about the abuse Telling the secretaries that they can find out all of the information about Angela's plan by reading her medical record

Telling the secretaries that Angela's information is confidential and should not be discussed RATIONALE: Information about a client's medical condition and any issues related to the client is confidential and should not be discussed openly. In a nurse-client relationship, information is not to be shared with a third party who is not directly involved in the client's care. If the nurse overhears an individual who is not directly involved in the client's care talking about a client's condition, the nurse must intervene to stop the conversation and remind the individual that the conversation is inappropriate. Ignoring the secretaries and telling them that Angela is doing something about her abuse are inappropriate actions. A client's record is confidential, and no one should be reading a client's medical records unless that person are involved in the client's care.

A nurse is preparing to work as a volunteer at a seafood festival, in charge of the first aid tent. What does the nurse understand about her work as a volunteer? Select all that apply. That she will not be provided legal immunity under the state's Good Samaritan law That she must have professional liability insurance, because the Good Samaritan law will not apply That Good Samaritan laws vary by state, and she must be aware of the law in the state in which she is volunteering That she will be covered by the Good Samaritan law as long as she provides nursing care within acceptable standards That she will not be covered by the Good Samaritan law, because it applies only to accidents that occur on highways

That Good Samaritan laws vary by state, and she must be aware of the law in the state in which she is volunteering That she will be covered by the Good Samaritan law as long as she provides nursing care within acceptable standards RATIONALE: Good Samaritan laws are passed by state legislatures. Because these laws vary by state, the nurse must be aware of the law in the state in which he/she is volunteering. Such laws encourage health care professionals to assist in emergency situations without fear of being sued for the care they provide. The law limits liability and offers legal immunity for people helping in an emergency, provided that they render reasonable care. Immunity from lawsuit applies only when all conditions of the state law are met (e.g., the primary health care provider receives no compensation for the care provided and the care given is not intentionally negligent). All nurses are encouraged to obtain their own professional liability insurance; if the nurse does have his or her own professional liability insurance the Good Samaritan law will still apply.

The nurse reviews the documentation written in the client's medical record by the student nurse. Which statements made by the student nurse reflect incorrect documentation and require correction? Select all that apply. The client CO pain and was given his PM. The client's abdominal dressing was changed. The client is a complainer and has repeatedly stated that the nurses take too long to answer his call bell. The client ate 50% of breakfast and 50% of lunch and consumed 100% of his protein snack. The client was able to sit in the chair for 30 minutes without experiencing shortness of breath or tiredness.

The client CO pain and was given his PM. The client's abdominal dressing was changed. The client is a complainer and has repeatedly stated that the nurses take too long to answer his call bell. RATIONALE: Documentation guidelines must be followed to help ensure when information about a client is being recorded, and all documentation must be objective, factual, and complete. Judgmental and evaluative statements should be avoided, so the notation that the client is a complainer is incorrect. Simply documenting that the client's abdominal dressing was changed is an incomplete statement; the nurse should also document the appearance of the wound and its size, as well as whether any drainage was noted and, if so, the drainage's characteristics, and how the client tolerated the procedure. Unacceptable abbreviations such as CO or PM must not be used because of the possibility of inaccurate interpretation by other members of the health care team. The notations that the client ate 50% of breakfast and 50% of lunch and consumed 100% of his protein snack and that the client was able to sit in the chair for 30 minutes without experiencing shortness of breath or tiredness both reflect correct, complete documentation.

The nurse calls Margaret's primary health care provider to report the fall, completes an occurrence report, and documents the occurrence in Margaret's medical record. Which statements should be included in Margaret's medical record? Select all that apply. The client was found lying on the floor. An occurrence report was placed in the medical record. The client's primary health care provider was notified. The client was not instructed in the use of the call bell. The client had no complaints of discomfort or pain after the fall. The client fell to the floor while ambulating from the bathroom back to bed.

The client was found lying on the floor. An occurrence report was placed in the medical record. The client was not instructed in the use of the call bell. RATIONALE: An occurrence report is a tool used to identify risk situations and improve client care. The report form should not be copied or placed in the client's record, and no reference should be made to the report form in the client's record. The occurrence report is not a substitute for a complete entry in the client's record regarding the occurrence. The nurse documents only an objective description of what was actually observed and any follow-up care that was rendered.

After eating lunch, Margaret gets out of bed and walks to the bathroom. On her way back from the bathroom she becomes lightheaded and grabs at the over-bed table, which rolls into the wall, causing Margaret to fall to the floor. The nurse rushes into the room on hearing the noise and finds Margaret lying on the floor. The nurse takes Margaret's vital signs and assesses Margaret for injuries. After determining that Margaret has sustained no further injuries, the nurse assists Margaret back into bed. Which statement indicates negligence on the part of the nurse with regard to Margaret's fall? Margaret did not call for assistance to get out of bed. The nurse placed Margaret's call bell within her reach. The nurse did not instruct Margaret in how to use the call bell. The nurse instructed Margaret to call for assistance to get out of bed.

The nurse did not instruct Margaret in how to use the call bell. RATIONALE: If a nurse does not instruct a client in how to use a call bell, the client cannot call the nurse for assistance. Negligence, conduct that falls below the standard of care, includes acts of commission as well as acts of omission. If a nurse gives care or fails to give care that does not meet standards, he or she may be held liable for negligence. The nurse must instruct the client in the use of the call bell, place the call bell within reach, and instruct the client to call for assistance to get out of bed.

Later that evening, a newly hired nurse comes to the emergency department and states to the nurse caring for Angela, "I've been assigned to work here, but I don't have a computer password yet. May I use yours?" How should the nurse respond? Select all that apply. The nurse gives the new nurse the password, then changes it at the end of the shift. The nurse gives the new nurse the password and asks her not to give it to anyone else. The nurse states, "No, I can't give you my password. It's against our hospital policy to share passwords." The nurse states, "I can't give my password to you, but I'll open the client records for you so that you can enter your own data." The nurse states, "Let's call the information technology department and see what they can do about getting a password for you."

The nurse states, "No, I can't give you my password. It's against our hospital policy to share passwords." The nurse states, "Let's call the information technology department and see what they can do about getting a password for you." RATIONALE: Passwords are essential for keeping client information confidential. One's password should not be known to anyone but the user and the information systems administrator. Passwords for health care agency computer systems should not be shared with anyone else, under any circumstances. The nurse should help the new employee obtain a new password within the guidelines of the health care facility.

The nurse who is admitting Michael to the hospital reviews the medical record that was sent from the surgeon's office and checks the informed consent for surgery. Because Michael's signature on the consent form was witnessed by the nurse in the surgeon's office, the hospital nurse makes which determination? The surgeon's nurse has explained the surgical procedure to Michael. Michael has an adequate understanding of the surgical procedure. All of Michael's questions about the surgical procedure have been answered. The surgeon's nurse was a witness to Michael's signature of the consent form.

The surgeon's nurse was a witness to Michael's signature of the consent form. RATIONALE: The surgeon who performs the surgical procedure is responsible for explaining the procedure, as well as its risks, benefits, and possible alternatives, to the client. The nurse may be involved in the process of obtaining informed consent for medical procedures by witnessing the client's signature of the consent form after the surgeon has completed the informed consent process. This role is different from obtaining consent, for the nurse is either obtaining the client's signature (when the nurse becomes a witness to signature only) or watching the client sign the form in the presence of the surgeon. The nurse's signature on the consent form does not guarantee that the client has an adequate understanding of the surgical procedure or that he has had all of his questions answered.

The nurse assumes which responsibilities during the process of informed consent? Select all that apply. Witnessing the client's signing of the consent form Providing detailed information about the surgical procedure Clarifying the information that was given to the client by the primary health care provider Dispelling any misunderstandings that the client may have about the surgery Witnessing the client's understanding of the information given about the surgery

Witnessing the client's signing of the consent form Clarifying the information that was given to the client by the primary health care provider Dispelling any misunderstandings that the client may have about the surgery RATIONALE: The surgeon is responsible for getting the consent form signed, which must be done before sedation is given and the procedure is performed. The surgeon, not the nurse, is also responsible for providing detailed information about the procedure. The nurse's role is to clarify the information that has been given to the client, to dispel any misunderstandings about the procedure that the client may have, and to verify that the client has signed the form (witnessing the signature).

Margaret's primary health care provider calls back to prescribe an x-ray and some blood chemistry studies. Which actions taken by the nurse who is taking a verbal prescription are correct? Select all that apply. Asking the unit secretary to document the prescription in the client's medical record Delaying implementation of the prescriptions until the primary health care provider can come in to acknowledge them Reading back the prescriptions to the primary health care provider before the primary health care provider hangs up the phone Documenting the prescriptions in the client's medical record as soon as the primary health care provider hangs up the phone Recognizing that the verbal prescription must be legally acknowledged by the primary health care provider as soon as possible, usually within 24 hours

Reading back the prescriptions to the primary health care provider before the primary health care provider hangs up the phone Documenting the prescriptions in the client's medical record as soon as the primary health care provider hangs up the phone Recognizing that the verbal prescription must be legally acknowledged by the primary health care provider as soon as possible, usually within 24 hours RATIONALE: Ideally, the primary health care provider or prescriber documents a prescription, but if a verbal prescription is necessary, the nurse should read the prescription back to the primary health care provider and document it in the client's medical record immediately. The primary health care provider or prescriber must acknowledge the prescription as soon as possible; most policies specify that this must be done within 24 hours. The nurse would not ask the unit secretary or any other person to document the prescription; this is illegal and could also result in an error. Implementation of verbal prescriptions is not delayed until a signature is acknowledged.

After Madeleine talks to her physician, a do-not-resuscitate (DNR) order is written. However, Madeleine's daughter expresses concern: "My mother isn't near death, is she? Does this mean you're going to stop giving her medical care?" Which of these responses by the nurse are correct? Select all that apply. "Unfortunately, yes; it does mean that she will die soon." "She will still be taking medications to treat her heart failure." "A do-not-resuscitate order means that your mother wishes to have all medical treatment stopped at this time." "It means that if her heart stops, she has chosen to let nature take its course rather than let us take measures to keep her alive." "A do-not-resuscitate order does not indicate that her death is coming soon. It just helps us follow her wishes in the event that her heart does stop."

"She will still be taking medications to treat her heart failure." "It means that if her heart stops, she has chosen to let nature take its course rather than let us take measures to keep her alive." "A do-not-resuscitate order does not indicate that her death is coming soon. It just helps us follow her wishes in the event that her heart does stop." RATIONALE: A "do not resuscitate" or "no code" order indicates that the client wishes that no extraordinary measures be taken if cardiac arrest occurs. It does not mean that all medical treatment will be stopped or signal that the end of life is near. The DNR order must be written by the health care provider after consultation with the client.

The nurse determines that which clients are capable of giving consent? Select all that apply. A 15-year old who seeks treatment in a clinic for signs/symptoms of the flu A 17-year old who is seeking treatment for a substance abuse problem A married 17-year old who requires treatment for a suspected respiratory infection A 17-year old soldier in the U.S. Army who requires sutures for a laceration sustained while home on leave A 14-year old who requires an ankle x-ray for a fall sustained while vacationing with a friend's family

A 17-year old who is seeking treatment for a substance abuse problem A married 17-year old who requires treatment for a suspected respiratory infection A 17-year old soldier in the U.S. Army who requires sutures for a laceration sustained while home on leave RATIONALE: Although guidelines for legal consent for medical treatment are guided by state law, generally situations in which minors can provide consent for treatment include: lawfully married or a parent (emancipated); pregnancy (excluding abortions); venereal disease; or a drug or other substance abuse problem. The 15-year-old who seeks treatment in a clinic for symptoms of the flu, and the 14-year-old who requires an ankle x-ray for a fall sustained while vacationing with a friend's family require the consent of a parent or legal guardian before treatment can be provided.

The nurse determines that which situations violate the rights? Select all that apply. A client with anxiety is offered the opportunity to participate in an experimental drug research program. A client with somatization disorder is allowed to keep her clothing and personal effects with her during the hospitalization. A client is refused acceptance into a university health sciences program because of a diagnosis of obsessive-compulsive disorder. A primary health care provider prescribes an intramuscular sedating medication for a client who is hyperactive without discussing the treatment with the client. A client with a paranoid disorder is informed that once he is hospitalized he will not have telephone rights and will not be able to communicate with anyone outside the hospital.

A client is refused acceptance into a university health sciences program because of a diagnosis of obsessive-compulsive disorder. A primary health care provider prescribes an intramuscular sedating medication for a client who is hyperactive without discussing the treatment with the client. A client with a paranoid disorder is informed that once he is hospitalized he will not have telephone rights and will not be able to communicate with anyone outside the hospital. RATIONALE: The mentally ill client has rights similar to those of the client who does not have a mental illness. The mentally ill client has the right to refuse participation in experimental treatments or research such as a drug research program. The hospitalized mental health client also has the right to keep clothing and personal effects with him or her. The client has the right to education, so denying him or her acceptance into a university because of mental illness is a violation of the client's rights. The client also has the right to give informed consent, so prescriptions must be discussed with the client. Not allowing a hospitalized client to communicate with persons outside the hospital is a violation of the client's rights.

What does the nurse understand with regard to a DNR order? The DNR order is applicable for the length of the client's hospitalization. The primary health care provider is the person who is primarily responsible for making the decision regarding a DNR order. A DNR order indicates that no resuscitative measures at all, including the administration of medication, should be instituted. Agency and/or state guidelines must be followed with regard to notification of the client or family about consideration of a DNR order.

Agency and/or state guidelines must be followed with regard to notification of the client or family about consideration of a DNR order. RATIONALE: A DNR order is written by a primary health care provider when a client has indicated a desire to be allowed to die if he or she stops breathing or his or her heart stops beating. Agency and state guidelines must be followed with regard to notification of the client or family about consideration of a DNR order. The DNR order must be reviewed on a regular basis in accordance with agency and state policy and must be clearly defined so that other treatment, not refused by the client, will be continued.

7. Which element of malpractice is addressed by the following statement: the nurse did not activate the bed alarm when the patient with dementia was admitted to the room. A. Duty B. Breach of duty C. Proximate cause D. Injury

B. Breach of duty

What is the ethical decision-making framework that supports the inherent rights of each individual as opposed to the common good? A. Utilitarianism B. Deontology C. Consequentialism D. Ethical relativism

B. Deontology (includes rights-based thinking, which believes in the inherent rights of each individual)

A primary health care provider writes a prescription for furosemide, 80 mg/day by mouth, for a hospitalized client with a diagnosis of heart failure. When the nurse brings the medication to the client, the client states that he normally takes only 40 mg of the medication each day. Which action on the part of the nurse would be most appropriate? Administering 40 mg instead of 80 mg Calling the primary health care provider who wrote the prescription Explaining to the client the need for the higher dose Checking the drug formulary and asking the client to read the information about safe dosage of the medication

Calling the primary health care provider who wrote the prescription RATIONALE: A nurse is obligated to fulfill a primary health care provider's prescription unless he or she believes a prescription to be harmful to the client. If the client questions a prescription, the nurse should contact the primary health care provider for clarification. A nurse who fulfills an inaccurate prescription may be legally responsible for any harm inflicted on the client. The nurse is responsible for clarifying an unclear or inappropriate prescription, or any prescription that is otherwise in question, with the primary health care provider. Administering 40 mg instead of 80 mg, explaining to the client the need for additional medication, and asking the client to read information about safe dosage of the medication are all inappropriate actions.

The nurse goes to check on Margaret and finds her crying. Margaret says, "I don't know what to do. My doctor has just told me that I have hepatitis, and I may have given it to my family, but I don't want them to know that I have this disease! Please don't tell them; it's none of their business." Which actions by the nurse are ethically correct? Select all that apply. Consulting the hospital's ethics committee. Documenting what the client has said in the medical record. Telling Margaret, "If you don't tell your family, we will have to do it." Telling her, "Margaret, I won't tell your family, but let's discuss what could happen if you don't tell them." Promising not to tell Margaret's son but, when he visits, telling him what Margaret has said.

Consulting the hospital's ethics committee. Documenting what the client has said in the medical record. Telling her, "Margaret, I won't tell your family, but let's discuss what could happen if you don't tell them." RATIONALE: In this situation, the nurse is challenged to balance the client's wish for privacy and confidentiality against the safety of her family members. Telling her son after promising not to tell him violates the ethical standard of fidelity (keeping promises). Threatening to tell her family violates the ethical standard of beneficence. Offering to discuss the situation with her is important. Though it is also important to document her statements, the nurse should go beyond that and also consult the hospital's ethics committee for assistance with this situation.

Michael tells the hospital nurse that he really doesn't understand this surgical procedure and that he is somewhat concerned because he will be awake during the surgery. Which action on the part of the nurse is appropriate? Asking Michael why he signed the consent form Contacting the surgeon to report that Michael has questions and concerns about the surgery Telling Michael not to be concerned about being awake, because a large drape will be used to cover his abdomen Telling Michael that he will not be awake during surgery and that the anesthesiologist will be visiting him to talk about the medication that will be administered

Contacting the surgeon to report that Michael has questions and concerns about the surgery RATIONALE: If the client raises questions about the surgical procedure, the nurse must determine whether the client is truly informed about the procedure. If the nurse determines that questions need to be answered and concerns addressed, the appropriate action is for the nurse to contact the surgeon to ensure that the client receives whatever additional clarification or information is necessary. Telling Michael not to be concerned about the surgery and asking him why he signed the consent form are nontherapeutic actions. Surgical procedures must be addressed by the surgeon, who must discuss the client's concerns with the client and provide explanations to the client.

According to HIPAA, in which situations could a client's PHI be used or disclosed? Select all that apply. For treatment purposes For any type of research For health care payment purposes To administer health care benefits To provide information to a family member at any time during the client's hospital stay For learning purposes for medical and nursing students if the client provides permission to do so

For treatment purposes For health care payment purposes To administer health care benefits For learning purposes for medical and nursing students if the client provides permission to do so

After the admission assessment, the nurse reviews Margaret's medical record and notes that the primary health care provider has written prescriptions. Which prescription should the nurse question? Chest x-ray today Incentive spirometry every hour Ibuprofen 400 mg every 4 hours prn Out of bed to chair with assistance only

Ibuprofen 400 mg every 4 hours prn RATIONALE: The nurse would question "Ibuprofen 400 mg q4h prn" because it does not indicate a route of administration. The components of a medication prescription, in addition to the date and time at which the prescription was written, are the name, dosage, and route and frequency of administration of any medication and the primary health care provider's signature. The other prescriptions are complete.

A nurse is gathering subjective data from a client being admitted to the hospital. The client tells the nurse that she has already prepared an advance directive. On the basis of this information, which action should the nurse take? Requesting a copy of the advance directive and placing it in the client's medical record Telling the client that the new hospitalization invalidates the existing advance directive Telling the client that it is best to prepare a new advance directive with each hospitalization Asking the hospital's client advocate representative to review the hospital's policies regarding advance directives with the client

Requesting a copy of the advance directive and placing it in the client's medical record RATIONALE: It is incorrect to tell the client that a new hospitalization invalidates the existing advance directive or that it is best to prepare a new advance directive with each hospitalization. Asking the client advocate representative to review the hospital's policies regarding advance directives with the client has no useful purpose or reason.

Michael tells the nurse that he is much too nervous about having surgery and that he has changed his mind: He does not want the surgery. Which action should the nurse take? Telling Michael that he is contracted to having the surgery since signing the informed consent Telling Michael that there is nothing to be nervous about because such surgical procedures are performed every day Telling Michael that he has a right to change his mind Telling Michael that it is his choice but that his surgeon will be very upset because the cancellation will cause a disruption in the operating room schedule

Telling Michael that he has a right to change his mind RATIONALE: The client has a right to make health care decisions and to change his mind in regard to treatment even if he has signed the informed consent. The primary health care provider must be notified, and the rejection should be documented in the client's record. Telling Michael that there is nothing to be nervous about or that he will upset the operating room schedule avoids his feelings and concerns and is inappropriate and nontherapeutic.

The nurse asks Madeleine whether she has discussed her health care decisions with her daughters. Madeleine tells the nurse that she plans to do so when they visit and that she would like to have a living will completed. Madeleine asks the nurse about the procedure for preparing a living will and wonders whether it can be done while she is in the hospital. How should the nurse respond? The living will must be legally prepared. Madeleine's primary health care provider may prepare the living will. The hospital's client-advocate representative may prepare the living will. Madeleine must have the living will prepared after she is discharged from the hospital.

The living will must be legally prepared. RATIONALE: An instructional living will is a document that instructs the primary health care provider to withhold or withdraw life-sustaining procedures when death is imminent. The document must be legally prepared, with appropriate witnessing of the client's signature. Requirements for the execution of living wills vary from state to state, but generally two witnesses, neither of whom may be a relative or primary health care provider, are needed when the client signs the document. The client's lawyer may prepare the document while the client is hospitalized.