PNC 1- Exam 2: Professionalism, Ethics, and Healthcare Law

Which action is the most important nursing responsibility when an ethical issue arises? A. Being able to defend the morality of one's own actions B. Remaining neutral and detached when making ethical decisions C. Ensuring that a team is responsible for deciding ethical questions D. Following the client and family wishes exactly

Answer: A Rationale: A nurse's actions in an ethical dilemma must be defensible according to moral and ethical standards. The nurse may have strong personal beliefs, but distancing oneself from the situation does not serve the client. A team is not always required to reach decisions, and the nurse is not obligated to follow the client's wishes automatically when they may have negative consequences for self or others.

The nurse who reports an incident of suspected child abuse or neglect is covered legally under what law or principle? A. Principle of Good Faith Immunity B. Health Provider Protection Law C. Principle of Civil Protection D. Whistleblower Protection Act

Answer: A Rationale: All states provide some form of immunity from liability for persons who in good faith report suspected instances of child abuse or neglect under the reporting laws. Immunity statutes protect reporters from civil or criminal liability that they might otherwise incur. This protection is extended to both mandatory and voluntary reporters. The term "good faith" refers to the assumption that the reporter, to the best of his or her knowledge, had reason to believe that the child in question was being subjected to abuse or neglect. Even if the allegations made in the report cannot be fully substantiated, the reporter is still provided with immunity.

A charge nurse is completing an incident report on a client who fell while attempting to get out of bed. The incident report includes all except: A. Disclosure of who or what is to blame for the fall B. The location, time, and date of the incident C. Names and identifying information of any clients and health care personnel involved D. Equipment involved

Answer: A Rationale: An incident report is an agency record of an accident or incident occurring within the agency. It is designed to collect adequate information to assist personnel in preventing future incidents or occurrences. No language regarding liability should be included. Incident reports generally include: names and identifying information of any clients and health care personnel involved; the location, time, and date of the incident; equipment used.

What group is primarily protected under the laws that regulate nursing practice? A. The public B. Practicing nurses C. The employing agency D. People with health problems

Answer: A Rationale: Each state protects the health of the public by regulating nursing practice. Standards of nursing practice provide the framework for nurses. An employing agency (e.g., hospital, clinic, or home care agency) is responsible for ensuring that employees are qualified. More people than just those with health problems are protected by the laws.(Adapted from Nugent PM, Green JS, Hellmer Saul MA, Pelikan PM

Professionalism exemplars related to leadership include which attribute? A. Influential B. Licensed C. Respectful D. Therapeutic

Answer: A Rationale: Exemplars related to leadership include influential, inspired, and proficient. Exemplars related to comportment include licensed, professionally certified, lifelong learner, and self-aware. Exemplars related to communication include therapeutic, accurate, skilled, and focused. Exemplars related to ethics include moral, beneficent, respectful, truthful, and honorable.

A nurse is preparing a client for surgery and understands that the first step in this process is: A. Proper identification of the patient B. Verifying any client allergies to medication C. Obtaining informed consent D. Marking the surgical site with a pen

Answer: A Rationale: Incorrect identification of clients is a problem, particularly in busy hospital units. The first steps in all nursing procedures is the proper identification of the client. While the nurse will assist in having the patient sign the informed consent, the physician will educate the patient in order to obtain the consent and this must happen after identification of the client. Verifying allergies and marking a surgical site occur after proper identification of the patient.

A nurse is present while the physician obtains informed consent from the client. The nurse understands that informed consent is based on what principle? A. Autonomy B. Nonmaleficence C. Competency D. Trust

Answer: A Rationale: Informed consent in the United States is based on the principle of autonomy—that is, each individual has the right to make his or her own decisions regarding treatment, provided that he or she is conscious or competent to do so. Nonmaleficence is to do no harm. Trust and competency do not apply.

Which situation shows that the student nurse is able to implement the idea of caring? A. The nurse is able to carve out time for a favorite hobby, at least once a week. B. The nurse is a volunteer at church and school events. C. The nurse takes care of his elderly parents in addition to providing care to his or her immediate family. D. The nurse makes lists every morning so the day stays organized and planned.

Answer: A Rationale: It is imperative that nurses attend to their own needs because caring for self is central to caring for others. As nurses take on multiple commitments to family, work, school, and community, they risk exhaustion, burnout, and stress. None of the other options depict the nurse caring for self or only for other people or trying to stay on top of the many tasks involved in a daily routine.

The nurse administers the wrong medication to the client and the client appears to have had no adverse reaction to the medication error. What is the best action for the nurse to take once she realizes her mistake? A. Notify the charge nurse. B. Document the error in the patient chart. C. Notify the Board of Registered Nursing. D. Reporting the incident is not necessary because the patient had no adverse reaction.

Answer: A Rationale: Medication errors do occur and the nurse is ethically bound to report these errors, regardless of whether the client had an adverse reaction or not. The nurse would notify the charge nurse of the mistake, who would document the error on an incident report, not in the patient's chart. Notifying the Board of Registered Nursing is not the nurse's responsibility, but the agency may be notified if the nurse's supervisor deems the mistake incompetent in nature

A nurse's coworker tells offensive jokes or stories with a sexual undertone during the shift. The best action of the nurse is to: A. Tell the coworker to stop the activity because the conduct is offensive. B. Ask to be scheduled opposite this coworker. C. Ignore the coworker and walk away. D. Report the incident to the nurse manager.

Answer: A Rationale: Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the coworker to stop, and why, is the first step in putting an end to the situation. Ignoring the situation or asking to be scheduled opposite this person is not addressing the situation in an assertive manner. Reporting the incident to the nurse manager would be a second step if the behavior does not stop after the nurse's approach.

The nurse understands that there are responsibilities related to mandatory reporting including all except: A. The reporting individual agrees to assist in the investigation. B. Report nurses suspected of being in violation of the nurse practice act. C. A legal obligation to report conduct that is incompetent, unethical, and illegal D. Report conduct that is incompetent, unethical or illegal.

Answer: A Rationale: Responsibilities related to mandatory reporting includes reporting nurses suspected of being in violation of the nurse practice act. Also, nurses have a legal obligation to report conduct that is incompetent, unethical, and illegal. An immunity clause protects the reporter acting in good faith. The reporter is not involved in the investigation process of the claim.

Which agency conducts research on nursing practice issues and provides online continuing education opportunities through the e-learning community? A. NCSBN B. NLC C. NCLEX-RN D. BON

Answer: A Rationale: The National Council of State Boards of Nursing (NCSBN) oversees all of the state's Boards of Nursing (BON). The NCLEX-RN is the licensing exam for the registered nurse and the NLC is the Nurse Licensure Compact, which allows nurses to practice in more than one state.

A nurse investigates incidents that might result in a potential lawsuit. This nurse is working in the role of: A. Risk manager B. Occupational health nurse C. Hospital advocate D. Private investigator

Answer: A Rationale: The nurse is acting in the role of risk manager. Strategies that health care organizations use to minimize risk include investigating incidents that might result in a potential lawsuit. The nurse is not acting in any other role listed.

A staff nurse is concerned about maintaining client confidentiality will do all actions except: A. Place medication from the pharmacy at the client's bedside. B. Ensure confidential papers are placed in closed bins for shredding. C. Keep passwords private for point of care computer terminals. D. Log off of computer terminal when the nurse must leave the work station.

Answer: A Rationale: The nurse maintains client confidentiality by logging off of computer terminals when away from the work station, ensuring confidential papers are placed in closed bins, and by keeping personal passwords private. Keeping a client's medication from the pharmacy at the client's bedside does not ensure confidentiality because the medication, most likely, has a label with the client's personal health information on it.

The nurse, who is opposed to abortion, is asked to give a medication to the client that will terminate the client's pregnancy. Which strategy might help the nurse in this case? A. Have self-awareness of values and beliefs. B. Refuse to participate in the collaboration regarding this client. C. Tell the client that taking the medication is immoral. D. Withhold the medication until the prescribing person arrives.

Answer: A Rationale: The nurse must become aware of personal values and the ethical aspects of nursing. The nurse must collaborate with other members of the healthcare team. When values conflict, compromise is essential. The nurse might have the charge nurse administer the medication. Nurses must not impose personal values and beliefs on their clients.

The nurse working with a client who has an advance directive should: A. Make sure to understand what the client's advance directive includes. B. Notify the physician so that the client's chart can be marked with "DNR." C. Make sure to provide only palliative nursing care to the client. D. Make sure to tell the patient that the advance directive will only be utilized in a life-threatening emergency.

Answer: A Rationale: The nurse working with a client who has an advance directive should understand what the client's advance directive includes. The nurse will provide all care to a client unless the advance directive states otherwise. The nurse will not notify the physician because the client has not specified a "Do Not Resuscitate (DNR)" order.

A new nurse needs further teaching when stating a valid consent involves which action? A. It must be presented to the patient by a nurse. B. The consent includes information about the risks and benefits of the procedure. C. The patient must have the capacity to give consent. D. The patient must voluntarily give consent.

Answer: A Rationale: The person presenting the informed consent document must be the provider performing the procedure. To be valid, information for consent must be given by the provider who will be performing the procedure and includes information about the risks and benefits of the procedure. The patient must voluntarily give consent.

Which of the following would be a violation of the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986? A. The hospital emergency room physician suspects that a patient is not competent in making decisions for his post-care treatment. The physician does not complete a competency evaluation prior to transfer for a non-emergent treatment and allows the patient with suspected incompetence to sign the consent for transfer. B. After providing a medical screening examination, the patient's attending physician determines that transfer for a psychiatric service is necessary and not provided by the hospital. The attending seeks consent from the competent surrogate decision maker for the patient prior to transfer. C. The patient's attending physician determines the patient to be in stable condition after completing the medical screening examination and stabilizing the patient. The patient's condition would deteriorate without a life-saving procedure not available at the hospital. The physician explains the risks of staying at the hospital and the risks of the transfer to the patient's power of attorney. Informed consent is received from the patient's power of attorney for the transfer. D. The hospital does not contract with the patient's insurance company. The emergency room physician completes a medical screening examination and stabilizes the patient for discharge. The patient financial services department informs the patient of insurance status after discharge and arranges for payment options.

Answer: A Rationale: The physician who allows the patient with suspected incompetence to sign the consent for transfer did not complete the medical screening examination. EMTALA required that any hospital that operated an emergency department and received Medicare funds provide an appropriate screening examination to anyone who presented and stabilize any emergency medical condition prior to transfer to another facility.

The nursing students are introduced to the staff, the relief charge nurse, the unit educator, and the physicians. The students identify which person as the formal leader in the group? A. The unit educator B. The physicians C. The staff nurses D. The relief charge nurse

Answer: A Rationale: The unit educator holds the formal position designated by the agency. Physicians are not considered formal leaders. The staff nurses may be informal leaders but do not have a leadership position chosen by the organization. Relief charge nurse is usually not a formal position but rather one appointed for a shift as a designee by the manager.

"Nurses advancing our profession to improve health for all" is the mission statement of which professional group? A. American Nurses Association B. Institutes of Medicine C. Joint Commission D. Robert Wood Johnson Foundation

Answer: A Rationale: This is the mission statement of the American Nurses Association (ANA). The Institutes of Medicine and Robert Wood Johnson Foundation have collaborated on health issues and produced

A 28-year-old married woman received word that she is pregnant. Sadly, the patient is not able to carry the pregnancy because she suffers from long QT syndrome, which causes an abnormality of the heart, meaning any rush of adrenaline could prove fatal. The pregnant patient states, "I want to have this baby." The nurse realizes that this is a conflict that involves the which ethical principle? of A. utilitarianism. B. deontology. C. autonomy. D. veracity.

Answer: A Rationale: Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Veracity is telling the truth in personal communication as a moral and ethical requirement. Deontology is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Autonomy is the principle of respect for the individual person. All persons have unconditional intrinsic value. People are self-determining agents who are entitled to decide their own destiny.

The nurse believes that a patient who states he is in pain is "faking it" and is hoping to get "high." The nurse decides to give the patient a placebo instead of the pain medication that was ordered for the patient. The nurse is violating which principle(s) of ethics? Select all that apply. A. Autonomy B. Utilitarianism C. Beneficence D. Dilemmas E. Veracity

Answer: All but D Rationale: Autonomy is the principle of respect for the individual person; the nurse does not respect someone upon whom the nurse is inflicting harm. Beneficence is providing benefit to others by promoting their welfare. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the patient's pain medication and substituting saline, the nurse did harm, not good, for the patient. Veracity is truth-telling. The nurse misled the patient to believe he/she was receiving a dose of pain medication. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Because the patient's pain medication was taken away, the consequences were all bad. Dilemmas are not included as a principle of ethics.

The client wishes to designate another person to make health care decisions on the client's behalf if the client is unable to do so. The nurse understands that this is called: A. Living Will B. Durable Power of Attorney C. Healthcare Designation Form D. DNR

Answer: B Rationale: A living will provides specific instructions about what medical treatment the client chooses to omit or refuse (e.g., ventilator support) in the event the client is unable to make such a decision. Through a durable power of attorney for health care, the client may designate another person (usually a family member, significant other, or close personal friend) as health care surrogate or health care proxy, and give that person power to make health care decisions on behalf of the client if the client is unable to do so. These may be combined into a single document or may be two separate documents. A DNR (Do Not Resuscitate) may be a part of an advance directive, but does not describe what the client desires here. A healthcare designation form does not exist.

A nurse reports to hospital administration regarding unsanitary practices of the hospital's general surgeon. Two months after reporting the findings, the nurse is terminated from her position. Which law would be enforced in this situation? A. HIPAA B. Whistleblower Protection Act C. Employee Protection Act D. Employer Accountability Act

Answer: B Rationale: A nurse who goes outside of the organization for the public's best interest when the organization fails to follow procedures regarding safety and client care is engaging in whistleblowing. The Whistleblower Protection Act of 1989 establishes certain protections for individuals who report gross misconduct on the part of their employers to authorities. To qualify for protection under the Act, the nurse must first make every effort to resolve the concern by following the internal reporting procedures of the agency that employs them. Additionally, an individual does not qualify for protection under the Act unless the employer has threatened or engaged in retaliation against the employee as a result of the employee making a complaint.

A nurse manager has the reputation of being an autocratic leader. Which statement by this manager would support that reputation? A. "I'd like to hear from you (addressing the staff) what your ideas are for promoting better morale in this unit." B. "The new work schedule is posted for the next 6 weeks." C. "I'm putting a suggestion box in the break room if anyone has ideas that would be helpful to the unit." D. "I put the new procedure manual out. Please add your comments to the blank sheet of paper attached to the front."

Answer: B Rationale: An autocratic leader makes decisions for the group and is likened to a dictator in that the autocratic leader gives orders and directions to the group, determines policies, and solves problems without input from the group. Creativity, autonomy, and self-motivation are group attributes that are not met with this type of leadership style. The other options would be more reflective of a democratic leader.

A patient and her husband used in vitro fertilization to become pregnant. The unused sperm were frozen so the couple could have more children later. They bore a little girl who was diagnosed with leukemia when she was 5 years old. The child now needs a bone marrow transplant (BMT). The best chance of a match for the BMT is a sibling. The couple would like to use the sperm to have another child so that they can increase the likelihood of a match. The nurse realizes that the unborn child poses an ethical dilemma involving which principle? A. Beneficence B. Human dignity C. Justice D. Veracity

Answer: B Rationale: Human dignity is the inherent worth and uniqueness of a person. Human rights are the basic rights of each individual. Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their welfare. Justice involves upholding moral and legal principles. Veracity is truth-telling.

A new nurse is assigned to the client who is disappointed by the care given by another nurse. The family of the client asks the new nurse how they can make a formal complaint. The nurse's best action is to: A. Refer them to the nurse manager. B. Offer to notify the agency patient advocate. C. Refer them to the physician. D. Have them contact the risk manager.

Answer: B Rationale: Most agencies have patient advocates whose job is to assist the client when conflict arises and to protect the client's rights. Neither the nurse manager nor the physician is the appropriate person to deal with the client. A risk manager is concerned with client and staff injuries.

A client reports to the nurse that the unlicensed assistive person (UAP) was violent toward the client during the client's bath and the client reveals a new bruise. The nurse knows that: A. The incident must be reported when the nurse is finished with morning assessments of all patients. B. The incident must be reported immediately. C. The patient is trying to retaliate against the UAP. D. The patient must report the incident to the nursing supervisor.

Answer: B Rationale: Nurses themselves have a legal obligation to report conduct that is incompetent, unethical, and illegal. This includes reporting violence, abuse, or neglect toward clients by other nurses and extends to reporting conduct involving third parties, including family members and other health care providers. Nurses are in a position to identify and assess cases of violence, abuse, and neglect. Assuming the patient is trying to retaliate against the UAP is incorrect and punitive towards the victim.

What is the goal of the professional nurse in the team leader role? A. Compliance with physicians B. Positive outcomes and patient satisfaction C. Satisfied physical therapists and occupational therapists D. Social service referrals for home care

Answer: B Rationale: Positive outcomes and patient satisfaction are goals of the professional nurse in the team leader role. Strong nursing leaders are in the best position to influence patient care and policy. A professional nurse would collaborate effectively with all team members; compliance connotes the inappropriate "handmaiden" role of a nurse. Satisfied health team members could improve outcomes, but that would not be the primary goal. Home care is not necessarily needed by all patients.

A family is struggling with the decision to remove life support on a child who was in a near-drowning accident. What is the best action for the nurse to take? A. Allow the family to grieve on their own and only intervene if family requests. B. Provide the family opportunity to talk about their decisions. C. Notify the family about the possibility of organ donation. D. Call the physician to be present at the client's bedside.

Answer: B Rationale: Some of the most frequent disturbing ethical problems for nurses involve issues that arise around death and dying. Nurses must learn to assist clients and families to discuss their options surrounding terminal care. It is appropriate for the nurse to provide the family opportunity to talk about their decisions. The family may wish to grieve on their own; however, the nurse must first assess to see if this is what the family requests. To notify the family of possible organ donation or to request the physician at the client bedside, is inappropriate.

The experienced nurse desires certification in a specialty practice area. The nurse understands that the American Nurses Credentialing Center (ANCC) does all except: A. Recognize health care organizations for nursing excellence through the Magnet Recognition Program. B. Provide credentialing to university nursing programs. C. Provide credentialing programs to certify nurses in specialty practice areas. D. Accredit providers of continuing nursing education and nursing specialty organizations.

Answer: B Rationale: The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), provides credentialing programs to certify nurses in specialty practice areas, recognizes health care organizations for nursing excellence through the Magnet Recognition Program, and accredits providers of continuing nursing education and nursing specialty organizations. The ANCC does not provide credentialing to university nursing programs.

A nurse is moving and will obtain a new job in the new state. Which statement is false regarding the model which allows the nurse to practice in more than one state? A. The license issuing state is responsible for any disciplinary action against the nurse's license. B. It allows for an additional license to practice in more than one state. C. Approximately half the states have entered the compact. D. It is named the Nurse Licensure Compact.

Answer: B Rationale: The Nurse Licensure Compact (NLC) is the model which allows the nurse to practice in more than one state. However, an additional license is not required to practice in another state. The NLC also states that the license issuing state is responsible for any disciplinary action against the nurse's license. Approximately half of all the states have entered this compact.

The nurse overhears a client on the phone arguing with someone about having the right to choose a healthcare plan. The nurse recognizes that the client's topic is addressed in: A. State law B. U.S. Advisory Commission on Consumer Protection C. The ANA Code of Ethics D. Medicare bill of rights

Answer: B Rationale: The U.S. Advisory Commission on Consumer Protection addresses the client's right to choose a healthcare plan. The ANA Code of Ethics determines the practice ethics of nurses. State laws are enacted from federal laws. Medicare does not have a bill of rights.

A nurse is asked to care for an openly gay client with AIDS. The nurse tells her supervisor that caring for the client is against her religious beliefs. Does this nurse have an ethical obligation to care for the client? A. No, because the client's behavior caused him to contract AIDS. B. Yes, unless the risk exceeds the responsibility. C. No, it may be distasteful to the nurse. D. No, the nurse does not have to violate religious beliefs.

Answer: B Rationale: The ethical obligation to care for an HIV-infected client cannot be set aside unless the risk exceeds the responsibility. The nurse has an ethical obligation to care for the client regardless of the client's reason for contracting the disease. The nurse's religious beliefs are not a valid reason to decline to care for the client. There are many times when caring for a client may be distasteful, but the client has the right to be cared for by the nurse.

The nurse hung a unit of blood on the wrong client, resulting in an anaphylactic reaction in the client. During the resuscitation, the nurse does not reveal that the wrong blood was given. Which moral principle was absent in the nurse's actions? A. Social justice B. Veracity C. Autonomy D. Human dignity

Answer: B Rationale: The moral principle of veracity refers to telling the truth, no matter the outcome. By lying, the nurse jeopardized the health of the client. Human dignity includes the belief of the inherent worth of the client. Autonomy is the right to self-determination. Social justice is the upholding of rules of equal treatment for all clients.

A 20-year-old client with Down syndrome lives in an assisted environment and works part-time. The parent of this client is adamant about refusing treatment whose side effects are unknown with Down syndrome clients. According to the nursing code of ethics, the nurse's first loyalty is to which person? A. The parent B. The client C. The nurse D. The physician

Answer: B Rationale: The nurse's first loyalty is to the client. Conflicts among obligations to families, physicians, employing institutions, and clients may arise because of the nurse's unique position. It is not always easy to determine which action best serves the client's needs.

Which statement is true regarding performance guidelines for nursing students? A. The student nurse practices under the faculty member's license while in the hospital. B. The student nurse will know the facility's policies and procedures before undertaking any clinical assignment. C. The student nurse may perform an intervention with which they are unfamiliar with as long as the nursing instructor is in the same unit. D. The student nurse's priority is to ease the burden of the staff nurse.

Answer: B Rationale: The nursing student is held accountable to the same standard of care as the licensed nurse. Clinical performance guidelines for nursing students includes the student's knowledge of the facility's policies and procedures before undertaking any clinical assignment. The student nurse will not perform an intervention with which they are unfamiliar with without the direct supervision of the staff nurse or nursing instructor. The student nurse does not practice under the faculty member's license and safety is the student nurse's priority, not easing the burden of the staff nurse.

A nurse protecting a patient's right to consent to a procedure is represented in which of the following answers? A. Finding that the informed consent document is not with the chart, the nurse gives the patient another consent document to sign before the procedure. B. When the nurse finds that the informed consent document is not yet complete, she holds the patient's pre-procedure narcotics until the physician can obtain patient consent. C. The nurse finds that the consent form is unsigned in the chart and waits until after the procedure to get the document signed. D. Knowing the patient is not competent to sign a consent form, the nurse asks the friend who came with the patient to sign it.

Answer: B Rationale: To be valid, information for consent must be given prior to the procedure by the provider who will be performing the procedure and the information given must include a description of the procedure, a description of the risks and benefits of the procedure, and a discussion of any alternatives to the proposed procedure. Consent by the patient must be voluntarily given, and the person who consents must have the capacity to consent. Capacity can be determined by the health care provider and may be affected by drugs or the current or underlying medical condition. If the patient is unable to give consent directly, he or she may designate a person who can give consent on his or her behalf. If such a person is not designated by the patient, most states provide a statutory solution or a law that lists "statutory surrogates."

The nurse is in a coffee shop and hears another health care provider discussing a client. The nurse is expected to: A. Report the incidence to the police department. B. Redirect the health care provider to maintain client privacy. C. Notify the state Board of Nursing D. Notify the client of the actions of the health care provider.

Answer: B Rationale: While discussing a client in public is not professional, reporting the incidence to the police department, notifying the Board of Nursing, or notifying the client of the incidence is inappropriate. Redirecting the health care provider to maintain client privacy is most correct.

Which ethical term matches this statement: "A problem for which in order to do something right you have to do something wrong"? A. Justice B. Veracity C. Ethical dilemma D. Fidelity

Answer: C Rationale: An ethical dilemma involves a problem for which in order to do something right you have to do something wrong. Justice involves upholding moral and legal principles. Veracity means telling the truth as a moral and ethical requirement. Fidelity is the principle that requires a person to act in ways that are loyal. In the role of a nurse, such action includes keeping promises, doing what is expected of you, performing your duties, and being trustworthy.

Which of the following is an example of a medical malpractice tort liability? A. A patient is informed of all known side effects of a medication and voluntarily takes the medication. The patient experiences an adverse effect from a medication prescribed by a physician. B. A nurse follows the standard of care for initiating an intravenous line, but the patient's vein bursts, causing a hematoma and the need for minor surgery to evacuate the fluid. C. A surgeon does not complete the postprocedure count process, and a sponge is retained in the patient's abdominal cavity. D. The Department of Justice fines an organization for releasing protected health information to a pharmaceutical company without individual patient consent.

Answer: C Rationale: For tort liability to attach, four elements must be satisfied: duty, breach, causation, and harm. An adverse effect experienced by a patient who was informed of all known side effects of a medication, is prescribed the medication, and voluntarily takes the medication is an adverse event, not a tort liability. When a nurse follows the standard of care for initiating an intravenous line, but the patient's vein bursts, this is an adverse event and not a tort liability. Releasing protected health information to a pharmaceutical company without individual patient consent is regulated by federal law enforcement; it is considered employer liability and may be considered to be criminal if proven to be purposeful and egregious.

A nurse manager is praised for establishing just culture on the unit. This manager displays all qualities except: A. Understands that errors are usually system failures, not human failures B. Encourages proactive system management C. Focuses on the individual rather than the whole culture of the unit. D. Promotes both individual and shared accountability

Answer: C Rationale: Just culture is based on the understanding that errors are often the result of system failures rather than human failures. Just culture focuses on the system rather than the individual while still maintaining an environment of individual and shared accountability for front line staff, leaders and managers. Successfully establishing an environment of just culture requires leadership to encourage proactive system management.

The experienced nurse understands that a client has both rights and responsibilities regarding their healthcare. The client's healthcare responsibilities include all except: A. Cooperating with the healthcare team B. Answering questions from the healthcare team C. Never refusing treatment recommended by the healthcare team D. Following the treatment plan recommended by the healthcare team

Answer: C Rationale: Most hospitals now publish lists of patient responsibilities, emphasizing that healthcare is a partnership between the patient and caregivers, that other patients have a right to be comfortable too, and that there are consequences if patients don't comply with treatment plans. Common patient responsibilities include cooperating with the healthcare team, answering questions from the healthcare team, and following the treatment plan recommended by the healthcare team. The patient always has the right to refuse treatment.

The professional nurse understands that negligence is nursing conduct that deviates from what a prudent nurse would perform in a particular circumstance. Negligence regarding client care includes all statements except: A. Failure to follow standards of care B. Failure to use equipment in a responsible manner C. Failure to attend staff meetings D. Failure to assess

Answer: C Rationale: Negligence is nursing conduct that deviates from what a prudent nurse would perform in a particular circumstance. Negligence regarding client care includes: failure to follow standards of care, failure to use equipment in a responsible manner, and failure to assess. It also includes failure to communicate, failure to document, and failure to act as a client advocate. While the nurse who does not attend meetings may be failing to meet staff standards, it is not a criteria of client negligence.

An ICU nurse reads a physician's order from the client's chart but is unsure of the dose of medication ordered. The nurse's best action is to: A. Assume the dose given is the standard dose. B. Ask the charge nurse to interpret the order. C. Seek clarification from the ordering physician. D. Ask the resident who is in the unit to interpret the order.

Answer: C Rationale: Nurses can minimize risk by analyzing procedures and medications ordered by the physician. It is the nurse's responsibility to seek clarification of ambiguous or seemingly erroneous orders from the prescribing physician. Clarification from any other source is unacceptable and is regarded as a departure from competent nursing practice. A negligent nurse assumes the dose is the standard dose given.

The charge nurse takes the new nursing student around to introduce the student to the staff members. The student recognizes that the charge nurse is: A. Knowledgeable about the clients on the unit B. Competent at nursing care C. Committed to socializing the student to the unit D. Following the orders of the manager

Answer: C Rationale: One of the best ways to show commitment to nursing is to treat students and new nurses in a way that makes them feel welcome to the profession by introducing them to unit members. The student would be unable to determine the competence or knowledge of the charge nurse from this exchange. The charge nurse may be following the unit manager's orders, but if it is performed in a warm manner, the conduct would be seen as a positive by the student.

A student nurse who has free time on the unit would best show commitment by: A. Following the charge nurse B. Checking in with each client again C. Reviewing the organizational disaster plan D. Taking the assigned break early

Answer: C Rationale: Organizational and/or professional commitment is best demonstrated by the student nurse reviewing the disaster plan of the hospital and unit. It indicates that the student is committed to the safety of all. Checking with the clients again may disturb the clients from needed rest. Following the charge nurse is good if the charge nurse is agreeable, but reviewing the disaster plan is better. Taking the assigned break early is not a sign of commitment.

A nurse participates in the hospital's Quality Improvement (QI) committee. What quality is the nurse displaying? A. Professional commitment B. Informatics C. Organizational commitment D. Personal competence

Answer: C Rationale: Organizational commitment is the loyalty and responsibility displayed by the nurse to the organization and its policies. While the nurse may also be displaying professional commitment, the nurse is showing more organizational commitment. Personal competence and informatics do not apply here

A nurse facing an ethical dilemma knows that decisions should be based on a decision-making model named: A. Johnson and Johnson B. Croft and Appleton C. Thompson and Thompson D. Redman and Redman

Answer: C Rationale: Responsible ethical reasoning is rational and systematic. It should be based on ethical principles and codes rather than on emotions, intuition, fixed policies, or precedent. Two decision-making models include the Thompson and Thompson model and the Cassells and Redman model. The options Croft and Appleton, Redman and Redman, and Johnson and Johnson do not exist.

A client asks the nurse why the client's friend cannot view the client's medical record. The nurse's best response is: A. "It is illegal for your friend to request access to your medical file, even if you consent to it." B. "Your friend cannot see your protected health information because it is our manager's policy." C. "It is illegal for me to give out your protected health information to your friend." D. "Your friend must have a doctor's order to view your health record."

Answer: C Rationale: The Privacy Rule under the Health Insurance Portability and Accountability Act (e.g., HIPAA), protects all protected health information and also includes provisions for the protection of clients that address access to medical records. It is illegal for the nurse, under this act, to give out the protected health information of the client without the consent of the client. If the client consents to the release of information, a form is signed and information may be released. The doctor does not authorize who views the client's medical record and it is not the policy of the manager, rather, the law under HIPAA that protects the patient's medical record.

Which situation is a violation of the underlying principles associated with professional nursing ethics? A. A client reports that he didn't tell the doctor the truth when asked if he was following his therapeutic diet at home. B. The hospital policy permits use of internal fetal monitoring during labor even though there is literature that both supports and refutes the value of this practice. C. A nurse colleague states, "I never look up medication indications. I just give what is prescribed." D. The nurses on the unit agree to sponsor a fund-raising event to support a labor strike proposed by fellow nurses at another facility.

Answer: C Rationale: The nurse has an ethical responsibility to act only when actions are safe or risks minimized. This nurse is putting the client at unnecessary risk for a medication error. Many medical practices are controversial but not necessarily unethical; the nurse should follow the agency policy. Although some may view nurses' strikes as unethical, supporting others who are striking is a personal decision. A client's statement to a nurse may have ethical overtones, but it does not automatically constitute an ethical dilemma. Since the assigned primary care provider is a member of the team, principles of confidentiality do not include him or her.

A terminally ill client asks the nurse to provide her with information on medical marijuana use, which is legal in the state she lives in. Which is the best response by the nurse? A. "You shouldn't take drugs." B. "I will notify your physician regarding your desire for more information." C. "Marijuana has been shown to be effective for certain conditions that have not responded to conventional therapy." D. "I cannot give you any information regarding that therapy."

Answer: C Rationale: The nurse is aware that marijuana has been shown to be effective for a condition a client has that has not responded to mainstream therapies. Although the nurses' personal moral issues may be involved, the nurse must determine whether, ethically, the client should be made aware of a potentially effective alternative. Telling the patient that they shouldn't take drugs is inappropriate because, in this case, marijuana for medical use is legal. Refusing to provide the client information and referring the client to their doctor for information regarding therapy, are incorrect answers.

A staff member suggests a change in how the unit delivers care. The unit manager uses transformational leadership skills by responding: A. "I think what we are doing works well enough." B. "It might upset the clients if we make a change in care delivery." C. "Perhaps you could form a committee and submit a proposal." D. "Why would you want to change our system?"

Answer: C Rationale: The successful manager would respond by asking the staff to submit a proposal for changing delivery of care since this may speak to not only staff satisfaction, but also client satisfaction. Being open to change is a hallmark of an effective leader. Telling the staff that the current system is fine will breed dissatisfaction by the staff and may reduce the staff's trust in the manager. Stating that the clients might not like a change is excuse-making and not an effective trait. Questioning the staff about wanting a change is a challenge and will not be received well by the staff.

To enter the nursing profession, an individual must successfully complete which criterion? A. Clinical checklist B. A graduate degree C. Licensure examination D. Ongoing education

Answer: C Rationale: To enter the nursing profession, an individual must have successfully completed a state board-credentialed education program (a minimum educational requirement) and passed a common licensure examination. Clinical checklists may be helpful but are not a required component of an educational program. There are a variety of educational programs that prepare individuals for the role of professional nurse, ranging from associate to doctoral degrees. A graduate degree is not a requirement. Ongoing education and clinical competence are expectations for continued practice but are not required for entry into the profession.

A client with cancer has decided against further treatment. Which action by the nurse would be most appropriate? A. Accepting the decision and making no comments to the client. B. Informing the client's spouse, and encouraging the spouse to talk to the client and intervene, if necessary. C. Making sure the client has accurate information and understands the consequences of the decision. D. Talking to the client and trying to persuade the client to think about reversing the decision.

Answer: C Rationale: To protect the client effectively, the nurse needs to understand what has influenced the client's decision and whether the client has thought about the results of the decision. The other choices do not respect the client's right to choose.

A client asks the nurse not to tell his wife that he has cancer. What would be the most appropriate response by the nurse? A. "I'm sorry, but the doctor already told her." B. "Why are you afraid to tell her?" C. "What benefits do you see from not telling your wife your diagnosis?" D. "Don't you think she has a right to know?"

Answer: C Rationale: When presented with an ethical situation, identify the moral issues and principles involved. The nurse should discuss the reasons the client does not want his wife to know the diagnosis. This will clarify the benefits the client sees in his decision. The other choices are disrespectful of the client's wishes, or imply something about the client that may not be true.

A homeless man presents to the emergency room with hypothermia. He tells the nurse that he is positive for human immunodeficiency virus (HIV) and sought revenge by deliberately having sex with his mate, who does not know of his HIV status. This patient is violating which ethical principle? A. Veracity B. Beneficence C. Nonmaleficence D. Autonomy

Answer: C Rationale: Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The patient is definitely violating this principle through his actions. Veracity is telling the truth in personal communication. Beneficence is promoting goodness, kindness, and charity. Autonomy is the principle of respect for the individual person. This concept maintains that all persons have unconditional intrinsic value.

A client's health care proxy requests access to all of the client's records. Which response from the nurse is correct? A. "Of course. Let me call the client's physician to get the order for the release of medical records." B. "I am sorry but the client must first give you permission to access the records." C. "I am sorry but due to HIPAA laws, I cannot allow you to access the records." D. "Of course. Let me call the Health Information Services department to get you help in accessing all the records."

Answer: D Rationale: A client's health care proxy, or surrogate decision maker, has legal rights to access the client's medical record because the client has signed an advance directive allowing this person to do so. The other responses are incorrect.

A 67-year-old male client states that he and his 37-year-old wife would like to have a child. A 23-year-old surrogate will carry the child. Which response by the nurse is most appropriate? A. "You could adopt a child instead." B. "You will be 87 when your child is 20." C. "Why isn't your wife carrying your own child?" D. "I will ask our counselor to give you additional information."

Answer: D Rationale: A moral framework guides moral decisions, but it does not determine the outcome. The decision is the family's decision, not the nurse's decision. Providing the client and his wife with more information is the most appropriate response. The other responses are judgmental and inappropriate.

A client with terminal cancer is dying, refusing food and fluids, and pushes the caregiver's hands away when he or she attempts to feed the client or offer any kind of fluid. The family is considering placing a gastrostomy tube because they feel the client is "starving to death." The nurse should: A. Talk to the physician so he or she can move forward with the family's wishes. B. Take the case to the hospital's ethics committee. C. Honor the family's wishes and have them sign a consent form. D. Honor the client's refusal and help the family come to terms with the situation.

Answer: D Rationale: A nurse is morally obligated to withhold food and fluids if it is determined that it is more harmful to administer them than to withhold them. The nurse must also honor competent patients' refusal of food and fluids. This position is supported by the ANA's Code of Ethics for Nurses, through the nurse's role as a client advocate and through the moral principle of autonomy. Clients, not their families, should make decisions about their own health care and treatment. The physician may or may not be involved but not to disregard the client's refusal. An ethics committee is usually considered when there is an ethical dilemma and more input is needed to make a decision. In this case, the client has made a decision and it should be honored.

The client's right to informed consent is mandated in which document? A. American Nurses Association Standards of Practice B. American Nurses Association Code of Ethics C. Nurse bill of rights D. Patient Self-Determination Act

Answer: D Rationale: All clients have certain rights. Some of these are guaranteed by federal law, such as the right to informed consent mandated in the Patient Self-Determination Act. The ANA's Standards of Practice and Code of Ethics pertains to the nurse, not to the client. The nurse bill of rights does not exist.

The parents of a child with no apparent brain function refuse to permit withdrawal of life support. Which moral principle is applied with the nurse's action to support the family's decision? A. Beneficence B. Justice C. Nonmaleficence D. Respect for autonomy

Answer: D Rationale: Autonomy is the client's (or surrogate's) right to make his or her own decision. The nurse is obliged to respect a parent's or significant other's informed decision regarding the client. This situation is not one of nonmaleficence (do no harm) or beneficence (do good). Justice (fairness) generally applies when the rights of one client are being balanced against those of another client.

A nurse practices beneficence when teaching a class of adolescents about the risks of drinking and driving. Beneficence is best described as: A. Do no harm and safeguard the client. B. Always telling the truth C. The right to self-determination D. The actions one takes should promote good.

Answer: D Rationale: Beneficence means "the actions one takes should promote good." A nurse teaching a class of adolescents is promoting the health and well-being of the community. Veracity is always telling the truth. The right to self-determination is autonomy. Nonmaleficence means to do no harm and safeguard the client.

A PICU nurse receives a high risk medication from the pharmacy to administer to the child client. The nurse acting to reduce risk will perform all actions except: A. Ensure dosage calculation is correct by having a second nurse check the dose. B. Ensure the rights of medication are correct. C. Calculate child's body weight in kg. D. Administer the dose after reading the label ensuring correct medication.

Answer: D Rationale: Children are at a higher risk for medical error than other patients and also may be more vulnerable to harm from errors due to their immature physiology. Medication dosage calculations for children are more complex than those for adults, thus increasing risk. Many medications are produced in adult concentrations requiring dilution, or dosages must be calculated based upon weight or body surface area. This means that the optimal dose is based on mg/kg and divided by number of doses to be given a day. The nurse always ensures the 5 rights of medication are present and having a second nurse check the dose reduces risk. Administering a medication without first checking the dose is incompetent and negligent.

A new nurse manager surveys the unit for areas of improvement. Which situation would concern the nurse most? A. Unit secretary has access to all patient names on the unit. B. A computer printer is located near the telemetry monitor. C. Staff uses passwords to access point of care computers. D. An open trashcan near the unit's copy machine.

Answer: D Rationale: Copies of patient health information can easily be discarded into an open trash can and read by unauthorized persons, thus breaking confidentiality. All the other choices are appropriate situations and would not concern the nurse.

A hospice nurse is caring for a terminally ill client with an inherited genetic disease. The role of the nurse in caring for the client includes: A. Notifying the Public Health Department regarding the genetic disease B. Asking all family members to be tested for the genetic disease C. Discussing birth control methods to family members of the client who are of child-bearing age D. Providing support to the client's family

Answer: D Rationale: During hospice care, hospice nurses may need to provide support to both clients and families affected by conditions known to have genetic predisposition. Asking family members to have genetic testing, discussing birth control methods, and notifying the Public Health Department are all inappropriate responses.

A nurse discovers that the pharmacy dispensed the wrong medication for the client. The best response to the pharmacy from the nurse is: A. "It is okay. No one needs to know about this." B. "You really need to pay closer attention." C. "I am glad we caught it. Do you want me to fill out the incident report or will you?" D. "I am glad we caught it. Please send the correct medication for the client."

Answer: D Rationale: In a just culture environment, each member has the responsibility to take action to prevent errors and respond to errors, recognizing that errors are more often the result of system failures than individual error. When individual error does occur, it is more likely to be accidental than willful or neglectful. The nurse's response to send the new medication is most appropriate because it is not punishing nor intimidating and suggests a shared accountability. The error should be reviewed to prevent any further errors like it; however, in this case an incident report implies a punishment. Telling some to pay closer attention is punishing and inappropriate. Not discussing the error is also inappropriate.

The competent nurse understands that informed consent differs from expressed consent in that: A. Informed consent for surgery is performed by the nurse, while the patient provides expressed consent to the procedure. B. There are no differences in these two types of consent. C. Informed consent is obtained when the client is properly informed of the procedure, while expressed consent is given when the physician agrees to perform the surgery. D. Informed consent refers to the client's legal and ethical rights to be informed of a procedure, while expressed consent is the client's oral or written agreement to a procedure.

Answer: D Rationale: Informed consent refers to the client's legal and ethical rights to be informed of a procedure, while expressed consent is the client's oral or written agreement to a procedure

A client requests information on completing an advance directive. The nurse knows that an advance directive: A. Cannot be utilized as a legal document B. Has been used in 35 of the 50 states in the United States C. Must always include a Do Not Resuscitate (DNR) clause D. Legal document representing a client's end-of-life decisions

Answer: D Rationale: Many moral problems surrounding the end of life can be resolved if clients complete advance directives. Currently, all 50 states have enacted advance directive legislation. Advance directives are legal documents representing a client's end-of-life decisions; they may include how clients want medical decisions to be made or whom they would like to make those decisions. An advance directive may include a DNR clause, but it is not mandatory.

A client notifies the nurse that he feels like his physician has mistreated him and violated his rights. The nurse will refer the client to: A. The house supervisor to ensure that the client's rights are maintained B. The police to file a report on the physician's behavior C. The physician to discuss the client's concerns D. The patient advocate to ensure that the client's rights are maintained

Answer: D Rationale: Many people encounter what they view as mistreatment or violations of their rights during the course of their experiences in the healthcare system. Many hospitals and large provider agencies have client advocates who can help clients navigate their system and intervene to ensure that their rights are maintained. It is inappropriate for the nurse to make the client speak to the physician whom the client feels violated their rights. It is also inappropriate to file a police report as more information regarding the compliant must be discussed. The nurse might discuss the patient's concerns with the charge nurse; however, the house supervisor would not be notified initially by the nurse.

A nurse working in the emergency department is caring for a child with ligature markings on his arms and legs and multiple unexplained bruises. The nurse's next action should be: A. Ask the child, with parents at bedside, what caused the suspicious markings. B. Ask the parents what happened to the child. C. Report the findings to the child's parents at the bedside. D. Report the findings to the physician and the charge nurse.

Answer: D Rationale: Reporting of abuse or suspected abuse of vulnerable individuals is mandated in most states. As a general rule, the nurse reports the required information through the administrative chain of the institution, beginning with the nurse's immediate supervisor and the primary health care provider. All information reported is documented in the client record. In most states, mandatory reporters are required only to have a good faith suspicion, based on information disclosed by the client and/or on physical symptoms manifested by the client. All other responses are incorrect and jeopardize the child's safety.

The student is held to the same legal standards that licensed nurses are held. In an effort to understand these standards, the student plans to: A. Meticulously follow physician orders. B. Study the standards of the American Nurses Association (ANA). C. Perform only tasks assigned by the instructor. D. Study the state's nurse practice act.

Answer: D Rationale: Since student nurses are held to the same standards as other nurses, the student should plan to know the state's nurse practice act before clinical rotations begin. The ANA standards of care do not reflect the law in every state. Physicians can make errors and are not always aware of the state laws regarding nursing practice. It is possible for the instructor to make an error, so the student should be aware of the law.

A nurse decides that attending an upcoming workshop about new pharmacological treatments would benefit their practice. This nurse is modeling which standard of professional performance? A. Education B. Quality of practice C. Research D. Professional practice evaluation

Answer: D Rationale: Standards of professional performance describe a competent level of behavior in the professional role. Professional practice evaluation, Standard 9, is behavior that evaluates one's own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. Deciding to enhance one's current knowledge base, in relationship to one's own practice, would describe this standard. Quality of practice is a systematic approach to enhance the quality and effectiveness of nursing practice. Education is knowledge attainment and competency that reflects current nursing practice. Research integrates research findings into practice.

Which of the following statements is true regarding The Joint Commission's authority relating to health care organizations? A. The Joint Commission standards have the same effect as law, and organizations can be fined by The Joint Commission for noncompliance. B. The Joint Commission regulations have no effect on the legal process in health care. C. The Joint Commission serves as an adviser to the federal government in establishing fines related to noncompliance. D. The Joint Commission regulations may be seen as having the effect of law because they accredit organizations to bill Medicare and the standards are frequently used in malpractice cases

Answer: D Rationale: The Joint Commission standards do not have the same effect as law; however, they are often utilized as best practice standards in a malpractice case against which negligence is measured. The Joint Commission does not establish fines for noncompliance.

The charge nurse on a unit with nurses from all generational groups is informed that a client will be admitted who has been in a serious ATV accident. The charge nurse expects which nurse to volunteer to be the primary caregiver for this client? A. The baby boomer nurse B. The veteran nurse C. The generation X nurse D. The millennial generation nurse

Answer: D Rationale: The millennial generation thrives on new challenges and would jump at the chance to take a client of this type. The veteran nurse and baby boomer would more likely prefer to back up the younger nurse in order to ensure that the client's needs are met. The generation X nurse also seeks challenges but might not want to abandon current clients. The expectation is that all groups would pitch in and help as needed as part of the nursing commitment.

The nurse manager hears that there is difficulty with a staff nurse who is consistently a few minutes late for work every time the nurse is scheduled to work. The nurse manager suspects this person is: A. A member of the millennial generation B. A veteran C. A baby boomer D. A member of generation X

Answer: D Rationale: The most likely candidate to be late is the generation X nurse because this group believes that having control of their time is an important need. A millennial generation nurse might be the second most likely one to be late, but this group is highly motivated to succeed and highly productive. The veteran nurse and baby boomers are loyal and have a respect for authority, recognizing that tardiness causes disruption in the unit functioning.

A nurse includes the client in decision-making when various planned activities would be most convenient for the client. The nurse benefits from this professional behavior because: A. Work will be completed on time. B. The client will do most of the work. C. The client's family will help with the work. D. The nurse gains the trust of the client.

Answer: D Rationale: The nurse including the client in the process is demonstrating respect for the client, which will build the client's trust in the nurse. Gaining trust does not help the work load. The client may or may not participate in care; that depends on the client's abilities. The family's participation in the client's care is not in evidence here.

A client asks the nurse to explain the physician ordered diet and for assistance in making good food choices. The nurse's best response might be: A. "I can't help you with that." B. "You will need to limit your carbohydrate intake." C. "You will need to monitor your food so that you get more vitamin K." D. "Let's sit and talk about the questions you might have."

Answer: D Rationale: The professional nurse will assess the client's level of knowledge and then deal with the specific questions on a level easily understood by the client. It would be unprofessional to tell the client the nurse cannot help the client. It would also be unprofessional to tell the client to limit carbohydrates since carbohydrates are found in all sources of food. Again, to simply tell the client to increase vitamin K intake, without assisting the client with the knowledge of foods high in vitamin K, would be unprofessional.