Advocacy/ Ethical/ Legal Issues
A nurse in charge in the surgical intensive care unit notes that a number of clients do not seem to be responding to morphine that was administered for pain. Later in the evening the nurse finds a staff nurse dozing in the nurses' lounge. When awakened, the staff nurse appears uncoordinated and drugged, with slurred speech. What should the nurse in charge do?
Ask the nurse manager to be present before confronting the staff nurse
Nurses have to make sure that the patient is competent to make an informed consent.
Competency
What is this an example of? 17 YO cancer patient doesn't want to have any more medical treatment, but parents want them to. They do not have a legal right to this decision, but they are competent enough to make this decision.
Competency
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
ANA Code of Ethics Provision 1
The professional obligation of a nurse to assume responsibility for actions is referred to as what?
Accountability
A nurse developed and implemented a discharge teaching plan based on the specific needs of a hospitalized client. Which element of decision-making does the primary nurse exhibit in this situation?
Autonomy
What is this an example of? A patient decides not to do any treatment and wants to leave the hospital against the advise of the physician. The nurse knows that this would not be in the best interest of the patient.
Autonomy
A nurse assisting in a research study calculates the risk-benefit ratio and concludes that there were no harmful effects associated with a survey of diabetic clients. This researcher was applying which principle?
Beneficence
Taking positive action to help others; desire to do good
Beneficence
According to Swanson's caring process, the nurse must know the client. Which factors enable the nurse to know the client better? -Economic constraints -Continuity of care by the nursing staff -Fewer nurses in the healthcare facility -Collection of data about the client's clinical condition -Engagement in a caring relationship without assumptions
Continuity of care by the nursing staff, collection of data about the client's clinical condition, and engagement in a caring relationship without assumptions.
An unemancipated pediatric client is to undergo a routine medical procedure. Who is the appropriate authority to provide consent?
Either of the child's parents
What does the professional nurse consider to be the center of decision-making when providing client care?
Ethics of care
What are the elements of discovery of a lawsuit? -Experts -Medical records -Proof of negligence -The depositions of witnesses -Petition-elements of the claim
Experts, medical records, and the dispositions of witnesses
A nurse leader is educating student nurses in helping clients to perform their difficult self-care activities. Which key idea from a Source of Power is this statement referring to?
Information power
Ensure that the patient understands all the information they need to know to make an informed decision.
Informed consent
To act daily and equitably
Justice
What is this an example of? You're taking care of a patient that does drugs/ smokes/ does a high risk behavior that causes damage to their body. You must treat these patients with the same fairness and respect as the patients who do not do these things.
Justice
A client who has a hemoglobin of 6 gm/dL (60 mmol/L) is refusing blood because of religious reasons. What is the most appropriate action by the nurse?
Notify the primary healthcare provider of the client's refusal of blood products
Patients have a right to control who sees their information
Patient confidentiality
The nurse is providing restraint education to a group of nursing students. The nurse should include that it is inappropriate to use a restraint device to do what?
Prevent an adult client from getting up at night when there is insufficient staffing on the unit.
It is determined that a staff nurse has a drug abuse problem. What approach to the staff nurse's addiction should be taken as an initial intervention?
Referred to the employee assistance program
Which nursing action is not likely to cause legal issues? -Using restraints on a non-cooperative client -Refraining from reporting suspected child abuse -Refraining from leaving the client during a staffing shortage -Allowing nursing assistive personnel (NAP) to administer medications
Refraining from leaving the client during a staffing shortage
What is the professional nurse's legal responsibility regarding child abuse?
Report any suspected abuse to local law enforcement authorities
While reviewing a client's prescriptions, the nurse finds that one of the prescribed drugs is redundant and notifies the primary healthcare provider. Which attitude of critical thinking does the nurse exhibit?
Risk taking
A client who has participated in caring for her infant in the neonatal intensive care unit for several days I preparation for the infant's discharge comes to the unit on the last hospital day with an alcohol odor on her breath and slurred speech. What is the most appropriate action for the nurse to take at this juncture?
Speak with the mother about her condition and assess her willingness to participate in an alternate discharge plan.
What legal complications might a nurse face for using a restraint without a legal warrant on a client?
The nurse may be charged with false imprisonment.
An elderly adult suffered an injury after falling down in the washroom. The primary healthcare provider performed a surgical procedure on the client and orders a blood transfusion. A family member of the client mentions that blood transfusions are not permitted in their community. What should the nurse do in order to handle the situation?
The nurse should inform the primary healthcare provider and not give blood to the client.
According to which stage of Kohlberg's theory would a nurse ask a higher authority to reduce the treatment expenses of a low-income client?
Universal ethical principle orientation
Truth telling
Veracity
What is this an example of? Wash hands and use sterile procedure before putting catheter in.
Nonmaleficence
What right of delegation refers to the giving of clear, concise descriptions of a task to the delegatee?
Right communication
The nurses primary commitment is to the patient, whether an individual, family, group, or population.
ANA Code of Ethics Provision 2
The nurse promotes, advocates for and protects the rights, health, and safety of the patient.
ANA Code of Ethics Provision 3
Respect for a person
Autonomy
The nurse is having difficulty understanding a client's decision to have hospice care rather than an extensive surgical procedure. Which ethical principle does the client's behavior illustrate?
Autonomy
A nurse on the medical-surgical unit tells other staff members, "That client can just wait for the lorazepam; I get so annoyed when people drink too much." What does this nurse's comment reflect?
Demonstration of a personal bias
A client in need of a lung transplant tells the nurse, "I will not take the organ of any person belonging to a different religion." The nurse initiates the process for resolving the ethical dilemma by collaborating with other healthcare team members. What should the team do after agreeing to a statement of the problem?
The team should determine all the possible courses of action based on available information.
The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
ANA Code of Ethics Provision 7
A primary healthcare provider notes that all conventional treatment procedures have proved to be ineffective in managing a client's disorder. The primary healthcare provider decides to try an experimental treatment. The nurse ensures that the client has understood the implications of the new treatment plan thoroughly and then signs the client's consent form as a witness. Which basic healthcare ethic does the nurse follow in this situation?
Autonomy
A client tells the nurse, "I am so worried about the results of the biopsy they took today." The nurse overhears the nursing assistant reply, "Don't worry. I'm sure everything will come out all right." What does the nurse conclude about the nursing assistant's answer?
It gives false reassurance
A nurse stops at the scene of an accident and finds a man with a deep laceration on his hand, a fractured arm and leg, and abdominal pain. The nurse wraps the man's hand in a soiled cloth and drives him to the nearest hospital. How will the nurse's behavior be interpreted?
The nurse is negligent and can be sued for malpractice
A nurse needs to obtain consent for the medical treatment of a child whose parent is a minor. What appropriate step should the nurse take to obtain consent?
The nurse should ask the minor to give consent
An elderly adult with Parkinson's disease falls while going to the bathroom and gets injured. The nurse taking care of the client informs the primary healthcare provider. What step should the nurse take to alert the risk management system?
The nurse should document the incident in the occurrence report tool
The profession of nursing, collectively through its professional organizations must articulate nursing values maintain the integrity of the profession and integrate principles of social justice into nursing and health policy
ANA Code of Ethics Provision 9
Which statement captures the essence of feminist ethics accurately? Which statement captures the essence of feminist ethics accurately? -Feminist ethicists propose that the value of something is determined by its usefulness. -Feminist ethicists propose that the greatest good for the greatest number of people is the right action. -Feminist ethicists propose that an action is right or wrong based on its "right-making characteristics." -Feminist ethicists propose that the natural human urge to be influenced by relationships is a positive value.
Feminist ethicists propose that the natural human urge to be influenced by relationships is a positive value.
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
ANA Code of Ethics Provision 6
What are the instances when an adult can give consent for medical treatment? -Any guardian for the adult's ward -Any parent for the adult's emancipated minor -Any parent for the adult's unemancipated minor -Any adult for the treatment of his or her minor brother or sister (if an emergency and parents are not present) -As a grandparent for a minor grandchild under normal circumstances
Any guardian, any parent for the adult's unemancipated minor, and any adult for the treatment of his or her minor brother or sister (if an emergency and parents are not present)
An ostomy specialist nurse is required to 'float' to the obstetric department. The nurse realizes that he or she lacks the required level of expertise to care for the clients in the unit. What course of action should the nurse take to deal with the situation?
Notify the nursing supervisor
The nurse has authority, accountability, and responsibility for nursing practice; make decisions; and takes action consistent with the obligation to promote health and to provide optimal care.
ANA Code of Ethics Provision 4
What problems may a nurse come across when dealing with ethical issues related to end-of-life care? -Clients are unable to communicate effectively. -All interventions for helping the clients seem futile. -Clients are often unfamiliar with the concept of autonomy. -Multiple medications affect the cognitive ability of the clients. -Predictions regarding health outcomes are not always accurate.
Clients are unable to communicate effectively, all interventions for helping the clients seem futile, and predictions regarding health outcomes are not always accurate.
A client with rheumatoid arthritis does not want the prescribed cortisone and informs the nurse. Later, when the nurse attempts to administer cortisone, the client asks what the medication is and the nurse gives an evasive answer. The client takes the medication and later discovers that it was cortisone. The client states an intent to sue. What factors in this situation must be considered in a legal action? -Clients have a right to refuse treatment. -Nurses are required to answer clients truthfully. -The healthcare provider should have been notified. -The client had insufficient knowledge to make such a decision. -Legally prescribed medications are administered despite a client's objections.
Clients have a right to refuse treatment, nurses are required to answer clients truthfully, and the healthcare provider should have been notified.
How would the student nurse describe a quasi-intentional tort occurring during the practice of nursing?
It is an act that lacks intent but involves volitional action
A nurse is teaching a client about false imprisonment. What information should the nurse provide?
It is an example of an intentional tort, it involves restraining a person unjustly without any legal warrant, and the clients should be aware of his or her confinement.
An older, confused client is being cared for at home by an adult child who works full-time. The client has lost weight and is wearing soiled and inappropriate clothing. The home care nurse suspects elder neglect. What should the nurse do?
Report the suspicion of neglect by the adult child to adult protective services.
A registered nurse is teaching a nursing student about malpractice insurance. Which statement by the nursing student requires correction? -"Malpractice insurance provides for a defense when a nurse is alleged to have committed professional negligence or medical malpractice." -"Most private insurance policies for nurses are primary policies that begin covering the nurse even before all hospital insurance coverage has been exhausted." -"If both the employing institution and the nurse are sued, the nurse needs to notify his or her private insurance carrier of the lawsuit, even though the nurse has insurance through the hospital." -"If both the hospital policy and the private policy are considered primary and the hospital loses as a result of the nurse's act, the hospital may sue the nurse's private insurer to recover its losses."
Most private insurance policies for nurses are primary policies that begin covering the nurse even before all hospital insurance coverage has been exhausted.
Agreement to keep our promises
Fidelity
Do no harm
Nonmaleficence
A person's right to decide what is done to them
Right to Self- determination
A nurse is examining different scenarios related to defamation of character. Which scenarios are examples of slander? -A nurse gives detailed information about the progress of an illness to a client's employer. -A nurse informs the primary healthcare provider falsely that a client shows signs of drug abuse. -A nurse notes that a client has contracted syphilis even though the client does not have the infection. -A nurse informs the client's caregivers that the client is aggressive, even though there is no evidence. -A nurse warns a colleague that a client displays inappropriate sexual behavior when no such event happened.
A nurse informs the primary healthcare provider falsely that a client shows signs of drug abuse, a nurse informs the client's caregivers that the client is aggressive, even though there is no evidence, and a nurse warns a colleague that a client displays inappropriate sexual behavior when no such event happened.
The family of an older adult who is aphasic reports to the nurse manager that the primary nurse failed to obtain a signed consent before inserting an indwelling catheter to measure hourly output. What should the nurse manager consider before responding?
A separate signed informed consent for routine treatments is unnecessary.
The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth
ANA Code of Ethics Provision 5
The nurse collaborates with other professionals and the public to protect human rights promote health diplomacy and reduce health disparities.
ANA Code of Ethics Provision 8
The nurse informs a client's family that the client is in pain and does not wish to proceed with chemotherapy. What is the role of the nurse in this situation?
Advocate
A client is admitted to the hospital for acute pain in the hip, and a total hip replacement surgery is scheduled. The client was diagnosed recently with early dementia. The client appears oriented and alert and responds appropriately when interviewed. When the nurse is providing preoperative teaching, the client says, "I don't want to have that surgery." The client's spouse voices a desire to proceed with the surgery to provide relief for the client. How should the nurse respond?
Ask the client if a power of attorney for health care has been established
A registered nurse is educating a nursing student on the various classifications of torts. What acts are classified as intentional torts in nursing practice?
Battery, assault, and false imprisonment.
A nurse withholds a prescribed opioid medication from a client with intractable pain because the nurse fears the client will become addicted. In this situation the nurse is adhering to which ethical principle?
Beneficence
What is this an example of? A nurse gives a pain medication to a patient 30 minutes prior to completing a complicated dressing change.
Beneficence
What is this an example of? Put a catheter in a patient that is in pain from lack of urination.
Beneficence
A nurse is recalling common terms that are used in health ethics. What does beneficence in health ethics refer to?
Beneficence refers to taking positive actions to help others
How does a nurse adopt the element of right circumstances during a task delegation?
By considering the appropriate client setting, available resources, and other relevant factors
A critical care nurse scheduled to be off work for a long weekend, is telephoned at 2 AM to come to work to assist with the care of multiple trauma victims. The nurse has a 15-year-old son, a 10-year-old daughter, and a spouse who is not expected to return from work until 8 AM. What should the nurse do first?
Call her spouse
A 20-year-old developmentally challenged woman is a resident in a group home. She has had four abortions in the past 2 years, and the agency supervisor recommends that she be sterilized. It is obvious that the client is unable to exercise informed consent for sterilization. The nurse understands that the procedure cannot be performed without legal consent from whom?
Court- appointed individual or group
What is this an example of? Before surgery the physician has to talk to the patient about the procedure, what is going to happen, everything that could happen (good/ bad/ ugly), and fully inform the patient before the patient can sign the consent from.
Informed consent
A visitor from a room adjacent to a client asks the nurse what disease the client has. The nurse responds, "I cannot discuss any client's illness with you." What legal issue supports the nurse's response?
Invasion of privacy
A nursing team leader identifies that a nurse is coming to work after drinking alcohol. What is the most appropriate way for the team leader to approach this ethical situation?
Notify the nurse manager about the problem
A child admitted to the hospital is in need of a life-saving heart transplant surgery. However, the parents refuse to allow the surgery stating that such surgeries are against their belief system. The nurse in charge of the client recognizes the situation as an ethical dilemma. What first step should the nurse take in order to resolve the dilemma?
Obtain information from the child, the parents, health care workers, and other sources.
When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes what important components? -Planning for future safety -Normalizing victimization -Validating the experiences -Promoting access to community services -Providing housing for the victim
Planning for future safety, validating the experiences, and promoting access to community services.
What are the best ways for a nurse to be protected legally? -Ensure that a therapeutic relationship with all clients has been established. -Provide care within the parameters of the state or provinces standards for nursing practice. -Carry at least $100,000 worth of liability insurance. -Document consistently and objectively. -Clearly document a client's nonadherence to the medical regimen.
Provide care within the parameters of the state or provinces standards for nursing practice, document consistently and objectively, and clearly document a client's non adherence to the medical regimen.
A primary nurse completes a nursing assessment of all assigned clients and develops a care plan for each client. Which element of decision-making does the nurse execute in this situation?
Responsibility
Litigation resulting from improper restraint use is a common nursing legal issue. A nursing student is listing points related to the use of restraints. Which factor needs correction? -Restraints can be used when less restrictive interventions are not successful. -Restraints can be used when all other alternatives have been tried and exhausted. -Restraints can be used only to ensure the physical safety of the resident or other residents. -Restraints can be used anytime without a written order from the healthcare provider.
Restraints can be used anytime without a written order from the healthcare provider
Two 14-year-old girls are best friends and always eat lunch together at school. One of the girls eats rapidly and then immediately leaves to go to the girls' restroom. After a week or so the other girl begins to suspect that her friend is using self-induced vomiting to keep her weight down. Because the friend is not sure what to do, she speaks with a relative who is a nurse. What should the nurse encourage her to do?
Talk to the school nurse about her concerns
A nurse signs as a witness to informed consent provided by the client. What does the signature of the nurse imply? -That the client's signature is authentic -That the client has given consent voluntarily -That the client appears to be competent to give consent -That the client cannot refuse treatment after its initiation -That the client has received a proper explanation of procedures from the nurse
That the client's signature is authentic, that the client has given consent voluntarily, and that the client appears to be competent to give consent.
The condition of a child dying of leukemia deteriorates, and the child becomes comatose. The parents state that a relative told them that they should not allow the child to be resuscitated, but they are unsure. Which response by the nurse best demonstrates recognition of the ethical issues involved? -"Let me tell you about the implications of a DNR order, and then you can decide." -"Maybe you should talk with your doctor first; I'll be happy to make the call for you." -"You should discuss this thoroughly with your doctor and with your religious adviser." -"The final decision must be made by you and your doctor, but it's important to talk about it."
The final decision must be made by you and your doctor, but it's important to talk about it.
A registered nurse is educating a nursing student about licensure. What information should the nurse provide? -"The hearing for suspension or revocation of a license occurs in a formal courtroom setting." -"The hearing for suspension or revocation of a license is conducted by a panel of professionals." -"The state board of nursing may revoke a license in case of a violation without informing the nurse." -"The nurse must be notified of any charges against him or her and given an opportunity to defend him or herself." -"The state board of nursing may revoke or suspend a license if a nurse's conduct violates provisions in the licensing statutes."
The hearing for suspension or revocation of a license is conducted by a panel of professionals, the nurse must be notified of any charges against him or her and given an opportunity to defend him or herself, and the state board of nursing may revoke or suspend a license if a nurse's conduct violates provisions in the licensing statutes.
A nurse is taking the vital signs of a client who has just been admitted to the healthcare facility. Which intervention by the nurse provides greater client satisfaction? -The nurse records the vital signs and leaves the room. -The nurse adjusts the bed and asks if the client is comfortable. -The nurse leaves the door of the room open while attending to the client. -The nurse tells the client that the primary healthcare provider will visit soon.
The nurse adjusts the bed and asks if the client is comfortable
A nurse notes that the primary healthcare provider has scheduled a surgery for an unconscious client. An informed consent has not yet been obtained. What course of action does the nurse expect to be taken to deal with the situation?
The surrogate decision maker designated by the client will give consent
A client who is admitted to the hospital and requires a colon resection states, "I want to be a do not resuscitate (DNR)." The nurse questions the client's understanding of a DNR order. Which response by the client best indicates to the nurse an understanding of a DNR order? "My doctor will know what to do." "My family can make the decisions for me." "If something happens to me, I would rather die." "If I have a heart attack, I do not want any medication."
"If something happens to me, I would rather die"
Before a treatment requiring informed consent can be performed, what information must the client be given? -The cost of the treatment -Alternative treatment options -The risks and benefits of the treatment -The risks involved in refusing the treatment -The nature of the problem requiring the treatment
Alternative treatment options, the risks and benefits of the treatment, the risks involved in refusing the treatment, and the nature of the problem requiring the treatment.
A nursing student is listing key points about ethics and values. Which point listed by the nurse indicates a need for more education? -"A nurse's point of view offers a unique voice in the resolution of ethical dilemmas." -"Professional nursing promotes accountability, responsibility, advocacy, and confidentiality." -"The American Nurses Association (ANA) code of ethics ensures that the code remains constant." -"Standards ethics in healthcare consist of autonomy, beneficence, nonmaleficence, justice, and fidelity."
"The American Nurses Association (ANA) code of ethics ensures that the code remains constant."
A nursing student is listing the characteristics of an ethical issue. Which point listed by the nursing student requires correction? -An ethical issue occurs if it is perplexing and if it is not easy to think logically or make a decision. -An ethical issue occurs if it is not possible to resolve solely through a review of scientific data. -An ethical issue occurs if the problem aims at the greatest good for the greatest number of people. -An ethical issue occurs if the answer to the problem has a profound relevance for areas of human concern.
An ethical issue occurs if the problem aims at the greatest good for the greatest number of people.
What is this an example of? You tell a patient you will be back in 10 minutes to give medication. You must keep your promise and come back in 10 minutes with that medication.
Fidelity
Which ethical principle is violated when the nurse forgets to give a painkiller to a patient as promised?
Fidelity
A nurse is planning to negotiate with the supervisor in order to achieve a better work environment. Which actions are appropriate in this context? -Making tradeoffs -Valuing the efforts of nursing colleagues -Asking for a more desirable work schedule -Displaying a positive and professional attitude -Making an effort to effect change by working collectively
Making tradeoff and asking for a more desirable work schedule.
What is this an example of? A physician orders a medication that is too high a dosage for the patients age/ physical condition. The nurse calls to clarify the order.
Nonmaleficence
The nurse receives information about a client through another nurse. The nurse then finds that information has some missing facts. Which critical thinking attitude would the nurse use to clarify the information after talking to the client directly?
Perseverance
A registered nurse is educating a nursing student about the utilitarian system of ethics. What information should the nurse provide? -"The value of something is decided by its usefulness." -"The main emphasis is on the outcome or consequence of the action." -"The system examines a situation for the presence of essential right or wrong." -"The greatest good for the greatest number of people determines the right action." -"The actions can be determined whether right or wrong based on their 'right-making characteristics.'"
The value of something is decided by its usefulness, the main emphasis is on the outcome or consequence of the action, and the greatest good for the greatest number of people determines the right action.
A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. What should the nurse explain regarding informing the client's parents?
They will not be contacted, because treatment at the clinic is confidential.
A registered nurse is educating a student nurse regarding the role of value clarification in the resolution of ethical dilemmas. What information should the nurse provide?
Value clarification involves tolerating differences of opinions
What is this an example of? Even if information might give your patient anxiety you must tell them and they have the right to know.
Veracity