BNS (VNSG 1323) CH. 3 "Laws and Ethics" NCLEX-STYLE QUESTIONS
A nurse observes another nurse place an unused dose of narcotics in their pocket. If caught, the nurse could be charged with which type of crime? A) Felony B) Misdemeanor C) Tort D) Negligence
A) Felony A felony is a serious criminal offense, and includes actions such as stealing narcotics, murder, falsifying medical records, and insurance fraud. A misdemeanor is a minor criminal offense; a tort is a lawsuit in which a plaintiff charges that a defendant committed a deliberately aggressive act. Negligence is harm that results because a person did not act reasonably.
A nurse caring for an older adult client following a total abdominal hysterectomy documents administration of morphine 4 mg intravenously for pain of 8 on 1-10 scale, bed in the lowest position, bed alarm on, side rails up times two, and call light in reach. After the nurse leaves the room, the client gets out of bed and falls. In which order should the nurse proceed? 1. Notify the physician 2. Document the incident. 3. Complete an incident report. 4. Assist the client back into bed. 5. Assess the client for injury.
Answers: 5, 4, 1, 2, and 3 Following a fall, the nurse should assess the client before moving the client. If the client can be moved, safely return the client to bed and make sure the client is secure per safety procedures. The nurse should then notify the physician. The nurse should document the incident and interventions or treatments provided. Finally, an incident report should be completed.
A nurse is caring for a client following endotracheal intubation. Before applying soft wrist restraints to prevent the client from pulling out the endotracheal tube, what is the most appropriate action of the nurse? A) Get written consent. B) Obtain a medical order. C) Notify the family. D) Sedate the client.
B) Obtain a medical order. Nurses must obtain a medical order before each and every instance in which they use restraints. Due to the severity of the client illness requiring endotracheal intubation, the client does not need to be sedated unless medically necessary, and although it is appropriate to notify the family, this is not the priority.
A nurse is caring for a client with a complete spinal cord injury that has caused paraplegia. The client is very distraught and asks the nurse, "Are they sure, even with therapy, I will never walk again?" Which statement made by the nurse demonstrates veracity? A) "Sometimes with physical therapy, a person may notice some improvement with movement." B) "It is too soon to tell. There is always a possibility you will regain movement in your legs." C) "You have a complete injury, which results in a total loss of movement and sensation below the level of injury." D) "I see you are upset; I can ask your physician to stop by and explain your injury in more detail."
C) "You have a complete injury, which results in a total loss of movement and sensation below the level of injury." Veracity means the duty to be honest and avoid deceiving or misleading a client. Personnel demonstrate respect for this right by explaining to the client the status of his or her health problem, the benefits and risks of treatment, alternative forms of treatment, consequences if the treatment is not administered. The other statements are not providing the truth about the client's condition, or are avoiding telling the truth."
Following a neonatal death, a maternity nurse has become named in a malpractice suit. When evaluating the nurse's actions, the court will compare the nurse's actions to: A) The judge's or jury's expectations of the nurse. B) The ethical principle of autonomy. C) The practice norms of nurses in similar circumstances. D) The actions of a reasonable citizen.
C) The practice norms of nurses in similar circumstances. Rather than being held accountable for acting as an ordinary reasonable lay person, in a malpractice case the court determines whether a health care worker acted in a manner comparable to that of his or her peers. The judge's or jury's subjective expectations are not the point of reference and ethical principle of autonomy does not guide this form of legal decision-making.
Which nursing action demonstrates the principle of fidelity? A) Witnessing a client signature on an informed consent. B) Treating an uninsured client in the emergency department. C) Administering a vaccination. D) Filing an incident report after making a medication error.
D) Filing an incident report after making a medication error. Fidelity means being faithful to work-related commitments and obligations. The ethical principle is best demonstrated by the nurse following the employer's policies by completing the incident report following a medication error. Administering vaccines is an example of beneficence; treating an uninsured client in the emergency room is an example of justice; witnessing a client signature on an informed consent is autonomy.
A nurse has become aware of a conflict between a client's children, one of whom want to withhold the client's recent cancer diagnosis from her in the belief that the client would "give up hope" if she became aware of her condition. Which response to this situation most clearly represents a deontological perspective? A) The morality of the withholding information from a client is the primary concern. B) The advantages and disadvantages of withholding this information should be weighed carefully. C) Precedents from similar cases in the past should guide the nurse's decision-making D) The wishes of the majority of the client's children should be respected.
A) The morality of the withholding information from a client is the primary concern. Deontology is ethical study based on duty or moral obligations. It proposes that the outcome is not the primary issue; rather, decisions must be based on the morality of the act itself. Consequently, priority would not be placed on precedents or the wishes of the majority of family members.
A nurse is completing required tasks prior to the end of a busy shift on a sub-acute geriatric unit. These tasks include the completion of documentation for each of the clients for whom the nurse provided care. What characteristics should be included in the nurse's documentation? (Select all that apply) A) The nurse should ensure that handwritten documentation is legible. B) Nursing actions should be documented subjectively. C) Documentation should be performed in the knowledge that it forms a legal record. D) Documentation should be co-signed by another member of the care team whenever possible. E) Documentation should be completed with the collaboration and input of the client.
A) The nurse should ensure that handwritten documentation is legible. C) Documentation should be performed in the knowledge that it forms a legal record. Documentation must be legible because it constitutes a legal record that may be presented in court if necessary. It should be objective and does not normally involve the direct participation of the client. It is not necessary to have another member of the care team co-sign documentation.
A nurse witnesses a 50-year-old woman go into cardiac arrest while traveling in a train and attempts to resuscitate her. In spite of the nurse's efforts, the woman dies, and the family members file a suit against the nurse. Which of the following statements about Good Samaritan Laws is applicable? A) The Good Samaritan Law will protect the nurse if she was negligent in her action. B) The Good Samaritan Law will likely protect the nurse because she acted in the woman's best interests. C) The Good Samaritan Law is not applicable to nurse's and health professionals. D) The Good Samaritan Law will protect the nurse from any lawsuit filled by family members.
B) The Good Samaritan Law will likely protect the nurse because she acted in the woman's best interests. The Good Samaritan Law provides legal immunity to passersby who provide emergency first aid to victims of accidents. Although these laws are helpful, no Good Samaritan law provides absolute exemption from prosecution in the event of injury. The law is applicable to health professionals as well.
A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the client's atenolol to 12.5 mg daily. However, since the physician is late for another visit, the physician requests that the nurse write down the order and sign it. What should be the appropriate nursing action in this situation? A) The nurse should inform the client of the change in medication. B) The nurse should ask the physician to come back and write the order. C) The nurse should implement the order and monitor the client closely. D) The nurse should discuss the order with a pharmacist.
B) The nurse should ask the physician to come back and write the order. The nurse should ask the physician to come back later and write down the order. Nurses are generally discouraged from following verbal orders, except in an emergency. The nurse should never write and sign an order on a physician's behalf. The client should be informed about the change of medications, but this is not an appropriate action. The order should not be implemented without appropriate documentation.
A nurse is working on a medical surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action made by the nurse is considered negligent if injury results from this action? A) Completing a physical assessment on a newly admitted client. B) Asking the LPN/LVN to teach a new diabetic client how to administer insulin. C) Delegating all wound care and oral medication administration to the LPN/LVN. D) Calling the healthcare provider about abnormal lab results.
B) Asking the LPN/LVN to teach a new diabetic client how to administer insulin. Negligence is harm that results because a person did not act reasonably. As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular healthcare providers to perform (scope of practice), as well as the policy for the facility at which they are employed. Teaching is not the current scope of practice for a LPN/LVN, and can be considered negligent. The other actions are within the scope of practice for registered nurses.
A client is unhappy with the health care provided to him. He approaches the nurse and informs her that he is leaving the facility. The client has not been discharged by the physician. The nurse finds that the client has dressed and is ready to go. What would the nurse's action be in this situation? A) The nurse should warn the client that he cannot come to the hospital again. B) The nurse should call the nursing supervisor and inform her about the situation. C) The nurse should let the client go because she cannot do anything. D) The nurse should get the client restrained and call the physician.
B) The nurse should call the nursing supervisor and inform her about the situation. The nurse should call the nursing supervisor and inform her about the situation. The client should be made to sign the document stating that he is responsible for his own actions. The nurse cannot keep the client restrained because that would be false imprisonment. Likewise, the nurse cannot overlook the incident because there is a responsibility for client care. Additionally, the nurse cannot warn the client that he will not be allowed to come back to the hospital because it is the client's right to access health care whenever required.
A nurse has been assigned to the ICU by a supervisor because of a number of sick calls. However, the nurse is not highly experienced in providing intensive nursing care. What would be the most appropriate action by the nurse? A) To refuse to go to the ICU and keep working in the previously assigned unit. B) To report to the nurse-in-charge for duty but explain the nurse's practice limitations. C) To call the lawyer and seek advice regarding the sudden change. D) To report to the ICU and take leave on the pretext of some illness.
B) To report to the nurse-in-charge for duty but explain the nurse's practice limitations. The most appropriate action that the nurse could take is to go to the ICU and inform the nurse-in-charge about the concerns. The nurse may help with the task if competent to do so. The nurse cannot take a legal action against the order because it is not legally wrong to change the duties as per requirement. It would be ethically wrong to take leave on the pretext of illness. Also, it would be disobedience to wholly disregard the order.
A nurse has applied soft wrist restraints to a client following endotracheal intubation. Which documentation is essential while using restraints? (Select all that apply.) A) Family at bedside. B) Chest physiotherapy completed. C) .9NS IV infusing at 100 mL/hr D) Patient assessment findings every 2 hours. E) Foley catheter draining clear yellow urine.
C) .9NS IV infusing at 100 mL/hr D) Patient assessment findings every 2 hours. E) Foley catheter draining clear yellow urine. When restraints are applied, charting must indicate regular client assessment; provisions or administration of fluids, nourishment, and bowel and bladder elimination; and attempts to release the client from the restraints for a trial period. Additional order completion and presence of family in the room are not required documentation for client restraint.
Recent staffing shortages on a hospital unit have resulted in unlicensed care providers being assigned to duties that are beyond their scope of practice. This has resulted in a number of near misses involving client safety. How should a nurse best respond to this trend of care? A) Take on an increased client assignment during shifts. B) Inform client's family members of the risk that this poses to client's. C) Make the appropriate hospital authorities aware of this practice. D) Remind the unlicensed care providers of their appropriate scope of practice.
C) Make the appropriate hospital authorities aware of this practice. This practice is unethical and illegal. As such, the nurse's first response should be ensure that the appropriate supervisors and authorities are made aware. This is more important than educating the unlicensed care providers, who are not the originators of the problem. Taking an increased workload would not resolve this problem and it would be inappropriate to involve family members at this early stage.
Which situation is an example of battery that the nurse may experience while performing her duties at the health care facility? A) Taking the client's photographs without consent. B) Telling the client that he cannot leave the hospital. C) Performing a surgical procedure without getting consent. D) Witnessing a procedure done on a client without his consent.
C) Performing a surgical procedure without getting consent. Performing a surgical procedure without the client's consent is an example of battery. To protect health care workers from being charged with battery, adult clients are asked to sign general permission for care and treatment during admission, and additional written consent forms for tests, procedures, or surgery. Telling the client not to leave the hospital is a false imprisonment. Taking the client's photographs without his permission and witnessing a procedure done on him without consent is violation of the client's privacy.
A client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure? A) The nurse ensures that the client signs the consent form. B) The nurse informs the family about advance directives. C) The nurse ensures that the client's family signs the consent form. D) The nurse informs the family about the living will.
C) The nurse ensures that the client's family signs the consent form. The nurse should ensure that the client's family signs the consent form. However, in some states and health care facilities, it is the physician who ensures that the client's family signs the consent form. The client cannot sign the consent form if he is not in an alert state or is unable to communicate. If the client is not in a condition to sign the consent form if he is not in an alert state or is unable to communicate. If the client is not in a condition to sign the consent, a family member can sign the consent on his behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery.
Two nurses meet at their home, where one of the nurses discusses a client who had been physically abused. The next day, the client is shifted to another nursing unit after a surgical procedure and becomes the care of the second nurse who had been part of the original discussion. Nurse No. 2 asks the client about the physical abuse. The client discovers that his original nurse revealed the information and is hurt. What would be the charges if the client files a suit? A) The nurses could be charged for libel. B) No charges are valid because the revelation took place in off-duty hours. C) No charges are valid because Nurse No. 2 is also involved in client care. D) The nurses could be charged for slander.
D) The nurses could be charged for slander. Slander is the character attack uttered orally in the presence of others. The injury is considered to occur because the derogatory remarks attack a person's character and good name. In this case, the nurse can be charged with slander. If the defamation had been written, it could be libel. Even if the discussion took place at home and Nurse No. 2 was involved in the care, the revelation was without the client's consent. Even if the nurse is off-duty or may not be directly involved in the client's care, the nurse can still be charged with slander.
A nurse enters the client's room and finds the client lying on the floor with ongoing seizures. The nurse helps the client to get up, makes him comfortable, and then informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report? A) To provide information to local, state, and federal agencies. B) To provide a method of deciding the nurse's fault in the incident. C) To evaluate the immediate care provided by the nurse to the client. D) To evaluate quality care and potential risks for injury to the client.
D) To evaluate quality care and potential risks for injury to the client. An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. Incident reports determine how to prevent hazardous situations and serve as a reference in case of future litigation. Accurate and detailed documentation often helps to prove that the nurse acted reasonably or appropriately in the circumstances. It may not always serve as a method of determining the nurse's fault in the incident. The document does not evaluate the immediate care provided to the client, rather states the actions taken.
A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which legal term describes the case? A) Felony B) Battery C) Misdemeanor D) Tort
D) Tort A tort is a litigation in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. The lack of action on the nurse's part truly indicates unintentional tort. A misdemeanor or felony would be an offense under criminal law, and neither is applicable in this case. Battery is unlawful physical contact.
A public health nurse is involved in planning a community outreach program for a large assisted living community. Due to the aging population within the community, the program will offer hypertension screening and management. This decision is based on which principle? A) Autonomy. B) Veracity. C) Nonmaleficence. D) Utilitarianism.
D) Utilitarianism. Teleology, also known as utilitarianism, is ethical decision making process based on final outcomes and what is best for the most people. The choice that benefits many people justifies harm that may come to a few. The nurse did not display veracity, nonmaleficence, or autonomy in this scenario.
