Chapter 11: Ethical and Legal Considerations

On which ethical theory do nurses implement their care when they act on the basis of the needs of one specific patient rather than the potential consequences to other patients? a. Deontology b. Autonomy c. Utilitarianism d. Nonmaleficence

Answer: a The ethical theory of deontology focuses on the act rather than on the consequences. Autonomy is an ethical concept that values an individual's right to make personal decisions. Utilitarianism is an ethical theory that focuses on the consequences of an action and the good of many rather than of an individual. The ethical principle of nonmaleficence asserts an obligation to "do no harm."

If a student nurse overhears a peer speaking disrespectfully about a patient, nurse, faculty member, or classmate, what is the most ethical first action for the student nurse to take? a. Discuss the peer's actions during group clinical conference b. Ignore the initial occurrence and observe if it happens again c. Report the actions of the classmate to the clinical instructor d. Speak to the peer privately to prevent further occurrences

Answer: d Alerting the peer who has acted disrespectfully in a private setting is the most professional way to approach this situation. It is never appropriate for a professional to belittle or reprimand a peer in front of others. Ignoring disrespectful behavior may only perpetuate its occurrence. Seeking help from a clinical instructor would be appropriate if the peer does not respond to the initial intervention from the fellow student.

What consequences may a nurse experience if the nurse is convicted of a crime? (Select all that apply.) a. Loss of nursing licensure b. Employment affirmation c. Monetary penalty d. Imprisonment e. Promotion

Answers: a, c, d Nurses who are convicted of a crime may have their nursing licenses revoked, be required to pay fines or pay restitution to patients or their families for damages, and be incarcerated for various periods, depending on the severity of the crime. Nurses who commit crimes are most often placed on probation pending the outcome of court proceedings or dismissed from their employment, not affirmed or promoted.

Making prejudicial, untrue statements about another person during conversation may expose a nurse to being charged with what offense? a. Libel b. Assault c. Slander d. Malpractice

Answer: c Conversation that includes prejudicial and false statements about another person is an example of oral defamation of character or slander. Libel is the written form of defamation of character. Assault is a threat of bodily harm accompanied by a sense of imminent danger. Malpractice is professional negligence caused by unsafe practice.

If a nurse threatens to strike a patient while rushing toward the patient in an angry manner, which intentional tort has been committed? a. Assault b. Battery c. Negligence d. Invasion of privacy

ANS: A Assault takes place when a threat of bodily harm is associated with a feeling of imminent harm and a demonstration of force by the perpetrator. Actual physical harm must have occurred in order for the offense to be considered battery. Negligence is an unintentional tort, and invasion of privacy relates to disclosure of private information or simple intrusion into a person's personal space.

Which statement is true regarding codes of ethics and laws? a. Ethical codes hold professionals to a higher standard than the law. b. Laws limit the scope of codes of ethics in most professions. c. Breaking the law is not always an ethical code violation. d. Codes of ethics delineate punishments for breaking laws.

ANS: A Professional ethical code requirements exceed legal standards of practice. Codes of ethics expand on legal requirements rather than being limited by the law. Breaking any law is a violation of ethical standards, and punishment for breaking laws is established by the legal system.

If an adult patient is mentally incompetent to make personal health care decisions, to which aspect of a patient's advance directives should the nurse refer first prior to seeking who is able to give informed consent on the patient's behalf? a. Living will b. Health care proxy c. Do not resuscitate orders d. Durable power of attorney

ANS: B A patient's health care proxy specifies who is to make health care decisions for individuals who are unable to comprehend information. It limits the scope of power of the designated individual to health care and treatment decisions. If a patient has not established a health care proxy, then the nurse would default to contacting a patient's durable power of attorney, who may be charged with the responsibility of making all legal decisions on behalf of the patient. A living will specifies treatment desired by patients if they are no longer capable of making decisions. Do not resuscitate orders are written by a patient's primary health care provider in consultation with patients, their immediate family members, and/or their health care proxy or durable power of attorney, if a health care proxy is not designated.

What nursing intervention best demonstrates a commitment to patient autonomy? a. Encouraging a patient to ambulate independently following surgery b. Collaborating with a patient while developing the patient's care plan c. Establishing patient-centered goals for decreased chronic pain d. Assessing a patient for potential postprocedural complications

ANS: B Patient autonomy is supported when patients are encouraged to participate in personal care decisions. Encouraging patient ambulation and completing a patient assessment are responsibilities of the nurse to promote patient wellness. Writing patient-centered goals without input from the patient does not indicate a commitment to autonomy.

Which components must exist for nursing malpractice to be established? (Select all that apply.) a. Intent of harm to the patient b. Omitted or substandard care c. Injury resulting from care provided d. Responsibility to provide nursing care

ANS: B, C, D Dereliction, direct cause, and duty (and damages) must all be established in cases of malpractice. Intent to harm someone is not a requirement for malpractice.

If a student nurse is asked by a staff nurse to complete a patient care procedure that the student has previously performed only in lab, what response by the student best exemplifies an ethical commitment to both safe practice and learning? a. Asking the staff nurse to perform the care procedure while the student observes b. Locating the clinical instructor to provide the patient care procedure with student oversight c. Reviewing the procedure prior to initiating the patient care with supervision of a registered nurse d. Requesting the help of another student who has previously performed the patient care procedure

ANS: C First reviewing the procedure and then completing it under the supervision of a registered nurse provide for both the patient's safety and the student's learning. Students should take every opportunity to apply their lab skills in real patient care settings. Asking the instructor or a fellow student to complete a procedure that has already been practiced in lab does not indicate an ethical commitment to learning.

Which action by the nurse best illustrates the ethical concept of fidelity? a. Caring for an incarcerated patient without expressing disdain b. Weighing the benefits versus the risks of medical treatment c. Ensuring that patients receive care that is promised d. Endorsing equal access to health care for everyone

ANS: C Nurses demonstrate the ethical concept of fidelity by keeping their promises, which serves to enhance trust levels among themselves and their patients. Weighing the benefits and risks of medical treatment is necessary for sound decision making but is not an illustration of fidelity. Caring for all patients regardless of their actions and endorsing equal access to health care are both examples of a commitment to justice.

Decisions regarding the legality of licensed practical nurses administering intravenous therapy established in the Nurse Practice Act are determined by which type of law? a. Constitutional b. Statutory c. Regulatory d. Case

ANS: C Regulatory law outlines how the requirements of statutory laws, such as the Nurse Practice Act, will be met. Constitutional law defines powers of governments and responsibilities of elected officials. Judicial decisions on specific court cases establish case law.

Veracity mandates which action by the nurse if a cancer patient inquires about diagnostic test results that show further metastasis (spread) of the patient's cancer? a. Telling the patient that the diagnostic test results are not available yet from the laboratory b. Avoiding further contact with the patient to prevent accidental disclosure of the information c. Encouraging the patient to discuss the results with the physician who ordered the diagnostic tests d. Sharing that the test results do not appear to indicate any significant changes at this time

ANS: C Veracity requires that a person tell the truth. Since the physician who ordered the diagnostic tests has the most extensive knowledge of the patient's case, it would be best for the patient to discuss the results with that physician. In this way the patient can receive the diagnostic test results and immediately discuss possible implications and treatment options. Nurses should try always to be honest with their patients and resist the urge to avoid uncomfortable situations.

What action by the nurse at the site of a motor vehicle accident is critical in order for requirements of the Good Samaritan Act to be met? a. Accepting compensation for professional services b. Transferring rescue efforts to family members c. Providing all needed emergency intervention d. Performing within nursing standards of care

ANS: D Good Samaritan laws in all states require that nurses provide care within their scope of knowledge and standards of care. This is the only way for nurses to avoid charges of negligence, even in the case of an emergency. No fees can be accepted or charged for services in order for a nurse's actions to be covered by a Good Samaritan Act. Rescue efforts should be transferred to equally competent professionals such as paramedics or emergency room personnel if the nurse is discontinuing care. Each nurse has a legal responsibility to provide only emergency care that is within his or her scope of nursing practice.

In the United States, practicing nursing without a license is what type of offense? a. Misdemeanor b. Malpractice c. Battery d. Felony

ANS: D Practicing nursing without a license in the United States is a felony rather than a misdemeanor due to the serious nature of the offense. Battery involves causing physical harm, which may not always occur as a result of someone impersonating a nurse. Malpractice is professional negligence.

What is the best way for a nurse to avoid crossing professional practice boundaries with patients? a. Spend extensive time with a patient without visitors b. Focus on the needs of patients and their families c. Intervene in problematic patient relationships d. Discuss personal information excessively

Answer: b The best way to avoid breaching professional practice boundaries is to focus on the patient's needs and those of the patient's family. Nurses should consistently avoid excessive self-disclosure of personal information, intervening in patient relationships, and spending excessive amounts of time with one patient. In addition to keeping patients' secrets, gaining personally from a relationship with a patient, and engaging in sexual overtures or behavior with a patient, these actions are considered violations of professional boundaries.

Which nursing intervention is the best example of patient advocacy? a. Collecting blood samples according to the physician's order each morning b. Assessing the vital signs of a patient who is receiving a blood transfusion c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain d. Accompanying an ambulating patient who is walking for the first time after undergoing surgery

Answer: c Advocacy requires a nurse to work on behalf of others who may be unable to speak for themselves. When a patient is in pain and the physician or primary care provider is not present, a nurse must advocate for the patient's needs by initiating contact with the person responsible for addressing an immediate need. In this case, an order for additional pain medication is needed, which requires collaboration with the patient's physician. Collecting blood samples, assessing vital signs, and assisting a patient with ambulation are primary responsibilities of the nurse that do not require advocacy to meet the patient's need.

What nursing intervention is best when a patient is struggling with the decision to abort an abnormally developing fetus discovered during genetic testing in the first trimester of pregnancy? a. Recommend additional testing b. Refer the patient to an abortion clinic c. Listen to the patient's concerns d. Discuss regional adoption agencies

Answer: c Listening is the best option for the nurse when patients are considering ethical care decisions. Patients often need someone to listen to their verbalized concerns to sort out feelings about the situation and make decisions that are best for them. The patient's primary care provider is responsible for recommending further testing or making requested patient referrals.

What action should nurses who demonstrate accountability take if they forget to administer a patient's medication at the ordered time? a. Document the medication as refused by the patient. b. Administer the medication as soon as the error is discovered. c. Record the medication as given after making sure the patient is okay. d. Follow the administration and documentation procedures for medication errors.

Answer: d Agency procedures must be followed after every medication error. Care must be taken to adhere to medication administration recommendations and documentation requirements to legally record the incident and provide patient safety. Documenting that the patient refused or already took the medication, when that is not factual, is illegal and unethical, regardless of the patient's condition. Administering the medication as soon as the error is discovered may not be recommended, depending on the medication's potency and frequency of administration.

What action should a nurse take if a patient who needs to sign an informed-consent form for nonemergency surgery appears to be under the influence of drugs or alcohol? a. Contact the physician to see what should be done. b. Ask the patient's spouse to sign the informed-consent form. c. Request permission to bypass the need for a signed consent form. d. Wait to have the informed-consent form signed when the patient is alert and oriented.

Answer: d When a normally competent patient is assessed to be under the influence of alcohol or drugs, it is the nurse's responsibility to delay a nonemergency procedure until legal informed consent can be obtained from the patient. Only in the case of an emergency is it possible to obtain informed consent from a spouse or designated power of attorney for a temporarily impaired adult. It is not necessary to contact the physician for guidance on what should be done because there is an established legal procedure to follow. The nurse should contact the surgeon who is scheduled to perform the surgery and the operating room staff regarding the need to delay due to the patient's status.

Nursing students are held to which standard by the Code of Ethics for Nurses? (Select all that apply.) a. Clinical skills performance equal to that of an experienced nurse b. Demonstration of respect for all individuals with whom the student interacts c. Avoidance of behavior that shows disregard for the effect of those actions on others d. Accepting responsibility for resolving conflicts in a professional manner e. Incorporating families in patient care regardless of patient preference

Answers: b, c, d Nursing students are expected to demonstrate respect, avoid hurting others by their actions, and take responsibility for resolving conflicts in a professional manner, much the same as professional nurses. Student nurses are not required to perform clinical skills at the level of expertise exhibited by an experienced nurse. Involving a patient's family in care without the patient's approval indicates a lack of respect for patient autonomy.