Chapter 7 - Understanding Legal and Ethical Issues

The nurse acknowledges which principles are most directly related to nursing care and play a role in solving ethical dilemmas? Select all that apply. 1. Beneficence 2. Distributive justice 3. Autonomy 4. Negligence 5. Non-maleficence

*Answer: 1, 2, 3, 5* *Explanation:* 1. Beneficence means action that is done for the benefit of others. 2. Distributive justice means socially just allocation of goods in a society. 3. Autonomy means the ability of an individual to determine his or her own course of action. 4. Negligence means failure to take proper care in doing something. 5. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome.

For malpractice to exist, which of the following elements must be present? Select all that apply. 1. Causation 2. Defamation 3. Breach of duty 4. Duty 5. Injury

*Answer: 1, 3, 4, 5* *Explanation:* 1. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 2. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. Defamation is not an element that must be present. 3. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 4. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 5. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met.

The RN recognizes that in cases of conflict involving client care decisions which principle overrides beneficence? 1. Negligence 2. Autonomy 3. Non-maleficence 4. Distributive justice

*Answer: 2* *Explanation:* 1. Negligence means failure to take proper care in doing something. 2. When an individual does not desire what others determine to be in that person's interest, the principles of beneficence and autonomy conflict. When in conflict situations involving client care decisions, the principle of autonomy overrides the principle of beneficence. 3. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. 4. Distributive justice is giving a person that which he or she deserves and it implies that benefits and burdens are distributed equally and fairly.

A 14-year-old client tells the nurse that she is going to have sexual activity with her boyfriend. What should the nurse say to the client? Select all that apply. 1. "You need to make an appointment to get birth control." 2. "Tell me more about this decision." 3. "Have you told anyone about this decision?" 4. "Do you have any insurance to pay for this visit?" 5. "I'll have to tell your parents about this."

*Answer: 2, 3* *Explanation:* 1. Telling the client to make an appointment and get birth control takes the client's autonomy away and does not address the client's present need. 2. Allowing the client to talk through this decision and giving options is helping to address the client's needs. 3. Enquiring about if the client has talked to anyone helps to address the client's need for information. 4. Knowing whether the client has insurance does not address the client's needs. 5. This answer is incorrect; the nurse would not need to tell the parents because this information is confidential.

Which of the following requirements are necessary for informed consent? Select all that apply. 1. Privacy 2. Voluntariness 3. Capacity 4. Information 5. Coercion

*Answer: 2, 3, 4* *Explanation:* 1. Privacy is not one of the basic requirements for informed consent. 2. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 3. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 4. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 5. Coercion is not one of the basic requirements for informed consent.

The charge nurse observes another nurse access a client's medical record. When asking about this behavior the nurse responds, "As a nurse I have the right to know what type healthcare coverage my clients have." What are the best responses to this nurse? Select all that apply. 1. "Are you assigned to this client?" 2. "You are not planning care for this client." 3. "This is a breach of confidentiality." 4. "What is your purpose in accessing the clients' healthcare coverage?" 5. "If you are not giving any type of care to this client, you should not be accessing the client's record."

*Answer: 4, 5* *Explanation:* 1. The charge nurse must determine the nurses' purpose for being in the chart. 2. The question does not address whether the nurse is planning care for this client. 3. It is not a certainty that the nurse is breeching confidentiality unless the nurse does not need to know the client's healthcare coverage. 4. The charge nurse must ascertain the nurses' purpose for being in the chart. 5. This is a correct statement by the charge nurse. If the nurse is not giving or preparing care for the client, the nurse should not access the record.

The nurse manager has had two incidents happen on the unit in the last month. An LPN administered an intravenous push (IVP) medication to a client and a nurse noticed alcohol on another nurse's breath. The manager is aware that the ________ will take action after being notified of these incidents.

*Answer: State Board of Nursing* *Explanation:* It is the nurses' duty to educate, examine and report another nurse's behavior to protect the health, safety, and welfare of the public.

The nurse completes an admission assessment with the client. The client hands the nurse two documents. The documents state the treatment the client wants withheld if permanently unconscious, in the event of terminal illness, and the primary physician's order for no heroics. The nurse communicates in report that copies of which documents are located in the chart? Select all that apply. 1. Do-Not-Resuscitate order (DNR) 2. Tort 3. Living will 4. Will 5. Durable power of attorney (DPOA)

*Answer: 1, 3* *Explanation:* 1. The DNR is a medical order that no resuscitative measures be administered to the client. 2. Tort is divided into unintentional (professional negligence) and intentional (intent to harm is present). 3. A living will is when the competent adult signs a form indicating what healthcare the person does and does not want in the event of terminal illness. 4. A will is a legal declaration by which a person, the testator, names one or more persons to manage his or her estate and provides for the distribution of his or her property at death. 5. The DPOA is for healthcare decisions permitting a competent adult to appoint a surrogate or proxy to make decisions in the event that the individual becomes unable to do so.

The nurse acknowledges the job of the State Boards of Nursing is to secure the safety of the public by which of the following? Select all that apply. 1. Practice defined by each state 2. Practice protecting the client's privacy 3. National licensure exam 4. Regulation of practice 5. Nationwide continuing education credits

*Answer: 1, 3, 4* *Explanation:* 1. In each state nursing practice is regulated and defined by the State Board of Nursing. 2. Nursing practice is meant to protect the public from unsafe practice. 3. Each nursing graduate must apply to the appropriate State Board of Nursing to take the National licensure exam. 4. In each state nursing practice is regulated and defined by the State Board of Nursing. 5. Not all State Boards of Nursing require continuing education (CE) credits but in the future all states may require CE credits to maintain competence of practice. The number of CEs required are dependent on the individual state's requirement.

The nurse discerns that the responsibilities essential in obtaining informed consent include which of the following? Select all that apply. 1. Determine that the client receives and understands information. 2. Probabilities of success 3. The client exercises freedom of choice without coercion. 4. Get consent signed before discussion of treatment. 5. Sign consent form as a competent adult.

*Answer: 1, 3, 5* *Explanation:* 1. Information must be furnished to clients in a manner that is understandable to them. Includes explanation of treatment, expected results, description of anticipated risks and discomforts, potential benefits, disclosure of alternatives, offer to answer questions, and a statement that the client may withdraw consent at any time. 2. No one can assure probability of success; the client must be informed of expected results. 3. One must be an adult in the technical and legal sense in order to consent to treatment. 4. The consent form must be signed after detailed information is given and all questions are answered. 5. Individuals act voluntarily when they exercise freedom of choice without force, fraud, deceit, duress, or any other form of coercion.

Which of the following are examples of statutory laws? Select all that apply. 1. Informed consent 2. Marriage by mutual agreement 3. Disability benefits 4. Licensing laws 5. Elder abuse

*Answer: 1, 4, 5* *Explanation:* 1. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. 2. Marriage by mutual agreement is a common law marriage. Common law is a type of law that establishes a custom or tradition by which other similar cases are judged. Awareness of this law assists nurses to function within the boundaries of their role and to advocate for nursing practice when necessary. 3. Disability benefits are governed by administrative laws. This allows the legislature to delegate the authority to create rules and regulations governing a specific administration to an administrative agency of experts in the field. 4. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. 5. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws.

Which document serves to inform the nurse and the public of nursing expectations in ethical matters? 1. The International Code of Ethics for Nurses 2. The Code of Ethics of the American Nurses Association 3. The American Association of Critical Care Nurses Ethics Work Group 4. Ethical Foundations for Critical Care Nursing Research

*Answer: 2* *Explanation:* 1. The International Code of Ethics for Nurses is a guide for action based on social values and needs. 2. The Code of Ethics of the American Nurses Association makes explicit the professional values and standards of ethical conduct. 3. The American Association of Critical Care Nurses Ethics Work Group is a work group of critical care nurses who develop case studies and scenarios regarding ethical dilemmas. 4. Ethical Foundations for Critical Care Nursing Research design and carry out research studies prominent to the needs of critically ill clients and their families.

Which of the following elements fall under unintentional torts Select all that apply. 1. Vicarious liability 2. Respondent superior 3. Negligence 4. Malpractice 5. Intentional torts

*Answer: 3, 4* *Explanation:* 1. Vicarious liability: the law ascribes negligence to certain parties who may not be negligent themselves but whose negligence is assumed because of association with the negligent person; this is not an element that falls under unintentional tort. 2. Respondent superior: this doctrine allows the courts to hold the employer responsible for the actions of the employee when the employee is performing services for the organization; this is not an element that falls under unintentional tort. 3. Negligence is defined as the failure of an individual not to perform an act (omission) or to perform an act (commission) that a reasonable, prudent person would or would not perform in a similar set of circumstances; this is an element that falls under unintentional tort. 4. Malpractice is professional negligence and it is under the premise that all individuals are responsible for the consequences of their actions or inactions and refers to any misconduct or lack of skill in carrying out professional responsibilities; this is an element that falls under unintentional tort. 5. Intentional torts is defined as the intent to harm is present. Assault, battery, false imprisonment, invasion of privacy, inappropriate disclosure of private information, libel, slander, and defamation of character are all examples of intentional torts; this is not an element that falls under unintentional tort.

A client has been diagnosed with leukemia and is scheduled to talk with the oncologist. After listening to the oncologist talk about treatment plans the client states, "God will take care of me. I don't want any treatment." The nurse knows the client has exercised the principle of ________.

*Answer: autonomy* *Explanation:* Autonomy is the ability of an individual to determine his or her own course of action.

A client is admitted for back pain and the client's family plans with the nurse what interventions will be initiated for the client. The issue with this plan of care is the lack of ________.

*Answer: autonomy* *Explanation:* Autonomy is the ability of an individual to determine his or her own course of action.

Restraining clients without consent or sufficient justification may be interpreted as ________.

*Answer: false imprisonment* *Explanation:* Restraining clients without consent or sufficient justification may be interpreted as false imprisonment. In addition to legal rights, the use of restraints involves ethical issues such as autonomy and beneficence.

Which of the following requirements are necessary for informed consent? Select all that apply. 1. Privacy 2. Voluntariness 3. Capacity 4. Information 5. Coercion

Answer: 2, 3, 4 Explanation: 1. Privacy is not one of the basic requirements for informed consent. 2. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 3. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 4. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 5. Coercion is not one of the basic requirements for informed consent.