ethics/legal issues

Newly hired nurses in a busy suburban hospital are required to read the state Nurse Practice Act as part of their training. Which topics are covered by this act? Select all that applies. A) violations that may result in disciplinary action. B) clinical procedures. C) medication administraiton D) scope of practice E) delegation policies F) medicare reimbursement

A) violations that may result in disciplinary action. D) scope of practice

Which criterion is needed for someone to give consent to a procedure? A. An appointed guardianship B. Unemancipated minor C. Minimum of 21 years or older D. An advocate for a child

A. (A guardian has been appointed by a court and has full legal rights to choose management of care.)

Which statement is correct? A. Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD). B. A second trimester abortion can be given without state involvement. C. Student nurses cannot be sued for malpractice while in a nursing clinical class. D. Nurses who get sick and leave during a shift are not abandoning clients if they call their supervisor and leave a message about their emergency illness.

A. (Anyone, at any age, can be treated without parental permission for an STD infection. The client is "advised" to contact sexual partners but is not "required" to give names. Permission from parents is not needed, based upon current privacy laws.)

Nurses are bound by a variety of laws. Which description of a type of law is correct? A. Statutory law is created by elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA). B. Regulatory law includes prevention of harm for the public and punishment for those laws that are broken. C. Common law protects the rights of the individual within society for fair and equal treatment. D. Criminal law creates boards that pass rules and regulations to control society.

A. (Statutory law is created by elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA).Statutory law is created by legislature. It creates statues such as the NPA, which defines the role of the nurse and expectations of the performance of one's duties and explains what is contraindicated as guidelines for breach of those regulations.)

A nurse is caring for a patient who is receiving chemotherapy. The nurse assessed the patient's port and found it was blocked and started a peripheral line to administer the chemotherapy. The medication infiltrated and caused permanent nerve damage to the patient's arm. The patient filed a malpractice suit against the nurse. How will the nurse's actions be evaluated? Select all that apply A. Policies and Procedures of the institution B. Patient' Self-Determination Act C. Standards of Practice of the nursing organization D. Physician Expert

A. -Policies and Procedures of the institution C. -Standards of Practice of the nursing organization

Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the: A. American Nurses Association's (ANA's) Code of Ethics B. Nurse Practice Act (NPA) written by state legislation C. Standards of care from experts in the practice field D. Good Samaritan laws for civil guidelines

A. American Nurses Association's (ANA's) Code of Ethics (This set of ethical principles provides the professional guidelines established by the ANA to maintain the highest standards for ideal conduct in practice. As a profession, the ANA wanted to establish rules and then incorporate guidelines for accountability and responsibility of each nurse within the practice setting.)

A nurse is looking at the healthcare provider orders for a patient. The healthcare provider ordered a medication to be administered intravenously via a bolus. The nurse knows that this medication should not be given through this route and calls the healthcare provider for clarification. The healthcare provider tells the nurse to give the medication. What action should the nurse take next? A. Hold the medication and notify a supervisor B. Hold the medication and call another healthcare provider in the same facility C. Administer the medication as ordered D. Administer the medication and document the healthcare provider's response

A. Hold the medication and notify a supervisor

Three nursing students are in the elevator and overhear another staff nurse, discussing a neighbor who was hospitalized last night for liver failure. The nurse told his colleague that a mutual friend told him that the neighbor was "known for liking his brandy." A family member was in the elevator and also overheard the conversation. What charges may be brought against the nurse by the patient and/or family: A. Slander B. Libel C. Malpractice D. Breach of confidentiality

A. Slander

A nurse is caring for an elderly patient. The patient falls and injures herself. Which of the following actions should the nurse take to decrease his/her liability? Select all that apply. A. Document the incident carefully on the designated form provided by the institution. B. Chart the facts surrounding the client's fall, condition, and follow-up care. C. It is not necessary to document anything about the fall. D. Report the incident to the next shift during report.

A.- Document the incident carefully on the designated form provided by the institution. B. -Chart the facts surrounding the client's fall, condition, and follow-up care. D. -Report the incident to the next shift during report.

A nurse was caring for a patient who reported syncopal episodes. The nurse placed the call bell in reach, and instructed the patient not to get out of bed without assistance. The patient forgot to call the nurse and got out of bed to go to the bathroom. The patient fell and broke a hip. The patient is now suing for negligence. What needs to be considered to constitute a negligence claim? Select all that apply A. Duty B. Breach of duty C. Spontaneous duty D. Harm

A.- Duty B.- Breach of duty D. -Harm

During ____, you ensure that your professional actions are explainable to your patients & your employer

Accountability

____ means that you are responsible professionally & legally for the type and quality of nursing care provided

Accountability

Name the 4 principles of the Code of Ethics

Accountability, Advocacy, Confidentiality, Responsibility

____ means you protect your patients human and legal rights and provide assistance in asserting these rights if the need arises

Advocacy

Advances & protects the nursing profession: ____ ____ ____

American Nurses Association (ANA)

Protects rights of people with physical or mental disabilities

Americans with Disabilities Act (ADA)

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? 1. An unintentional tort 2. Assault 3. Invasion of Privacy 4. Battery

Answer #4 (Rationale: Battery is the willful touching of a person without permission. Another name for an unintentional tort is malpractice. This situation is an intentional tort because the nurse executed the act on purpose.)

If a nurse goes above their scope of practice, they may be charged with ____

Assault

We often demonstrate the patient's _____ through the informed consent process

Autonomy

____ is respect for an individuals right to make their own decisions

Autonomy

Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive personnel (UAP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. Which legal tort has the UAP violated? a. Libel b. Slander c. Assault d. Negligence

B- (Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (Libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or an offensive contact. Negligence involves the actions of professionals that fall below standard of care for a specific professional group)

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

B. (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.)

A bioethical issue should be described as: A. The physician's making all decisions of client management without getting input from the client B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of a specific drug therapy. C. The withholding of food and treatment at the request of the client in a written advance directive given before a client acquired permanent brain damage from an accident. D. After the client gives permission, the physician's disclosing all information to the family for their support in the management of the client.

B. (A research project that included treating all the white men and not treating all the black men to compare the outcomes of a specific drug therapy.The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in the white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early in the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed.)

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, the nurse does not have to violate religious beliefs. D. No, it may be distasteful to the nurse.

B. (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.)

A nurse was called before the State Board of Nursing. The nurse had been in practice for over six years, had her license suspended because an audit of her continuing education credits showed that she had not met the mandatory course requirements. The Board of Nursing has the ability to do this based on: A. Case law B. Administrative law C. Civil law D. Statutory law

B. Administrative Law

A nurse is caring for a patient who suffered a stroke. The patient's daughter brings a DNR and the power of attorney documents to the hospital. What is the purpose of the DNR? A. Document the terminal nature of the client's condition B. Allow an alternative to the universal standing order to provide cardiopulmonary resuscitation to all clients C. Provide an opportunity for the client, family, and caregivers to discuss the nature of the client's condition and the best possible course of action if the client has a cardiac arrest D. Provide legal protection for nurses who believe a client should not be resuscitated

B. Allow an alternative to the universal standing order to provide cardiopulmonary resuscitation to all clients

A nurse graduated from an associate degree nursing program two years ago. The nurse is brought before the State Board of Nursing for offering to give physicals for $25.00 to children who needed them for or summer camp. What charge can the State Board of Nursing apply to the nurse? A. Misdemeanor B. Felony C. Tort D. Larceny

B. Felony

____ is an intentional tort which involves touching

Battery

The best interests of the patient remain more important than self interest. This is called _____

Beneficence

____ means doing good for others

Beneficence

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.

C. (Assess the client's point of view and prepare to articulate this point of view. Rationale:Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.)

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. Respect for autonomy D. Nonmaleficence

C. (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.)

Which factor is least significant during assessment when gathering information about cultural practices? A. Language, timing B. Touch, eye contact C. Biocultural needs D. Pain perception, management expectations

C. (Biocultural needsCultural practices do not influence biocultural needs because they are inborn risks that are related to a biological need and not a learned cultural belief or practice.)

The distribution of nurses to areas of "most need" in the time of a nursing shortage is an example of: A. Utilitarianism theory B. Deontological theory C. Justice D. Beneficence

C. (Justice is defined as the fairness of distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff.)

When a client is confused, left alone with the side rails down, and the bed in a high position, the client falls and breaks a hip. What law has been broken? A. Assault B. Battery C. Negligence D. Civil tort

C. (Knowing what to do to prevent injury is a part of the standards of care for nurses to follow. Safety guidelines dictate raising the side rails, staying with the client, lowering the bed, and observing the client until the environment is safe. As a nurse, these activities are known as basic safety measures that prevent injuries, and to not perform them is not acting in a safe manner. Negligence is conduct that falls below the standard of care that protects others against unreasonable risk of harm.)

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 physician. B. Refer them to the nurse manager. C. Offer to notify the agency patient advocate. D. Have them contact the risk manager.

C. (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.)

After administering an incorrect dosage of a medication the nurse realizes that too little medication was given to the client. The nurse then administers a second dose in order to give the correct dosage. What should the nurse do? Select all that apply: A. Report the error B. Explain what happened to the patient C. Document that the correct medication was administered D. Chart both times the medication was administered

C. Document that the correct medication was administered

The clients right to refuse treatment is an example of ____ law

Civil

A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance obtaining a witness to the will. Which is the most appropriate response to the client? a. "I will sign as a witness to your signature." b. "You will need to find a witness on your own.' c. "Whoever is available at the time will sign as a witness for you." d. "I will call the nursing supervisor to seek assistance regarding your request."

D- (Living wills, also known as natural death acts in some states, are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding living wills vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option 2 is nontherapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.)

Besides the Joint Commission on Accreditation of Healthcare Organizations (JACHO), which governing agency regulates hospitals to allow continued safe services to be provided, funding to be received from the government and penalties if guidelines are not followed? A. Board of Nursing Examiners (BNE) B. Nurse Practice Act (NPA) C. American Nurses Association (ANA) D. Americans With Disabilities Act (ADA)

D. (Americans With Disabilities Act (ADA)If the hospital fails to follow ADA guidelines for meeting special needs, the facility loses funding and status for receiving low-income loans or reimbursement of expenses. ADA protects the civil rights of disabled people. It applies to both the hospital clients and hospital staff. Privacy issues for persons who are positive for human immunodeficiency virus (HIV) have been one issue in relationship to getting information when hospital staff have been exposed to unclean sticks. The ADA allows the infected client the right to choose whether or not to disclose that information.)

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. "Don't you think she has a right to know?" D. "What benefits do you see from not telling your wife your diagnosis?"

D. (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 nurse is caring for a patient who was admitted with a subarachnoid hemorrhage. The healthcare provider orders state that neurological assessments need to be preformed every 30 minutes. The nurse forgets to perform the assessments on two different occasions. An action that can lead to a malpractice suit would be: A. Assessing the patient more than once per shift. B. Explaining the patient's current condition to the family. C. Holding the next dose of sedation in order to perform a neurological assessment. D. Altering the time the assessments were performed

D. Altering the time the assessments were performed

_____ defines actions as right or wrong based on their adherence to rules & principles such as fidelity to promises, truthfulness, & justice

Deontology

When a patient presents to an emergency department, they must be treated

Emergency Medical Treatment and Active Labor Act

Locking the brakes on a wheelchair of a confused patient to keep them in your site is an example of: ____ ____

False Imprisonment

Restraint or seclusion of a person without safety or legal reason: ____ ____

False Imprisonment

____ is achieved when we strive to provide excellent care to all patients, including those whose values are different from our own

Fidelity

____ means following through with a promise

Fidelity

Limit liability and offer legal immunity if a nurse helps at the scene of an accident: ____ ____ ____

Good Samaritan Laws

Nurses must ensure Personal health information (PHI) is protected

Health Information Technology Act (HITECH)

Establishes patient rights regarding privacy of their health care information and records

Health Insurance Portability and Accountability Act (HIPAA)

Assault, battery, & false imprisonment are ____ torts

Intentional

____ is the distribution of benefits and services fairly

Justice

Status that states a nurse meets the requirements for safe & competent practice

Licensure

If a nurse does not meet the standard of care, they may be found ____

Negligent

____ is the principle of never doing anything to harm someone

Nonmaleficence

Testifies about the standards of nursing care as applied to the facts of a case; base their opinions on existing standards of practice established by the Nurse Practice act, federal/state licensing law, policies/procedures, job description, etc.: ____ ____

Nurse Experts

State laws intended to protect citizens, make nurses accountable and assure that care is consistent with best practice within the scope and standards of nursing: ____ ____ ____

Nurse Practice Act

Information & technology combined to improve the delivery of nursing care: ____ ____

Nursing Informatics

Requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive

Patient Self-Determination Act

Laws affect individuals, populations, and communities that are intended to improve the health of people: ____ ____ ____

Public Health Laws

____ ____ is research to change & improve current policies

Quality Improvement

____ ____ torts are acts in which a person may not intent to cause harm but does. Examples include invasion of privacy, slander & libel

Quasi-intentional

____ ____ is limiting the unsafe practices in a healthcare system

Risk Management

The goal is patient safety & improved care. It identifies possible risks and acts to reduce the risks. It's put in an occurrence report, not in the patient's chart

Risk Management/Quality Improvement

What a reasonably prudent nurse would do under similar circumstances in the geographic area in which the alleged breach occurred: ____ ____ ____

Standard of Proof

Guidelines that outline the appropriate care a patient can expect to receive: ____ ____ ____

Standards of Care

Nurse Practice Acts fall under ____ laws

Statutory

The ____ ____ ____ ____ Act determines actual death by 2 standards- cardiopulmonary & whole-brain

The Uniform Determination of Death Act

An ethical problem is called a dilemma when...

Two opposing courses of action can both be justified by ethical

Negligence & malpractice are ____ torts

Unintentional

______: Values are determined by their usefulness

Utilitarianism

____ ____ is needed to distinguish from values/facts/opinions

Values clarification