legal and ethical

American Nurses Association (ANA)

Developed the code of ethics for nurses, which defines the nurses responsibility for upholding clients rights

Beneficence

Doing good or causing good to be done; kindly action

Ethical codes

Ethical codes provide broad principles for determining and evaluating pt care

autonomy

Respect for an individuals right to self determination and making one's own decisions

components of a medication order

1. Date and time prescription was written 2. medication name 3.medication dosage 4. route of administration 5. frequency of administration 6. primary health care provider signature

clinical judgement : take action One hour before a scheduled surgical procedure, the pt states to the nurse, " I have changed my mind. I don't want this surgery." Actions to take by the nurse include the following:

1. Talk to the pt about the request 2.explore with the pt concerns about not wanting the surgery 3. withhold further surgical preparation, and contact the surgeon to report the pts request 4. document the pts request and that the surgeon was notified.

Morals

Behavior in accordance with customs or traditions, usually reflecting personal or religious beliefs

advocate

An advocate is a person who speaks up for or acts on the behalf of the pt, protects the pt rights to make their own decisions, and upholds the principle of fidelity

3. The nurse has just assisted a client back to bed after a fall. The nurse and primary health care provider (PHCP) have assessed the client and have determined that the client is not injured. After completing the occurrence report, the nurse would implement which action next? A. Reassess the client. B. Conduct a staff meeting to describe the fall. C. Contact the nursing supervisor to update information regarding the fall. D. Document in the nurse's notes that an occurrence report was completed.

Ansuwer: A Rationale: After a client's fall, the nurse must frequently reassess the client because potential complications do not always appear immediately after the fall. The client's fall needs to be treated as private information and shared on a need to know" basis. Communication regarding the event would involve only the individuals participating in the client's care. An occurrence report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nusing supervisor has been made aware of the occurrence, the supervisor will contact the nurse if status update is necessary.

8. Which notations indicate accurate nursing documentation by the nurse? Select all that apply. 1. The client slept through the night. 2.Abdominal wound dressing is dry and intact without drainage 3. The client seemed angry when awakened for measurement of vital signs. 4.The client appears to become anxious when it is time for respiratory treatments. 5. The client's left lower medial leg wound is 3cm In length without redness, drainage, or edema.

Answer: 1, 2, 5 Rationale: Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. The use of vague terms, such as seemed or appears, is not acceptable because these words suggest that the nurse is stating an opinion.

7. The nurse has made an error in documentation of the dose administered of an opioid pain medication in the client's record. The nurse draws 1 mg from the vial and another registered nurse (RN) witnesses of the remaining 1mg. When scanning the medication, the nurse entered into the medication administration record (MAR) that 2 mg of hydromorphone was administered instead of the actual dose administered, which was 1 mg. The nurse would take which action(s) to correct the error in the MAR? Select all that apply. 1. Complete and file an occurrence report. 2. Right-click on the entry and modify it to reflect the correct information 3. Document the correct information and end with the nurses signature and title. 4. Obtain a cosignature from the RN who witnessed the waste of the remaining 1mg. 5. Document in a nurse's note in the client's record detailing the corrected information.

Answer: 2, 3, 4, 5

11. The nurse calls the primary health care provider (PHCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the PHCP, and the medication is due to be administered. Which action would the nurse take? A. Contact the nursing supervisor. B. Administer the dose prescribed. C. Hold the medication until PHCP can be contacted D. Administer the recommended does until the PHCP can be located

Answer: A

4. The nurse arrives at work and is told to report (float)to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurse to care for the clients. The nurse has never worked in the ICU. The nurse would take which best action? A. Refuse to float to the ICU based on lack of unit orientation B. Clarify the ICU ient assignment with the team leader to ensure that it is a safe environment. C. Ask the nursing supervisor to review the hospital policy on floating D. Submit a written protest to nursing administration, and then call the hospital lawyer.

Answer: B Rationale: Floating is an acceptable practice used by hospitals to solve understaffing problems. Legally, the nurse can not refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse would set priorities and identify potential areas of harm to the client. That is why clarifying the client assignment with the team leader to ensure that it is a safe one is the best option. The nursing supervisor is called if the nurse is expected to perform tasks that they cannot safely perform. Submitting a written protest and calling the hospital lawyer are premature actions.

12. The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate initial nursing action. A. Call the police. B. Cut up the photograph and throw it away. C. Call the nursing supervisor and report the occurrence. D. Call the laboratory, and ask for the name of the individual who sent the photograph.

Answer: C

2. A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscIOUs. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? A. Obtain a court order for the surgical procedure. B. Ask the EMS team to sign the informed consent. C. Transport the victim to the operating room for Surgery. D. Call the police to identify the client and locate the family.

Answer: C Rationale: In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action because it delays necessary emergency treatment. Test-Taking Strategy: Note the strategic word, best. Also note that an emergency is present. Recalling that a delay in treatment for the purpose of obtaining informed consent could result in injury or death will direct you to the correct option.

5. The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? A. Call security. B. Call the police. C. Call the nursing supervisor. D. Lock the coworker in the medication room until help is obtained.

Answer: C Rationale: Nurse practice acts require the reporting of impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This occurrence needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, so this is not the appropriate action. Option 4 is an inappropriate and unsafe action.

1. The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the primary health care provider, and completes an occurrence report. Which statement would the nurse document on the occurrence report? A. The client fell out of bed. B. The client climbed over the side rails. C. The client was found lying on the floo. D. The client became restless and tried to get out of a bed.

Answer: C Rationale: The occurrence report needs to contain a factual description of the occurrence, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options 1, 2, and 4 are interpretations of the situation and are not factual information as observed by the nurse. Test-Taking Strategy: Focus on the subject, documentation of events, and note the data in the question to select the correct option. Remember to focus on factual information when documenting, and avoid including interpretations. This will direct you to the correct option.

6. A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The cdient asks the nurse for assistance in obtaining a witness to the will. The nurse plans to make which 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 assis- tance regarding your request."

Answer: D Rationale: Instructional directives (living wills) are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Law and guidelines regarding instructional directives 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 would seek the assistance of the nursing supervisOr.

9. A nursing instructor delivers a lecture to nursing students regarding the issue of clients' rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right? A. Performing a procedure without consent B. Threatening to give a client a medication C. Telling the client that they cannot leave the hospital D. Observing care provided to the client without the client's permission

Answer: D Rationale: Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure without consent is an example of battery. Threatening to give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.

10. An older client is brought to the emergency department for treatment of a fractured arm. On physical assessment, the nurse notes old and new ecchymot-iC areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that a family member frequently hits the client if supper is not prepared on time when the family member arrives home from work. The nurse plans to make which most appropriate response? A. "Oh, really? I will discuss this situation with your Family member." B. "Let's talk about the ways you can manage your time to prevent this from happening." C. "Do you have any friends who can help you out until you resolve these important issues with your family member?" D. "As a nurse, I am legally bound to report abuse I will stay with you while you give the report and help find a safe place for you to stay."

Answer: D Rationale: The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with nonmedical personnel or the client's family or friends without the client's permission. Clients need to be assured that information is kept confidential unless it places the nurse under a legal obligation. Options 1, 2, and 3 do not address the legal implications of the situation and do not ensure a safe environment for the client.

Malpractice

If the nurse owed a duty to the pt and did not carry out the duty and the pt was INJURED because the nurse failed to perform the duty

American Hospital Association

Issued pt care partnership (formerly pt bill of rights)

Justice

Tasks determining the order in which clients should be cared for

Nonmaleficence

The obligation to do or cause no harm to another; in providing care the nurse is obliged to refrain from acts that unnecessary cause injury, harm, or suffering

ethical dilemma

a situation in which you have to decide whether to pursue a course of action that may benefit you or your organization but that is unethical or even illegal

Occurrence report

confidential document that describes any patient accident while the person is on the premises of a health care agency

Negligence

failure to take proper care of pt but did not injured them

fidelity

loyalty, do no wrong to the client

Ethics

the principles of right and wrong that guide an individual in making decisions

veracity

truthfulness, honesty