Legal, Ethics and Leadership Passport

A mentally incapacitated client is scheduled for surgery. Considering the principle of autonomy, who should give the consent for surgery?

Surrogate decision maker.

A nursing student and a preceptor nurse are discussing nursing liability. Which statement if made by the student would indicate to the nurse that the student understands the concept of liability?

"A client can still file a lawsuit outside of the statute of limitations if the discovery of the harm has been more recent."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

"The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device."

A nurse-manager must include which items as part of the personnel budget?

Anticipated overtime payments for staff

The nurse manager is holding a meeting with the nursing team to discuss management's decision to reduce staffing on the nursing unit. During the discussion, one of the staff nurses stands up and yells at the nurse manager, using profanity, and threatening "to take this decision further." To defuse this situation, which of the following would be the best step for the nurse manager to take?

Call a break in the meeting and talk to the nurse in a private place.

A client with pulmonary fibrosis is prescribed home oxygen therapy. Which health team member is responsible for evaluating the client's knowledge of home oxygen use?

Home health nurse

A nurse is working with a student nurse who is caring for a client with an acute bleeding cerebral aneurysm. Which action by the student nurse requires further intervention?

Keeping the client in one position to decrease bleeding

What is the nurse expected to do when filing a report about an incident of finding an elderly client with mild dementia on the floor?

The nurse must file an incident or adverse event report.

The nurse applies which ethical principle when telling the truth to a client about the prognosis?

Veracity

For a hospitalized client, the physician orders morphine, 4 mg I.V., every 2 hours as needed for pain. However, the client refuses to take injections. Which nursing action is most appropriate?

Calling the physician to request an oral pain medication

A 14-year-old adolescent tells the nurse that she's in love with her 22-year-old neighbor and that they've had sex on several occasions. She doesn't want her parents to know because she loves him and is afraid they'll be angry. What is the nurse's best course of action?

Tell the adolescent that the law requires her to report the sexual contact because of the age difference.

A nurse-manager has decided to delegate responsibility for the review and revision of the surgical unit's client-education materials. Which statement illustrates the best method of delegation?

Ask the two most proficient staff nurses to form a task force to review and revise client-education materials within the next 6 weeks. Have these nurses solicit input from clients and staff members.

The nurse is caring for postpartum caesarean client and realizes that she has made a medication error. She administered intravenous morphine instead of intramuscular meperidine. What should be the nurse's immediate action?

Assess the client and contact the physician.

A client with end-stage pulmonary hypertension tells the physician he doesn't want any heroic measures should his heart stop, and he doesn't want to be placed on a ventilator. The physician enters a do-not-resuscitate order into the hospital's computer system. Which ethical principle is the nurse upholding by supporting the client's decision?

Autonomy

A 15-year-old unmarried primiparous client is being cared for in the hospital's birthing center after vaginal birth of a viable neonate. The neonate is being placed for adoption through a social service agency. Four hours postpartum, the client asks if she can feed her baby. Which response would be most appropriate?

"I will bring the baby to you for feeding."

After a prenatal class one week, a group of concerned mothers approach the nurse to tell her that one of the nurse facilitators has been sharing their personal stories with other parents outside the group. Which value within the American Nurses Association (Canadian Nurses' Association) Code of Ethics is the nurse violating?

Confidentiality

A client with cancer of the stomach tells the nurse, "I cannot bear the pain anymore. Please give me some poison to free myself from this agonizing pain." The nurse faces a value conflict. Which of the following is true in such a condition?

Human need may affect the values conflict.

A new graduate nurse is assigned to care for several children with advanced cancer, and the nurse finds the assignment extremely challenging and is considering requesting a different assignment. Which of the following is the best course of action by the nurse to resolve the situation?

Suggest a shared assignment with a senior staff nurse.

The family of a client who is unconscious following a stroke tells the nurse they feel "pressured" by the resident physician to insert a feeding tube. They are reluctant to agree to the procedure because they believe this action is not something the client would want. Which of the following responses by the nurse illustrates ethical practice?

"I can arrange for you to talk with the healthcare team about your loved one's situation."

A nurse is working within the managed care delivery model. Which of the following is true regarding managed care?

All systems reflect the values of efficiency and effectiveness.

A client is scheduled to undergo an exploratory laparoscopy. The registered nurse (RN) asks the licensed practical nurse (LPN) to prepare the client for surgery. The RN must confirm that the LPN has specialized training before delegating which task?

Initiating I.V. therapy, as ordered

A nurse discusses the HIV-positive status of a client with other colleagues. The client can sue the nurse for which of the following?

Invasion of privacy.

A client asks the nurse why it is necessary to complete an advanced directive on admission to the hospital. The nurse's best response is:

It is your chance to make your wishes known if you ever become incapable of making your own decisions."

A novice nurse is caring for a client who requires a cesarean section for labor dystocia. The client's husband signs the consent form for cesarean section. Which of the following individuals is responsible for obtaining the informed consent prior to a cesarean section?

Physician

A nurse-manager on an oncology unit has been informed that she must determine which nursing care delivery system (NCDS)/nursing care delivery model (NCDM) is best for efficient client care, client satisfaction, and cost reduction. Knowing that two or three registered nurses, four licensed practical nurses, and five nursing assistants are generally on duty on each shift and that the clients can easily be grouped by geographic location and client care needs, the nurse-manager and her staff appropriately decide to implement which NCDS/NCDM?

Team nursing

An infant who has been in foster care since birth requires a blood transfusion. Who is authorized to give written, informed consent for the procedure?

The foster mother

A nurse is caring for a toddler who was diagnosed with an inoperable brain tumor. The parents are having difficulty deciding on a course of action for their child. Why is it important to have the nurse involved in an ethical discussion about a planned course of treatment?

The nurse can act as a liaison between the child, the child's parents, and the health care team.

A home care nurse is caring for a paralyzed client who needs regular position changes and back massages. A man identifying himself as a family friend inquires if he can be of any help to the family. What should be the nurse's response be?

The nurse should ask the man to talk to the family directly.

A nurse who works on a palliative care unit has participated in several clinical scenarios that have required the application of ethics. Ethics is best defined as:

The principles that determine whether an act is right or wrong.

A nurse is assigning the care of a client admitted with appendicitis. The nurse should assign this client's care to:

a registered nurse pulled from the cardiac unit.

A client is being prepared for a bronchoscopy. The nurse can delegate which task to the unlicensed assistive personnel (UAP)?

placing the client on NPO status

A nurse manager is making morning assignments for the nursing team. Which duties can be assigned to the nursing assistant/unlicensed worker? Select all that apply.

• Changing the linen of a client on a pressure releasing mattress • Transferring a client from the bed to the chair using a mechanical lift • Totaling the intake and output for the entire unit • Repositioning a client on complete bedrest

A home care nurse visits a client with muscular dystrophy. Which comment by the client indicates that he needs more information about an advance directive?

"I love apple pie. I don't ever want a feeding tube when the time comes that I can't eat."

A staff nurse is caring for a client who is a potential heart donor. The client's family is concerned that the recipient will have access to personal donor information. Which response by the nurse demonstrates knowledge of the organ donation process?

"I will have the transplant coordinator speak with you to answer your questions."

A nurse, a licensed practical nurse (LPN), and a nursing assistant are caring for a group of clients. The nurse asks the nursing assistant to check the pulse oximetry level of a client who underwent laminectomy. The nursing assistant reports that the pulse oximetry reading is 89%. The client Kardex contains an order for oxygen application at 2 L/min should the pulse oximetry level fall below 92%. The nurse is currently assessing a postoperative client who just returned from the postanesthesia care unit. How should the nurse proceed?

Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy.

A nurse caring for a group of clients on the neurological floor is working with a nursing assistant and a licensed practical nurse (LPN). Their client care assignment consists of a client with new-onset seizure activity, a client with Alzheimer's disease, and a client who experienced a stroke. While administering medications, the registered nurse receives a call from the intensive care unit (ICU), saying a client who underwent a craniotomy 24 hours ago must be transferred to make room for a new admission. The ancillary staff is providing morning care and assisting clients with breakfast. How should the nurse direct the staff to facilitate a timely transfer?

Ask the nursing assistant to finish providing care to the clients and the LPN to administer the remaining medications so the registered nurse can accept the client from the ICU.

(see full question) A client has soft wrist restraints to prevent the client from pulling out the nasogastric tube. Which nursing intervention should be implemented while the restraints are on the client?

Check on the client every 30 minutes while the restraints are on.

A nurse is caring for a client with bruises on her face and arms. Her husband refuses to leave the client's bedside and answers all of the questions for the client. Which intervention by the nurse would be most appropriate?

Collaborate with the physician to make a referral to social services

The nurse-manager of an outpatient facility isn't satisfied with discharge planning policies and procedures. Knowing other managers at similar facilities regarded as the "best" in the country, which steps should the nurse-manager take as part of a continuous quality-improvement process?

Contact the nurse-managers at the best facilities and compare their discharge planning policies and procedures with those of her facility.

While providing care for a hospitalized infant, a nurse is summoned to the phone. The caller requests information about the infant's condition. Which of the following is the correct action by the nurse?

Determine if the infant's parents want information released to the caller.

A nurse-manager appropriately behaves as an autocrat in which situation?

Directing staff activities if a client experiences a cardiac arrest

When assessing if a procedural risk to a client is justified, the ethical principle underlying the dilemma is known as which of the following?

Nonmaleficence

A nurse-manager of a home health agency is planning for the home health needs of an 8-year-old child who requires around-the-clock care by nursing assistants. When delegating tasks to the nursing assistant, which of the following is the responsibility of the nurse-manager?

Provide written instructions, education, and ongoing supervision

An elderly client who has been diagnosed with delusional disorder for many years is exhibiting early symptoms of dementia. His daughter lives with him to help him manage daily activities, and he attends a day care program for seniors during the week while she works. A nurse at the day care center hears him say, "If my neighbor puts up a fence, I will blow him away with my shotgun. He has never respected my property line, and I have had it!" Which action should the nurse take?

Report the comment to the neighbor, the daughter, and the police since there is the potential for a criminal act.

Parents of a 5-year-old call the clinic to tell the nurse that they think their child has been abused by her day-care provider. What should the nurse advise them to do?

Schedule an immediate appointment with their health care provider.

A staff nurse is caring for a child with a urinary tract infection. The nurse is 1 hour late administering the child's prescribed antibiotic therapy and pain medication. The charge nurse challenges the staff nurse about the lateness of the medications. The staff nurse responds, "It's no big deal; at least the child got the medication." What is the best course of action for the charge nurse to take?

Speak to the unit manager and fill out a medication error report.

When interviewing the parents of an injured child, which sign is the strongest indicator that child abuse may be a problem?

The injury isn't consistent with the child's history or age.

A nurse is providing home care to a client with a foot ulcer related to diabetes. The client needs daily insulin injections. Family caregivers do not possess the technical skills to inject insulin. Which of the following should the nurse keep in mind?

The nurse needs to be creative in integrating the technical and relational aspects of care.

A client is admitted to the hospital. The graduate nurse is completing a nursing assessment and asks the client if he/she has an advanced directive. The client asks for an explanation of advanced directives. The registered nurse preceptor would intervene if she heard the graduate nurse inform the client that an advance directive is:

a legal document initiated by the physician to give the client "do not resuscitate" (DNR) status.

The nurse enters the nondiabetic client's room shortly after a group of health care providers has made rounds. The client asks, "Why did the doctor tell the others that I am not compliant with my diabetes regimen?" The nurse is aware that which ethical principle has been violated?

confidentiality

A client is transferred from the emergency department to the locked psychiatric unit after attempting suicide by taking 200 acetaminophen tablets. The client is now awake and alert but refuses to speak with the nurse. In this situation, the nurse's first priority is to:

ensure safety by initiating suicide precautions.

Because of an outbreak of influenza among the nursing staff, the hospital is very short staffed. The nurse manager prioritizes client needs on the surgical unit by which strategy?

ensuring that clients receive medications but omitting full bathing when possible

A charge nurse is completing client assignments on a neurologic unit. One full-time nurse from the unit, two floating nurses, and one agency nurse are present for the shift. The charge nurse should assign the unit's full-time nurse to care for the client who:

had a craniotomy 24 hours earlier for a brain hemorrhage.

After the nurse informs the surgeon that a chest tube is malfunctioning, the health care provider asks the nurse to reposition the tube and obtain a chest radiograph. The nurse should:

inform the surgeon this is not within the safe scope of practice.

(see full question) A client has a reddened area over a bony prominence. The nurse finds an unlicensed nursing personnel (UAP) massaging this area. The nurse should:

instruct the UAP that massage is contraindicated because it decreases blood flow to the area.

Four clients injured in an automobile accident enter the emergency department at the same time. The triage nurse evaluates them immediately. The nurse should assign the highest priority to the client with the:

maxillofacial injury and gurgling respirations.

While preparing medication for a client in labor, the observes a co-worker slipping a vial of morphine into their side pocket. The nurse should:

notify the supervisor of the unit.

A prescription has just been received for a 72-year-old client with gastrointestinal hemorrhage to have two blood transfusions. The registered nurse caring for the client is a pediatric nurse temporarily assigned to the unit who has never administered blood before. The best action of the charge nurse is to:

reassign the client to another nurse who is experienced in blood administration.

The parents of a preschooler are refusing a blood transfusion to treat severe hypovolemia because they are Jehovah's Witnesses. The parents are aware of the potential consequences of refusing the treatment. The priority intervention for the nurse at this point is to:

pursue obtaining orders for alternative treatments to a blood transfusion.

The nurse is caring for an elderly client with a possible diagnosis of pneumonia who has just been admitted to the hospital. The client is slightly confused and is experiencing difficulty breathing. Which activities would be appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Select all that apply.

• Obtain vital signs. • Apply antiembolic stockings. • Keep the client oriented.

A parent brings their 7-month-old child to the emergency department stating the child is not responsive. The unlicensed assistive personnel (UAP) checks the pulse as requested and the nurse observes them obtaining the pulse in the inappropriate location. What should the nurse inform the UAP at this time?

"To assess a pulse under age 1, you should check the brachial artery."

A client with obsessive compulsive disorder reports to the nurse that the routine of having the nightlight on was not followed on the night shift. What would be the nurse's best course of action?

Ask the night nurse about the experience of caring for client the previous night.

A nurse manager notices that a number of medication errors have occurred on the unit with nurses giving hydralazine instead of hydroxyzine. What would be the most appropriate action for the nurse manager?

Consult with pharmacy to ensure distinct labeling of the medications

A woman employed full-time wants to request a leave of absence to care for her father who is being treated for colon cancer 300 miles (480 km) away. What should the nurse advise the client to do first?

Contact her employee resources department about policies guiding leaves of absence.

A client continually reports of pain after the administration of an oral analgesic. The physician writes an order for the nurse to administer a placebo to the client the next time the client reports of pain. The doctor states, "Tell the client it is a stronger analgesic." What would be the appropriate action by the nurse?

Refuse to administer the placebo to the client.

The nurse has asked the unlicensed assistive personnel (UAP) to ambulate a client with Parkinson's disease. The nurse observes the UAP pulling on the client's arms to get the client to walk forward. The nurse should:

explain how to overcome a freezing gait by telling the client to march in place.

A client in a long-term care facility signed a form requesting not to be resuscitated. The client develops pneumonia, and the client's health rapidly deteriorates. The client is no longer competent, but the family wants everything possible done for the client. When the family asks the nurse what will be done, what is the best response by the nurse?

"We will continue to use antibiotics to treat the pneumonia."

A client being treated for complications of chronic obstructive pulmonary disease needs to be intubated. The client has previously discussed his wish to not be intubated with his girlfriend of 5 years, whom he's designated as his health care power of attorney. The client's children want their father to be intubated. A nurse caring for this client knows that:

clients commonly confer health care power of attorney on someone who shares their personal values and beliefs.

The charge nurse in the newborn nursery has an unlicensed assistive personnel (UAP) with her for the shift. Under their care are 8 babies rooming in with their mothers, and 1 infant in the nursery for the night on tube feedings. There is a new client whose infant will be brought to the nursery in 15 minutes. Which tasks would the nurse assign to the UAP? Select all that apply.

• record voids/stools • document feedings of infants • vital signs on all stable infants

The charge nurse in the newborn nursery has an unlicensed assistive personnel (UAP) with her for the shift. Under their care are 8 babies rooming in with their mothers, and 1 infant in the nursery for the night on tube feedings. There is a new client whose infant will be brought to the nursery in 15 minutes. Which tasks would the nurse assign to the UAP? Select all that apply.

• vital signs on all stable infants • document feedings of infants • record voids/stools

A client with stage IV Parkinson's disease is admitted to the emergency department with heart failure. The client's advance directive dictates no cardiopulmonary resuscitation, intubation, or artificial feedings. The client is receiving diuretics to treat heart failure. The licensed practical nurse states, "This client shouldn't have come to the hospital because she has an advance directive." Which response by the registered nurse is best?

"Just because the client has an advance directive doesn't mean that we shouldn't treat reversible conditions such as heart failure."

The nurse assigns an unlicensed assistive personnel (UAP) to care for a client who has a newly applied long-leg plaster cast. What should the nurse tell the UAP about proper care of the cast while it is drying?

"Turn the client every 2 hours to promote even drying of the cast."

A client who's a member of Jehovah's Witnesses refuses a blood transfusion based on his religious beliefs and practices. His decision must be followed based on which ethical principle?

Autonomy of the client

A nurse assesses a client with psychotic symptoms and determines that the client likely poses a safety threat and needs vest restraints. The client is adamantly opposed to this. What would be the best nursing action?

Contact the physician and obtain necessary orders.

In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values

Integrity.

A nurse is caring for a client with multiple sclerosis. The client informs the nurse that a lawyer is coming to prepare a living will and requests the nurse to sign as witness. Which of the following actions should the nurse take?

Note that the nurse caring for the client cannot be a witness.

The nursing instructor is working with a student in a pre-operative unit. The student notices that the informed consent has not been signed. Which is the best action taken by the student nurse for obtaining informed consent?

Notifying the physician involved with the procedure that the consent has not been signed

The nurse is making team assignments and is assigning tasks to the unlicensed assistive personnel (UAP). unit. What information should the nurse know before delegating tasks to the UAP?

The UAP's level of knowledge and comfort level in performing specific nursing activities should be considered.

The nurse manager has assigned a nurse as the circulating nurse for a surgical abortion. The nurse has a religious objection and wishes to refuse to participate in an abortion. The nurse manager of the operating room should:

change the assignment without comment.

A client recruited to participate in a clinical trial to treat non-Hodgkin's lymphoma tells a nurse and physician that he's willing to start the trial, but doesn't know if adverse effects of the treatment will prevent him from completing it. To protect the ethical principle of autonomy, the nurse must tell the client:

that he may withdraw at any time.

A nurse is caring for a client who has had a massive stroke. The family communicates concern about the actions of the nurse on the previous shift. The family reports that the nurse didn't administer medications properly or maintain client privacy. When responding to complaints about a colleague, the nurse should say:

"I'd be happy to get the charge nurse to see what we can do for the client."

The nurse is caring for an adolescent with cancer who is well informed about the medical condition and treatment. The adolescent refused the morning medications and states intentions of refusing all future medications. What is the best action by the nurse?

Document the adolescent's choice and offer to discuss feelings about the medication.

A nurse is conducting a physical assessment on an adolescent who doesn't want her parents informed that she had an abortion in the past. Which statement best describes the information security measures the nurse can implement in this situation?

Respect the adolescent's wishes and maintain her confidentiality.

(see full question) A nurse is caring for a client declared brain dead following a motor vehicle accident. When the nurse enters the client's room, his spouse and family are talking with friends about the possibility of organ donation. Which statement by the nurse reflects an ethical practice dilemma?

"If you're thinking about organ donation, my sister is waiting for a kidney transplant. She'd be an excellent recipient. I can give you her phone number."

A client arrives at the emergency department after falling in the home. The nurse performing the assessment notes the presence of pediculosis corpus. The client's skin and clothing are dirty. The client reports that his children work and no one has time to assist him with his self-care activities. The nurse should:

Contact the nursing supervisor.

An alert and oriented older adult female with metastatic lung cancer is admitted to the medical-surgical unit for treatment of heart failure. She was given 80 mg of furosemide in the emergency department. Although the client is ambulatory, the unlicensed assistive personnel (UAP) are concerned about urinary incontinence because the client is frail and in a strange environment. The nurse should instruct the UAP to assist with implementing the nursing plan of care by:

placing a commode at the bedside and instructing the client in its use

A person calls the neonatal intensive care unit stating that his son is receiving care there. He tells the nurse that he and the mother "aren't together," and requests information about his son's condition. The nurse should:

obtain more data before giving the caller any confidential information.

Several hours into a shift, a nurse on a very busy medical-surgical unit privately asks the charge nurse to change her assignment. She is frustrated because she has had to devote so much time and energy to helping a newly licensed nurse provide discharge teaching for clients with diabetes mellitus. The charge nurse should:

offer to assist with the discharge teaching needs.

An adolescent with pneumonia is admitted to the pediatric unit. After his parents leave the unit for the evening, he tells the nurse he may have contracted human immunodeficiency virus (HIV). He wants to be tested, but he doesn't want his parents to know about the test. What should the nurse say?

"I'll call your physician for the order. No one will tell your parents."

A 15-year-old female who is 26 weeks pregnant has been admitted to the labor and delivery unit with a complaint of abdominal pain. Her parents want to speak with a nurse about to her condition. How should the nurse respond?

"I'll need a signed consent from your daughter to give you medical information."

A nurse is talking with a client who recently attempted suicide. The client asks the nurse not to tell anyone about their conversation. How should the nurse respond?

"If information is important to your care, I'll need to share it with the rest of your health care team."

The charge nurse on the adolescent unit must decide which nurse should admit a new client. Based on the present client care assignments, who is the best candidate to admit the client?

A nurse who was reassigned from another ward at the beginning of the shift.

A severe winter storm has prevented most staff members from getting to work on a busy medical-surgical unit. One registered nurse, two licensed practical nurses, and three nursing assistants have been able to get to work. A nurse-manager must decide which nursing care delivery system (model) (NCDS) should be implemented for the best possible client care during this staffing crisis. The nurse-manager directs the staff to implement which NCDS (NCDM)?

Functional nursing

A family member of a resident in a long-term care facility reports to the nurse that her mother's diamond ring is missing. Another resident reported a day earlier that a twenty-dollar bill was missing from his/her night table. What should the nurse do in this situation?

Notify the supervisor and call the police.

A client is scheduled for surgery at 8 a.m.(0800). While completing the preoperative checklist, the nurse sees that the surgical consent form isn't signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation?

Notifying the surgeon that the client hasn't signed the consent form

A group of nursing students are reviewing current nursing Codes of Ethics. Such a code is important in the nursing profession because:

Nursing practice involves numerous interactions between laws and individual values.

A nurse-manager works for a nonprofit health care corporation whose revenues have significantly exceeded annual expenses. The nurse-manager has been told to anticipate which action?

Receiving a portion of the revenue to improve client services on the unit

A nurse is caring for a client who has end-stage chronic obstructive pulmonary disease receiving IV push morphine for pain management. During rounds, the nurse discusses with the physician the need to begin the client on a continuous morphine infusion. The nurse bases this request on:

servicing as a client advocate is an important role.

A school-age child reveals to the nurse that his father has been abusing him. What constitutes a breach of the child's right to confidentiality?

Tell the child in the next room, who also suffered abuse, so the two children can talk to each other

An unlicensed assistive personnel (UAP) is providing care to a client with left-sided paralysis. Which action by the UAP requires the nurse to provide further instruction?

pulling up the client under the left shoulder when getting the client out of bed to a chair

An alarm signals, indicating that a neonate's security identification band requires attention. The nurse responds immediately and finds that the parents removed the identification bands from the neonate. Which action should the nurse take next?

Compare the information on the neonate's identification bands with that of the mother's, then reattach the identification bands to one of the neonate's extremities.

The nurse is obtaining informed consent from a client. To adhere to ethical and legal standards, the nurse must ensure that the informed consent consists of which of the following? Select all that apply.

• Discussion of pertinent information • The client's agreement to the plan of care • Freedom from coercion