Adaptive Quizzing for the NCLEX-RN Exam - Ethics

A nursing student is listing the points that need to be remembered about the loss of a client's medical records. Which point listed by the nursing student is accurate?

"There is an assumption that the care provided to the client was negligent." Rationale: In case a client's medical record is lost, there is an assumption that the care provided to the client was negligent. Loss of medical records may lead to a malpractice claim. The entire institution is responsible for maintaining medical records. Primary healthcare providers need to demonstrate why the medical records were lost.

A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching?

The application of force to another person without lawful justification Rationale: Battery means touching in an offensive manner or actually injuring another person. Battery refers to actual bodily harm rather than threats of physical or psychological harm. Battery refers to harm against persons, not property. Behaving in a way that a reasonable person with the same education would not is the definition of negligence.

A registered nurse is educating a nursing student about the process of resolving an ethical dilemma. What information should the nurse provide regarding negotiation of outcomes?

"A nurse should provide a personal point of view." Rationale: During the process of negotiating outcomes, the nurse is required to provide a personal point of view. Negotiations may take place informally at the client's bedside or in a formal setting. After gathering relevant information regarding an ethical dilemma, the nurse is required to examine his or her own values and formulate an opinion regarding the matter. When verbalizing the problem, the group agrees to a statement of the problem to begin discussions. This step is performed before negotiating outcomes. Negotiations take place after determining all possible courses of action.

A registered nurse is educating a nursing student on the various classifications of torts. What acts are classified as intentional torts in nursing practice? Select all that apply.

- Battery - Assault - False Imprisonment Rationale: Intentional torts include battery, assault, and false imprisonment. Unintentional torts include negligence and malpractice.

Which situation does not cover nurses who respond to a mass casualty incident (MCI) for malpractice or negligent lawsuits under the Good Samaritan Act?

Terrorist act Rationale: When terrorist acts occur, nurses are often required to go to an assigned site to offer aid. When this occurs, the nurse is not covered from malpractice or negligent lawsuits. Nurses who respond to injuries that occur in a neighborhood fire, roadside car accident, or a high school sporting event are covered under the Good Samaritan Act.

What legal complications might a nurse face for using a restraint without a legal warrant on a client?

The nurse may be charged with false imprisonment. Rationale: If a nurse uses restraints without a legal warrant on a client, he/she may be charged with false imprisonment. Libel is the written defamation of character. Negligence is any conduct that falls below the standard of care. Malpractice is a type of negligence that is regarded as professional negligence.

Litigation resulting from improper restraint use is a common nursing legal issue. A nursing student is listing points related to the use of restraints. Which factor needs correction?

Restraints can be used anytime without a written order from the healthcare provider. Rationale: Restraints can be used only on the written order of a healthcare provider. Restraints can be used when less restrictive interventions are not successful. Restraints may be used after all available alternatives have been tried and exhausted. Restraints can be used only to ensure the physical safety of the resident or other residents.

What is the priority nursing intervention before a client undergoes amniocentesis?

Ensuring that informed consent has been obtained from the client Rationale: An invasive procedure such as amniocentesis requires informed consent. An intravenous infusion is unnecessary. A vaginal examination is not done before an amniocentesis. The infection rate is 1%; informing the client that the procedure may result in an infection is not an appropriate nursing intervention. The primary healthcare provider explains the risks and benefits of a procedure.

A client who has a hemoglobin of 6 gm/dL (60 mmol/L) is refusing blood because of religious reasons. What is the most appropriate action by the nurse?

Notify the primary healthcare provider of the client's refusal of blood products. Rationale: The nurse serves as an advocate for the client to uphold their wishes. Synthetic blood products are available but must be prescribed by the primary healthcare provider. Therefore the primary healthcare provider needs to be notified of the client's refusal for blood so alternatives can be considered. The chaplain's role is to offer support, not to convince the client to go against beliefs. It is a Health Insurance Portability and Accountability Act (HIPAA) (Canada: Personal Health Information Protection Act [PHIPA]) violation to discuss the case with coworkers unless they are involved in the care of the client. The nurse should not use threats or fear to coerce the client.

A nurse is working with an unlicensed assistive personnel (UAP) in caring for a group of clients. Which statement by the UAP indicates a correct understanding of the UAP's role?

"I will take clients' vital signs after their procedures are over." Rationale: Monitoring vital signs after procedures is within the scope of a UAP's role. Registered professional nurses or licensed practical nurses, not UAPs, should perform turning off clients' intravenous (IV) infusions that have infiltrated. Using unit written materials to teach clients before surgery should be performed by registered professional nurses or licensed practical nurses, not UAPs. Helping by giving medications to clients who are slow in taking pills should be performed by registered professional nurses or licensed practical nurses, not UAPs.

A nonviolent client on the psychiatric unit suddenly refuses to take the prescribed antipsychotic medication. What should the nurse do?

Honor the client's decision and document the behavior and all interventions. Rationale: A client has the right to refuse treatment and should not be forcibly medicated unless the client is deemed dangerous to self or others. An authoritarian approach is not therapeutic and may compromise the nurse-client relationship. Calling the primary healthcare provider is premature; first the nurse should attempt therapeutic interventions to meet the client's needs. Starting proceedings to have the client declared incompetent is appropriate for a client who is considered to be dangerous to self or others or incompetent to evaluate necessary treatment.

Which nursing action is not likely to cause legal issues?

Refraining from leaving the client during a staffing shortage Rationale: The nurse should not abandon clients if there is a staffing shortage. This action helps to avoid legal complications. Using restraints without the order of the primary healthcare provider may lead to battery and false imprisonment charges. The nurse should always report cases of suspected child abuse. A nurse should never allow nursing assistive personnel (NAP) to administer medications because this action may lead to malpractice charges.

A 16-year-old single mother of a 1-year-old infant and the infant's grandmother bring the baby to the emergency department and report that the infant accidentally fell down the stairs. The nurse knows that a consent form for treatment should be signed. Who has the responsibility for signing the consent?

The mother, despite her age Rationale: The client is an emancipated minor, meaning that she has adult status. In most states the age of majority is 18 years; however, parents younger than 18 years are considered emancipated minors and may sign consents for themselves and their children. Consent always is needed when a parent is present and capable of providing it. The grandmother does not have the legal right to give consent. Family court is unnecessary.

Which nursing action indicates that the nurse is actively listening to the client?

The nurse interprets what the client is saying and reiterates in his or her own words. Rationale: The nurse is listening actively if he or she is able to take in what the client says. A nurse who is listens attentively interprets and reiterates what the client is saying in his or her own words. A nurse who states his or her own opinions when the client is speaking is being judgmental. A good listener should be able to reach out by exchanging his or her own stories with the client. If a nurse reads the client's health record during the conversation, it is an indication that the nurse is not really interested in the conversation.

A 17-year-old mother is to sign the consent for her son's myringotomy. What should the nurse say to the mother about this procedure?

"Tell me what you know about this procedure." Rationale: Informed consent requires that the responsible person understand the procedure. Predicting therapeutic outcomes is not within the role of the nurse. Predicting future surgical interventions is not within the role of the nurse. A 17-year-old mother is an emancipated minor who has the legal authority to sign her child's consent form.

A client who had previously signed a consent form for a liver biopsy reconsiders and decides not to have the procedure. What is the nurse's best initial response?

"Can you tell me your reasons for refusing the procedure?" Rationale: The response "Can you tell me your reasons for refusing the procedure?" attempts to explore why the client is refusing the procedure; the question promotes communication. The response "Why did you sign the consent form originally?" is accusatory; the client has the right to withdraw consent at any time. The response "I can understand why you changed your mind" is a conclusion without appropriate data; it may also increase the client's anxiety level. "You must be afraid about something concerning the procedure" is a conclusion without appropriate data; it also puts the client on the defensive.

A nurse is caring for a client with renal failure. The client wants to go back home but the family members want the client to undergo a kidney transplant. The nurse gives details about the possible threats and benefits of the surgery to the family and informs them that the client wants to stay home. What role does the nurse play here?

Advocate Rationale: The nurse in the given scenario plays the role of an advocate by protecting the client's human and legal rights and by providing assistance in asserting these rights. As an educator, the nurse explains concepts and facts about health and the reason for routine care activities, demonstrates procedures, and evaluates the client's progress in learning. As a caregiver, the nurse helps clients to maintain and regain health, manages diseases and symptoms, and attains a maximal level function and independence through the healing process. As a manager, the nurse coordinates the activities of members of the nursing staff in delivering nursing care and has responsibility for personnel, policy, and budgetary issues for a specific nursing unit or agency.

A nurse is obtaining consent from an unemancipated minor to perform an abortion. When would the nurse consider the consent-giving process to be appropriately completed? Select all that apply.

- When consent has been given specifically by a court - When self-consent has been granted by a court order - When consent has been obtained from at least one parent of the minor Rationale: An unemancipated minor is allowed to consent to an abortion if one of three conditions is fulfilled. The minor may give consent if consent has been obtained from at least one parent. The minor may also give consent if consent has been given specifically by a court or self-consent has been granted by a court order. The spouse or grandparents of unemancipated minors are not allowed to give consent for abortions.

What does the nurse understand by the word felony?

A felony is a crime of a serious nature that has a penalty of imprisonment for longer than one year or even death. Rationale: A felony is a crime of a serious nature that has a penalty of imprisonment for longer than 1 year or even death. A misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year. Slander is the publication of false statements that occurs when one speaks falsely about another. Libel is the publication of false statements that occurs when false entries are made in the medical record.

A client has been diagnosed with type 1 diabetes mellitus. When providing instructions on sharps disposal, the nurse should instruct the client to place the syringes in what?

A plastic liquid detergent bottle with a screw-top lid Rationale: Most states (provinces) allow patients to place used needles/pen needles and lancets ( sharps) in a household container such as a laundry detergent bottle, bleach bottle, or other opaque sturdy plastic container with a screw-top lid. Some states (provinces) do have disposal drop-off locations. Bubble wrap, a garbage bag, and cardboard put those who are handling the containers at risk for needle sticks.

The professional obligation of a nurse to assume responsibility for actions is referred to as what?

Accountability Rationale: Nurses have an obligation to uphold the highest standards of practice, assume full responsibility for actions, and maintain quality in the knowledge base and skill of the profession; this is referred to as accountability. Individuality and responsibility are positive characteristics of the nurse but are not necessarily professional obligations. Bioethics is a field of study concerned with the ethics and philosophical implications of certain biologic and medical procedures and treatments.

A nurse, providing care in a hospital skilled nursing unit, witnesses a client's spouse shaking the elderly client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with managers and report the abuse to which party?

Adult Protective Services Rationale: The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified. The term Adult Protective Services refers to the range of laws and regulations enacted to deal with abusive situations. The laws and regulations are typically administered by an agency within the state, for example, the Department of Social Services, which receives and investigates complaints.

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture?

Asking the parents what they were told about the test Rationale: Informed consent is required. The procedure should be explained to the parents by the practitioner, and the nurse should confirm the parents' comprehension and have them sign the consent form. The child is too young to comprehend a demonstration of the procedure. Although staying with the child may be important to the parents, it is not the priority. Although a pacifier may keep the child calm, this is not the priority, either.

A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and got a positive result. She confides that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl whether she has told anyone else, she replies, "Yes, but my mother doesn't believe me." Legally, who should the nurse notify?

Child protective services for immediate intervention Rationale: It is the nurse's legal responsibility to report child abuse to the appropriate agency. Safety is the priority, and child protective services will provide immediate intervention. Although the police may be notified, this is not the nurse's responsibility at this time. Notifying the primary healthcare provider may be done later, but it is not the priority. The girl's pregnancy has not been confirmed; at this time it is most important to protect her and her sisters.

The nurse is planning to triage clients after a disaster. Which client does the nurse categorize into the green-tagged category?

Client D - Bruises and lacerations on skin Rationale: The disaster triage tag system categorizes triage priority by color. Clients with minor injuries that can be managed in a delayed fashion are categorized as green-tagged. Therefore client D with bruises and lacerations on the skin is green-tagged. Client A, with the life-threatening condition of an airway obstruction is red-tagged. Client B with large wounds and open fractures needs treatment within 30 minutes to 2 hours and is yellow-tagged. Client C with critical massive head trauma is black-tagged.

A nurse on the medical-surgical unit tells other staff members, "That client can just wait for the lorazepam; I get so annoyed when people drink too much." What does this nurse's comment reflect?

Demonstration of personal bias Rationale: When nurses make judgmental remarks and client needs are not placed first, the standards of care are violated and quality of care is compromised. Assessments should be objective, not subjective and biased. There is no information about the client's acuity to come to this conclusion regarding priorities. The statement does not reflect information about complexity of care.

Which type of clients are often referred to as the "walking wounded" in a mass casualty scene?

Green tagged clients Rationale: Green tagged clients have minor injuries that can be managed in a delayed fashion, and they can evacuate themselves from the mass casualty scene and go by private vehicle. Therefore they are termed the "walking wounded" clients. Red tagged clients need immediate intervention because they have an immediate threat to life. Black tagged clients are those who are considered as dead or about to die. Yellow tagged clients also have major injuries that need treatment within 30 minutes to 2 hours and are not considered "walking wounded" clients.

How would the student nurse describe a quasi-intentional tort occurring during the practice of nursing?

It is an act that lacks intent but involves volitional action. Rationale: A quasi-intentional tort lacks intent but involves volitional actions such as invasion of privacy and defamation of character. An intentional tort is a willful act that violates another's rights. This includes assault, battery, and false imprisonment. A tort is a civil wrong made against a person or property. An unintentional tort involves negligence and malpractice.

Which is an appropriate action for the registered nurse regarding assisted suicide?

Nurses' participation in assisted suicide violates the code of ethics. Rationale: According to the ANA, a nurse's participation in assisted suicide will violate their code of ethics. According to the American Association of Colleges of Nursing (AACN) and the International Council of Nurses', the nurse may have an open attitude toward the client's end of life. According to the American Association of Colleges of Nursing (AACN) and the International Council of Nurses', nurses may listen to the client's expressions of fear and to attempt to control the client's pain. According to the Oregon Death with Dignity Act (1994) the primary health care provider in the state of Oregon can participate in assisted suicide only if an individual with terminal disease makes an oral and written request to end his or her life in a humane and dignified manner.

Which right of delegation refers to the giving of clear, concise descriptions of a task to the delegatee?

Right communication Rationale: Right communication refers to the giving of clear and concise descriptions of a task, including its objectives, limits, and expectations while delegating a task. Right task refers to delegating a task that is repetitive, requires less supervision, and has predictable results. Right person is delegating a task to the correct person who has the ability to perform said task. Right supervision refers to providing appropriate monitoring, evaluation, and feedback of the delegated task.

What is the school nurse's most important action when monitoring an adolescent who has just returned to high school after a suicide attempt?

Speaking with the adolescent regarding feelings about returning to school Rationale: Speaking with the adolescent regarding feelings about returning to school shows the adolescent that the nurse is available and is interested and concerned. Observing the adolescent with frequent summonses to the health office will draw too much attention to the adolescent; also, it is demeaning. Requesting that teachers and friends report any changes in behavior will place responsibility on others and may interfere with the adolescent's relationship with them. Also, it violates the adolescent's right to privacy. Telling the teachers what happened and having them ask whether there are any problems violates the adolescent's right to privacy.

Which act protects a person who is HIV positive?

The Americans with Disabilities Act (ADA) Rationale: The Americans with Disabilities Act (ADA) protects a person who is HIV positive. The National Organ Transplant Act protects the donor's estate from liability for injury or damage that results from the use of the organ. The Patient Self-Determination Act (PSDA) requires healthcare associations to provide written information to clients about their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects individuals from losing their health insurance when changing jobs by providing portability.

What stage of Kohlberg's theory of moral development defines "right" by the decision of the conscience?

Universal ethical principle orientation Rationale: Kohlberg's theory of moral development consists of six stages. Universal ethical principle orientation is the sixth stage. It defines "right" by the decision of the conscience in accordance with self-chosen ethical principles. Social contract orientation is the fifth stage of Kohlberg's theory. During this stage, an individual follows societal law but recognizes the possibility of changing the law to improve society. Society-maintaining orientation stage is the fourth stage. Individuals expand their focus from a relationship with others to societal concerns during this stage. Instrumental relativist orientation is the second stage. In this stage, the child recognizes that there is more than one right view.

While visiting the hospital, the spouse of a client slips and falls on a recently washed floor in the hallway leading to the client's room. To meet the criteria of ethical practice, what action should the nurse who witnessed the occurrence take?

Initiate an agency incident report. Rationale: Health care agencies document the occurrence of any event out of the ordinary that results in or has the potential to harm a client, employee, or visitor. Falls by visitors are not required to be reported to state (provincial) health departments. However, incident reports are required to be presented to accrediting agencies for review when an agency is in the process of being accredited. Writing a brief description of the incident to be kept by the nurse manager is not a requirement of ethical practice. However, a nurse who is involved in an incident or is a witness to an incident should write an accurate description of the event, along with the names of individuals involved. This documentation should be kept by the nurse at home. Lawsuits may take several years before they come to trial, and personal notes may help the nurse recall the event. The documentation must accurately contain the same elements included in the formal incident report. Taking no action is irresponsible. All events out of the ordinary that result in or have the potential to harm a visitor should be documented in an agency incident report.

A 3-year-old child with eczema of the face and arms has disregarded the nurse's warnings to "stop scratching, or else!" The nurse finds the toddler scratching so intensely that the arms are bleeding. The nurse then ties the toddler's arms to the crib sides, saying, "I'm going to teach you one way or another." How should the nurse's behavior be interpreted?

These actions can be construed as assault and battery. Rationale: Assault is a threat or an attempt to do violence to another, and battery means touching an individual in an offensive manner or actually injuring another person. The nurse's behavior demonstrates anger and does not take into account the growth and developmental needs of children in this age group. Although the behavior (scratching) needs to be decreased, this can be done with mittens, not immobilization. A 3-year-old child does not have the capacity to understand cause (scratching) and effect (bleeding).

What should a nurse understand about healthcare proxies or a durable power of attorney for healthcare?

A proxy is a legal document that designates a person or persons to make health care decisions on behalf of the client. Rationale: Healthcare proxies enable another person or persons to make healthcare decisions on the client's behalf when the client is no longer able to make decisions on his or her own. The National Organ Transplant Act of 1984 prohibits the purchase or sale of organs. This act is not related to healthcare proxies. The ethical doctrine of autonomy ensures the client's right to refuse medical treatment. A living will is a written document that directs treatment in accordance with the client's wishes in case of a terminal illness or condition.

The nurse is caring for a client who is in pain following surgery. The nurse informs the primary health care provider about the client's request for pain medication. What is the role of the nurse in this situation?

Advocate Rationale: The nurse acts as a client advocate by speaking to the primary health care provider on behalf of the client. The nurse acts as an educator while teaching the client facts about health and the need for routine care activities. The nurse manager uses appropriate leadership styles to create a nursing environment for client-centered care. The nurse administrator manages client care and delivery of specific nursing services within a health care agency.

A woman arrives at the prenatal clinic stating that her pregnancy test is positive. She asks the nurse for information regarding an abortion. After verifying that the woman is at 8 weeks' gestation, the nurse counsels her that having an abortion is controversial and that many women have long-lasting feelings of guilt after an abortion. What is the nurse's legal responsibility?

To provide the client with correct, unbiased information Rationale: Nurses who counsel clients regarding abortion should know what services are available and the various methods that are used to induce abortion. Nurses who cannot control their negative feelings regarding abortion should not counsel women who are thinking of undergoing the procedure. Nursing practice necessitates knowledge of research results; statements must be based on fact, not personal feelings or beliefs. The nurse should give the client only the information requested, not state personal feelings. The nurse is responsible for giving information about abortion and need not defer to the primary healthcare provider.

A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? Select all that apply.

"I'd like to end it all with sleeping pills." "The voices say I should kill all prostitutes." Rationale: The statement about ending it all is a suicide threat; it is a direct expression of intent without action. Likewise, the threat to harm others must be heeded. Confiding feelings of sadness or depression does not indicate that the client plans to self-harm or harm others. The statement about the boss reflects the client's feelings of anger and the cause but does not indicate a threat to self or others.

A nursing student is listing the points that need to be remembered regarding the United Network for Organ Sharing (UNOS) program. Which point listed by the nursing student is accurate?

"The United Network for Organ Sharing (UNOS) has a contract with the federal government." Rationale: The United Network for Organ Sharing (UNOS) has a contract with the federal government. The National Organ Transplant Act of 1984 protects the donor's estate from liability for injury or damage. The United Network for Organ Sharing gives priority to clients in their geographical area who need organs on an urgent basis. The National Organ Transplant Act of 1984 provides civil and criminal immunity to the hospital and the healthcare provider.

What is true about psychosocial changes observed in adolescents? Select all that apply.

"They search for personal identity." "They develop their own ethical systems." Rationale: An adolescent tends to search for his or her personal identity and develop his or her own ethical system during psychosocial development. During cognitive development, adolescents consider themselves invincible and consider their parents materialistic. Adolescents work at becoming emotionally independent from their parents while retaining family ties.

What are the instances when an adult can give consent for medical treatment? Select all that apply.

- Any guardian for the adult's ward - Any parent for the adult's unemancipated minor - Any adult for the treatment of his or her minor brother or sister (if an emergency and parents are not present) Rationale: An adult can give consent for medical treatment as a guardian for his or her ward. An adult can give consent for medical treatment as a parent for his or her unemancipated minor. An adult can give consent for the medical treatment of his or her brother or sister in case of an emergency if the client's parents are not present. An adult cannot give consent for his or her emancipated minor. An adult can only give consent as a grandparent for a minor grandchild in emergency cases when the parents are not present.

What are the elements of discovery of a lawsuit? Select all that apply.

- Experts - Medical Records - The depositions of witnesses Rationale: Experts, medical records, and the depositions of witnesses are elements of discovery of a lawsuit. Proof of negligence is a part of a trial. Petition and elements of the claim are a part of the pleadings phase.

What are the important points to be considered when imparting practical knowledge to nursing students about preventing complications in the hospital? Select all that apply.

- Nursing students should never be assigned any tasks they are unprepared for. - Nursing students can work as nursing assistants or nurse's aides when not attending classes. - Nursing students should notify the nursing supervisor in case they are delegated tasks they are not prepared for. Rationale: Nursing students should never be assigned to perform tasks for which they are unprepared. A nursing student can work as a nursing assistant or a nurse's aide when not attending classes. In case anyone instructs a nursing student to perform a task that he or she is unprepared for, the nursing supervisor should be notified as soon as possible. A nursing student is indeed accountable if a client is harmed. A nursing student is not an employee of the hospital and he or she cannot act as a witness to consent forms because these forms are legal documents.

A client is presented with the treatment option of electroconvulsive therapy (ECT). After discussion with staff members, the client requests that a family member be called to help make the decision about this treatment. What ethical principle does the nurse consider when supporting the client's request?

Autonomy Rationale: Autonomy is the ethical principle of respecting the independence and right to self-determination of others. In this situation the nurse focuses on helping the client make a choice. Justice is the ethical principle that requires all people to be treated fairly, regardless of sex, age, religion, diagnosis, marital status, or socioeconomic level. Veracity is the ethical principle that requires truthfulness. Beneficence is the duty to do good and promote the welfare of others.

A nurse who promotes freedom of choice for clients in decision-making best supports which principle?

Autonomy Rationale: The principle of autonomy relates to the freedom of a person to form his or her own judgments and actions. The nurse promotes autonomy nonjudgmentally so as not to infringe on the decisions or actions of others. Justice means to be righteous, equitable, and to act or treat fairly. Beneficence relates to the state or act of doing good and being kind and charitable. It also includes promotion of well-being and abstaining from injuring others. Paternalism encompasses the practice of governing people in a fatherly manner, especially by providing for their needs without infringing on their rights or responsibilities.

A visitor from a room adjacent to a client asks the nurse what disease the client has. The nurse responds, "I will not discuss any client's illness with you. Are you concerned about it?" This response is based on the nurse's knowledge that to discuss a client's condition with someone not directly involved with that client is an example of what?

Breach of confidentiality Rationale: The release of information to an unauthorized person or gossiping about a client's activities constitutes a breach of confidentiality and an invasion of privacy. Libel occurs when a person writes false statements about another that may injure the individual's reputation. Negligence is a careless act of omission or commission that results in injury to another. Defamation of character is the publication of false statements that injure a person's reputation.

An unemancipated pediatric client is to undergo a routine medical procedure. Who is the appropriate authority to provide consent?

Either of the child's parents Rationale: For unemancipated pediatric clients, the parents are required to provide consent. Either parent may do so. The court intervenes in situations where the parents refuse to allow a child to undergo treatment. A grandparent may provide consent only if the situation is an emergency and the parents are not present. The client is underage and unemancipated; therefore if at all possible, consent must be obtained from one of the child's parents in a non life-threatening situation.

A psychiatric nurse is hired to work in the psychiatric emergency department of a large teaching hospital. While reviewing the manuals, the nurse reads, "People with mental health emergencies shall be triaged within 5 minutes of entering the emergency department." What does the nurse consider this statement to represent?

Hospital policy Rationale: Policies are statements that help define a course of action; what is to be done is stated in policies, and how a task or skill is to be performed is defined in a procedure manual. Standards of care are published by the American Nurses Association; they reflect current knowledge and represent levels of practice agreed on by experts within the specialty; in legal terms, the standard of care is that level of practice that a reasonably prudent nurse would provide. A hospital procedure defines how a task or skill is to be performed. The Mental Health Bill of Rights states that all clients have the right to respectful care, confidentiality, continuity of care, relevant information, and refusal of treatment, except in an emergency or by law.

What is a living will?

It is a written document that directs treatment according to the client's wishes, in case of a terminal illness or condition. Rationale: A living will is a written document that directs treatment on the basis of the client's wishes if he/she has a terminal illness or condition. A license allows registered nurses to offer the special skills to the public. A 'do not resuscitate' (DNR) order prevents primary healthcare providers from reviving clients or performing cardiopulmonary resuscitation (CPR). A durable power of attorney is a legal document that designates a person or persons chosen by a client to healthcare decisions on his/her behalf when the client is unable to do so.

A client is placed on a stretcher and restrained with straps while being transported to the x-ray department. A strap breaks, and the client falls to the floor, sustaining a fractured arm. Later the client shows the strap to the nurse manager, stating, "See, the strap is worn just at the spot where it snapped." What is the nurse's accountability regarding this incident?

Liable, along with the employer, for misapplication of equipment or use of defective equipment that harms the client Rationale: Using a stretcher with worn straps is negligent; this oversight does not reflect the actions of a reasonably prudent nurse. The nurse is responsible and must ascertain the adequate functioning of equipment. The hospital shares responsibility for safe, functioning equipment.

A nurse administers intravenous (IV) therapy to the wrong client. What possible legal complications might the nurse face in such situation?

Malpractice Rationale: If a nurse administers IV therapy to a wrong client, the nurse may face the charge of malpractice. Assault is any action that places the client or the nurse in fear of a harmful or offensive contact without consent. Battery is any intentional touching without consent. False imprisonment occurs with unjustified restraint of a person without legal warrant.

A client dies in the hospital 2 hours after being admitted. Who has the authority to decide if a post-mortem should be conducted?

Medical examiner Rationale: If a client dies within 24 hours of being admitted to the hospital, the medical examiner has the right to decide whether a post-mortem should be conducted. If the client's death does not need to be reviewed by the medical examiner and the client has not requested an autopsy in writing, the surviving spouse may request a post-mortem. The nursing manager and the primary healthcare provider are not authorized to make decisions regarding a post-mortem.

A female client is scheduled for a hysterectomy. While discussing the preoperative preparations, the nurse determines that the client's understanding of the surgery is inadequate. What is the next nursing intervention?

Notifying the surgeon that the client needs more information Rationale: Legally the person performing the surgery is responsible for informing the client adequately; the nurse may clarify information, witness the client's signature, and co-sign the consent form. Describing the proposed surgery to the client is beyond the scope of nursing practice. The nurse could face criminal charges of assault and battery for proceeding when there is a lack of informed consent. Explaining gently that she should have asked more questions places blame on the client; it is the responsibility of the surgeon to impart the vital information required for consent.

What does a nurse understand by the term regulatory law as applied to nursing practice?

Regulatory law reflects the decisions made by administrative bodies such as the State Boards of Nursing. Rationale: Regulatory law, also known as administrative law, reflects the decisions made by administrative bodies such as the State Boards of Nursing when they set down the rules and regulations. Civil laws protect the rights of individuals within society and provide for fair treatment in case civil wrongs or violations take place. Nurse Practice Acts are responsible for describing and defining the legal boundaries of the nursing practice within each state. Common law is based on judicial decisions made in courts when individual legal cases are decided.

What action should the nurse take if abuse of a 10-year-old child is suspected?

Report the suspicion to local authorities. Rationale: A nurse is mandated by law to report suspected child abuse. Child protective services are notified to make appropriate investigations. Assessment is an ongoing process throughout treatment, but legally the nurse is bound to report suspected abuse. Referring the parents to a group therapy meeting is not the primary safety action at this time. The nurse must comply with state (Canada: provincial/territorial) law because all 50 states (Canada: 12 provinces and territories) require the nurse to be a mandated reporter. The healthcare provider can be notified, but this is not the priority action.

Refusing to follow the prescribed treatment regimen, a client plans to leave the hospital against medical advice. What is it important for the nurse to inform the client of?

That the client must accept full responsibility for possible undesirable outcomes Rationale: The client has the right to self-determination, which includes refusing medical treatment. However, if the client does so, he or she must accept full responsibility for the illness and possible injury or undesirable outcomes. Healthcare professionals have a responsibility to inform the client and, if possible, have the client sign an informed waiver or a leaving against medical advice document. Acting irresponsibly is a subjective assumption. The client may be violating the hospital policy; however, if the client is deemed competent, he or she has the right to refuse treatment. Leaving against medical advice does not mean that the current primary healthcare provider will refuse to provide care to the client in the future.

An infant needs emergency surgery. A nurse is aware that the child's mother is 13-years-old and that the father is 16-years-old. The father and the paternal grandmother, who both take care of the infant, are the only family members at the bedside. From whom should the nurse obtain the informed consent?

The 16-year-old father Rationale: Regardless of age, parenthood confers the rights of an adult on a teenager. Since the mother is not at bedside, the father has the legal right to sign the surgical consent. The mother has a legal right to give consent but is not available. It is not legal for the grandmother to sign the consent because she is not the legal guardian. The hospital administrator would never provide consent.

A nursing student is recalling the order of priority for giving consent to perform an autopsy in cases where a medical examiner review is not needed. Which person receives the highest priority for giving consent?

The client in writing before death Rationale: If a medical examiner's review is not necessary, the highest priority is given to the client. The client may provide the consent in writing before death. If the client or the surviving spouse is unable to give consent for the autopsy, a surviving child may be requested to give consent. The surviving parent may give consent for an autopsy if the client, the surviving spouse, and the surviving child are unable to do so. In case the client has not provided written consent before death, the nurse may obtain consent from the surviving spouse.

A 1-week-old infant has been in the pediatric unit for 18 hours after placement of a spica cast. The nurse obtains a respiratory rate slower than 24 breaths/min; no other changes are noted. Because the infant is apparently well, the nurse does not report or document the slow respiratory rate. Several hours later the infant experiences severe respiratory distress, and emergency care is necessary. What should be considered if legal action is taken?

Vital signs that are outside the expected parameters are significant and should be documented. Rationale: A respiratory rate of less than 30 breaths/min in a young infant is not within the expected range of 30 to 60 breaths/min; a drop to less than 30 breaths/min is a significant change and should be documented. Respirations will accelerate when there is discomfort. Any significant change should be reported immediately. The respiratory tract is fully developed at birth, and the respiratory rate is a cardinal sign of the infant's well-being.

When should a medical examiner decide whether a postmortem examination should be conducted?

When a client dies within 24 hours of admission to the hospital Raitonale: If a client dies within 24 hours of admission to the hospital, the medical examiner is required to decide whether a postmortem examination should be conducted. If a client dies under suspicious circumstances, the medical examiner decides whether a postmortem examination is necessary. The medical examiner does not make the decision regarding postmortem examination if the client dies after 48 hours of being admitted to the hospital. A client may give a written consent before death to perform an autopsy. Such instances are not subject to the review of the medical examiner.

A client who consented to electroconvulsive therapy (ECT) is being prepared for the second session. The client tells the nurse, "I've decided that I don't want this treatment." What is the best response by the nurse?

"I'll tell your psychiatrist that you don't want the treatment." Rationale: A client has the right to revoke consent for treatment at any time; continuing treatment is a violation of the client's rights. "It's too late to stop the treatment now" is incorrect, and continuing with the treatment would be an act of battery. Teaching about the advantages and disadvantages of therapy should be conducted before, not after, the treatment; giving the client treatment without consent is an act of battery. A statement such as "You need more than one treatment for it to be successful" is considered coercion; continuation of treatment after the client's refusal would be an act of battery.

What is the most appropriate approach for the school nurse to take regarding children who are to be given medications while in school?

Assuring the children that their privacy will be respected Rationale: Children's and adults' confidentiality is protected by privacy laws. Although health classes may address medication as part of its curriculum, the information should be taught on a general, not a personal, level. Children and their teachers should not be encouraged to divulge private information.

A nursing student is recalling the definitions of acts that are classified as torts in nursing practice. Which tort involves intentional touching without the client's consent?

Battery Rationale: Battery is defined as intentional touching without the client's consent; this action may cause an injury or may be offensive to the client's personal dignity. Invasion of privacy is the announcement of a client's medical information to an unauthorized person. False imprisonment occurs when the nurse places the client in restraints without the approval of the primary healthcare provider. Defamation of character is the publication of false statements that result in damage to a person's reputation.

A nurse is recalling common terms that are used in health ethics. What does beneficence in health ethics refer to?

Beneficence refers to taking positive actions to help others. Rationale: Beneficence refers to taking positive actions to help others. Fidelity refers to the agreement to keep promises. Accountability refers to the ability to answer for one's actions. Nonmaleficence refers to avoiding harming an individual.

Which color tag is used for a client who is expected to die after a disaster with mass casualties?

Black tag Rationale: The disaster triage tag system categorizes triage priority by color. The clients who are expected to die after a disaster are marked with a black tag. The clients who have an immediate threat to life and need emergency treatment are marked with a red tag. The clients who have minor injuries that do not require immediate treatment are marked with a green tag. The clients who have major injuries and require treatment are marked with a yellow tag.

A nursing student is recalling the definition of Nurse Practice Acts. What do the Nurse Practice Acts do?

Nurse Practice Acts describe and define the legal boundaries of nursing practice within each state. Rationale: The Nurse Practice Acts describe and define the legal boundaries of nursing practice within each state. They help to distinguish between nursing and medical practice and establish education and licensure requirements for nurses. Standards of care reflect the knowledge and skills possessed by nurses who are active practitioners in their profession. Standards of care are legal requirements that define the minimum acceptable nursing care. The Health Insurance Portability and Accountability Act (HIPAA) protects individuals from losing their health insurance when changing jobs by providing portability.