Ethics

The nurse suspects that a patient is a victim of intimate partner violence (IPV) based on bruises on the neck, arms, and legs. Which data about the patient's spouse increases the risk for IPV? Select all that apply. One, some, or all responses may be correct. A. Substance abuse B. Unemployment C. Job stress D. Chronic illness E. Borderline personality traits

A, B, E Rationale IPV is a global issue. The risk factors for engaging in IPV include using drugs or alcohol, especially heavy drinking; unemployment; low self-esteem; gambling; antisocial or borderline personality traits; desire for power and control in relationships; and being a previous victim of physical or psychological abuse. Stress caused by a job or chronic illness are not identified risk factors of IPV.

A patient is abusive and rude with the student nurse. The student nurse documents that the patient is uncooperative and shows symptoms of alcohol withdrawal. As a result, the patient will be transferred to a different floor. Which term best classifies this nurse's error? A. Libel B. Slander C. Malpractice D. Invasion of privacy

A. Rationale Libel is documentation of false entries or defamation of character. The nurse is offended by the patient's behavior, so the nurse documents signs of alcohol withdrawal, even though this is not indicated by rude behavior alone. Slander is oral defamation of character. The nurse is documenting the report, but not verbalizing it, so this is not considered slander. Malpractice is negligence of a professional role. This nursing action does not indicate negligence. Invasion of privacy typically involves releasing a patient's private information without the patient's consent. The nurse has not violated the patient's privacy in this instance.

Which behavioral finding in children indicates possible abuse? A. Regressed behavior B. Strong relationship with peers C. Difficulty sitting or walking D. Pain, itching, or unusual odor in the genital area

A. Rationale A behavioral finding in children that indicates possible abuse is regressed behavior. Poor (not strong) relationships with peers occurs. Sitting and walking difficulties are physical (not behavioral) findings of abuse in children, as is pain, itching, or an unusual odor in the genital

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? A. Fidelity B. Beneficence C. Nonmaleficence D. Respect for autonomy

B. Rationale The immunization is a clear effort to provide benefit. Beneficence refers to doing good. Fidelity refers more to keeping promises. Nonmaleficence refers to the commitment to avoid harm. Respect for autonomy refers to the commitment to include patients in the decision-making process regarding health care plans.

A patient has difficulty breathing. The nurse provides oxygen therapy to the patient, after which the patient feels better. Which principle is involved in this situation? A. Fidelity B. Autonomy C. Beneficence D. Nonmaleficence

C. Beneficence refers to taking positive actions to help others. The nurse provided oxygen therapy to the patient to relieve breathlessness. The nurse's action was aimed to benefit the patient. The main principle of beneficence is fundamental to the practice of nursing and medicine. Fidelity is related to the agreement to keep promises. In this case, the nurse is not trying to keep promises but is trying to provide benefits. Autonomy focuses on the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. The patient's decision-making has not been challenged. Nonmaleficence is avoidance of harm or hurt. The nurse tries to prevent interventions that may potentially harm the patient.

The nurse is caring for a surgical patient in the preoperative area. The nurse witnesses the patient's informed consent for the surgical procedure. Which statement is true regarding informed consent? Select all that apply. One, some, or all responses may be correct. A. It must be signed while the patient is free from mind-altering medications. B. It can be witnessed by the nurse or nursing student. C. It may be withdrawn at any time. D. It must be signed by patients age 16 and older. E. It is usually obtained by the health care provider and not the nurse.

A, C, E Rationale An informed consent must be signed while the patient is free from mind-altering medications and after the patient has received all information necessary to make an informed decision. In most situations, the health care provider, not the nurse, obtains informed consent because the nurse does not perform surgery or direct medical procedures. Signed consent must be witnessed by the nurse but never by a nursing student because of the legal nature of the document. Informed consent may be withdrawn at any time before the procedure and must be signed by patients age 18 and older. A parent or guardian's signature is required for minors.

The nurse attends to a patient who sustained injuries when crossing the street. The patient was hit by a car that failed to stop at a stop sign. The patient was rushed to the emergency department and then to surgery to repair injuries. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The health care provider informs the nurse that patient confidentiality should be strictly maintained. What should the nurse interpret from this? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected A. The nurse should respect that the patient has the right to keep personal information from being disclosed. B. The nurse should avoid discussing the patient's medical reports in public areas with other health care professionals. C. The nurse should not disclose information about a procedure to the patient. D. The nurse must protect any private information about the patient once it has been disclosed in health care settings. E. Message boards where daily nursing care information is posted in the patient's room cannot contain information revealing the patient's medical condition.

A, B, D, E Rationale Confidentiality means that nurses and all health care providers must avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any manner. Confidentiality protects private patient information once it has been disclosed in health care settings. Privacy is the right of the patient to keep personal information from being disclosed. Patients have the right to get every possible detail before undergoing a particular procedure. Message boards used in patients' hospital rooms to post daily

A nurse is teaching a group of student nurses about ethics in the health care setting. Which education about nonmaleficence would the nurse provide? Select all that apply. One, some, or all responses may be correct. A. Nonmaleficence means avoidance of harm to the patient. B. The nurse should balance the risks and benefits of patient care. C. Nonmaleficence means to keep promises made to the patient. D. The nurse should allow the patient to read the informed consent. E. Nonmaleficence means using the therapeutic approaches with the least risk of harm.

A, B, E Rationale Nonmaleficence is the avoidance of harm or hurt to the patient. The nurse should balance the risks and benefits of patient care to make sure that it causes the least harm to the patient. Nonmaleficence also means choosing those therapeutic approaches that are least harmful for the patient. To keep promises made to the patient is a part of the standards of fidelity. Allowing the patient to read the informed consent is a practice of respecting the patients autonomy.

The nurse is explaining to students the difference between nonmaleficence and beneficence. Which information would the nurse include in the explanation to help the students understand the two concepts? Select all that apply. One, some, or all responses may be correct. A. According to the concept of beneficence, all interventions should consider the patient's best interest. B. According to the concept of beneficence, maximum priority is given to patients by allowing them to make their own health care decisions. C. According to the concept of nonmaleficence, the health care provider should weigh the risks and benefits of the intervention before delivering it. D. According to the concept of nonmaleficence, the nurse should be loyal and not abandon the patient even when the treatment procedure is complicated. E. According to the concept of nonmaleficence, the nurse should keep promises by following through on actions and interventions.

A, C

In a public health clinic, the nurse notices bruises on the back and injuries to the genitalia and breasts of a female patient. The patient also appears apprehensive in the presence of her husband. Which action would the nurse take? Select all that apply. One, some, or all responses may be correct. A. Notify the relevant authorities. B. Tell the woman to ask her husband to leave the room. C. Discuss the findings with the woman when her husband is not around. D. Advise the woman to divorce her husband. Instruct the woman to contact legal authorities.

A, C Rationale Abuse in any form, including physical, emotional, or sexual, is a major public health problem. In many states, nurses and health care providers must inform the relevant authority when they suspect that an individual is at risk. If the nurse suspects abuse of the patient, the nurse should interview her when her husband is not around, if possible. To prevent endangering her patient, the nurse should not directly ask the husband to leave the room, nor should she have the woman do so. Advising the woman to divorce her husband is not appropriate because it is the woman's personal decision. The nurse should not instruct the woman to contact legal authorities because the woman may fear the consequences.

The nurse is learning about negligence in unintentional torts. Which action would the nurse consider as a common act of negligence? Select all that apply. One, some, or all responses may be correct. A. Failure to follow prescriptions B. Failure to perform malpractice C. Failure to document monitoring D. Failure to follow policies and guidelines E. Failure to explain the risks of a surgery to a patient

A, C, D Rationale Failure to follow prescriptions is an act of negligence because it is the duty of the nurse to follow all given prescriptions. Documentation of monitoring is one of the best practices to prevent legal issues and is important to communicate with other health care team members. Policies and guidelines are created in accordance with laws and regulations, so they should be followed. Malpractice is professional negligence and

Which criterion can be used to establish nursing malpractice? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected A. The nurse owed a duty to a patient. B. The nurse followed the instructions given for a patient. C. The nurse did not follow a prescribed intervention for a patient. D. The nurse conveyed appropriate discharge instructions to the patient. E. The nurse's failure to carry out a duty caused an injury to the patient.

A, C, E Rationale If the nurse owed a duty to a patient, did not perform the given duty, and if the failure to perform that duty caused injury to the patient, then the nurse could be liable for nursing malpractice. Following the given instructions for a patient and conveying appropriate discharge instructions are both examples of good and ethical nursing practice. These actions would not make the nurse liable for nursing malpractice.

While caring for an 8-year-old patient, the nurse finds that the child appears scared of the parents and has bruises on the soles of the feet and on the back. Which laws obligate the nurse to report suspected abuse to law enforcement authorities? A. Public health laws B. Good Samaritan laws C. Mental Health Parity Act (MHPA) D. Failure to act laws

A. Rationale The nurse observes that the child is scared of the parents and has bruises on unexpected places of the body such as the soles of the feet and back. The bruises indicate that the child is facing abuse, so the nurse is obligated by public health laws to report the abuse to higher officials. Good Samaritan laws protect health care professionals from charges of negligence in providing emergency care outside the hospital. The MHPA forbids health insurance policies from placing lifetime or annual limits on mental health coverage. Failure to act laws require health care professionals to provide emergency care if they are qualified to do so, but these laws do not require the report of abuse.

A 50-year-old patient admitted with a cute exacerbation of asthma is now clinically stable and is planned for discharge the nurse teaches the patient about deep breathing exercises to improve the patient's lung capacity which professional behavior is the nurse showing? A. Advocacy B. Autonomy C. Accountability D. Collaboration

Autonomy Rationale Deep-breathing exercises and chest physiotherapy are performed to prevent respiratory complications. The nurse does not need medical orders to prescribe breathing exercises in this case. The professional behavior shown here by the nurse is autonomy. Autonomy involves the initiation of independent nursing interventions without medical orders. Advocacy refers to protecting the patient's human and legal rights and providing assistance in asserting these rights when needed. Accountability means that the nurse is responsible, professionally and legally, for the type and quality of the nursing care provided. Collaboration refers to nurse interaction with interprofessional health providers to provide the best possible care to the patient.

The nurse has failed to obtain informed consent before performing a procedure on a patient. Which type of tort results from this nursing action? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected A. Assault B. Battery C. Negligence D. False imprisonment E. Libel

B, C Rationale Battery is any intentional touching without consent. Because the nurse has failed to obtain informed consent, doing any intervention on the patient would be considered as battery. Negligence is performing an action that falls below a standard of care. Failure to obtain informed consent is an act of negligence. Assault refers to an action that places a person within harmful or offensive contact without consent. False imprisonment is the unjustified restraint of a person without legal warrant. Failure to obtain informed consent would not result in assault or false imprisonment. Libel is written defamation of character.

The nurse attends to a trauma patient who has been transferred from the intensive care unit (ICU). The nurse finds out that the ICU nurse provided a detailed explanation on the patient's condition to the family without consent from the patient. The ICU nurse also gave the patient a steroid shot even though the patient refused the medication. The ICU nurse would be guilty of which tort? Select all that apply. One, some, or all responses may be correct. A. Malpractice B. Battery C. Invasion of privacy D. Negligence E. Defamation of character

B, C Rationale Battery is any intentional touching without consent. Giving a steroid injection after the patient has rejected an invasive procedure is considered battery. The patient's privacy has been invaded when the health care provider informs the family of the patient's present medical condition without consent. Malpractice occurs when the health care delivered falls below the standard of care expected. Negligence is conduct that falls below a standard of

The nurse is caring for a patient who is extremely irritable and agitated. The nurse first transfers the patient forcefully to an isolated room to avoid disturbing other patients in the ward. The nurse then sedates the patient by giving a morphine injection. Which tort has the nurse committed? Select all that apply. One, some, or all responses may be correct. A. Assault B. Battery C. False imprisonment D. Invasion of privacy E. Defamation of character

B, C Rationale The nurse has committed battery and false imprisonment. Battery is intentional touching without the patient's consent. The nurse gives a morphine injection without requesting consent. This is indicative of battery. Transferring the patient to an isolated room indicates false imprisonment. The tort of false imprisonment refers to the unjustified restraint of a person without legal warrant. Assault is an action that places an apprehensive patient within harmful or offensive contact without consent. Threatening the patient to give the injection is an example of assault. Invasion of privacy refers to the unwanted intrusion into the personal matters of the patient. Defamation of character is the publication of false statements about a person that could damage a person's reputation.

The nurse is practicing according to the professional nursing code of ethics. Which action is in accordance with the standards of responsibility? Select all that apply. a. Protecting the patient's right to privacy b. trying to remain competent to practice c. Being responsible for delegated tasks d. being willing to respect professional obligations e. supporting the health, safety, and rights of the patients

B, C, D Ratinale: Nurses should strive to remain competent to practice in order to perform responsibly. All nursing interventions are the responsibility of the nurse including those that the nurse has delegated. The standards of practice involving responsibility include the nurses willingness to respect professional obligations and keep promises to patient protecting a patient privacy and supporting the health, safety, and rights of a patient are standards of advocacy not responsibility.

The nurse is learning about nursing malpractice. Which statement would the nurse consider as good nursing practice? Select all that apply. One, some, or all responses may be correct. A. Nursing notes can be illegible as long as the nurse can read them. B. Nursing notes should be maintained properly. C. Nursing records should be properly preserved. D. Institutions should maintain complete nursing records. E. Only basic duties should be recorded in nursing records.

B, C, D Rationale Nursing notes are important because they contain evidence needed to understand the care received by a patient. The notes should be legible to all people, not just the nurse. Similarly, complete nursing records should be properly preserved because they may be required to show what care was provided. Basic nursing duties as well as advanced nursing care should be recorded in the nursing records. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging a battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study for 4 hours. The improvement in the efficiency of the rested mind will balance out the difference in the time spent studying. Knowing your natural body rhythms will help you determine the amount of sleep you need for most efficient learning.

Which action indicates that the nursing student displays an understanding of accountable nursing care? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected A. Suspend care after discharge B. Exhibit a commitment to providing excellent patient care. C. Inform patients about ways to improve self-care. D. Deny responsibility for patient care outcomes. E. Check with the patient about his or her health status after discharge.

B, C, E Rationale Accountability means the nurse is answerable for the actions performed and that he or she should accept the commitment to provide excellent patient care. The nurse is accountable for ensuring that each patient learns the information necessary to improve self-care. Checking with the patient about his or her health status after discharge shows the accountability of the nurse and the nurse's commitment to providing quality care to the patient.

Which assessment finding is a clinical indicator of abuse in an older adult? Select all that apply. One, some, or all responses may be correct. A. Dry skin B. Bedsores C. Weight gain D. Excoriation on wrists or legs E. Hematomas at various healing stages

B, D, E Rationale Bedsores are a clinical indicator of older-adult abuse because these could be a result of caregiver neglect. Excoriation on wrists or legs indicates restraints have been improperly used, indicating older-adult abuse. Hematomas at various healing stages are also a clinical indicator of older-adult abuse. Dry skin is common in older adults because the activity of sebaceous and sweat glands decreases. Weight gain is not a clinical indicator of older-adult abuse; however, weight loss is a clinical indicator.

Which element is included in informed consent for participants of a research study? Select all that apply. One, some, or all responses may be correct. A. The patient and a family member should sign the consent form. B. The patient should be capable of understanding the research procedure. C. Once the patient has signed the forms, the patient must participate until the end of the research. D. Informed consent assures the patient that all the information of the study will be confidential. E. The patient has the right to refuse to participate at any point during the research,

B, D, E Rationale Informed consent stipulates that the patient should be capable of understanding the research procedure, assures the patient that all the information of the study will be confidential, and guarantees the patient the right to refuse to participate at any point during the research. Informed consent ensures research participants are given full and complete information about the study, including the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment. If the patient is participating in the study, the family members are not required to sign the consent form. Signing a consent form does not mean that the patient has to participate until the end of the research. The patient can withdraw at any time.

The surgical nurse is collecting the necessary documents to obtain a patient's informed consent before a surgery. In which instance would the nurse refrain from obtaining informed consent? A. The patient voices no concerns regarding the surgery. B. The patient was administered morphine. C. The patient's family members are not present. D. The surgery is associated with risk of severe complications.

B. Rationale Informed consent is usually obtained when the patient is alert, is able to understand and process information, and can make decisions. Morphine may cause drowsiness, preventing the patient from making informed decisions. Even if the patient voices no concerns or has no questions, the consent form still needs to be presented and explained to the patient. Presence of family members is not necessary for giving informed consent unless the patient is unable to do so for any reason. Every surgery is associated with risks, which are explained in the associated documentation, so this is not a valid reason for not obtaining an informed consent.

The nurse is caring for a patient with a bacterial infection. After administering an antibiotic, the nurse realizes that the wrong dose was given. The nurse immediately informs the patient and the health care provider. Which principle of the nursing code of ethics has the nurse followed? A. Advocacy B. Accountability C. Responsibility D. Confidentiality

B. Rationale The nurse has followed the principle of accountability. Accountability refers to the ability to answer for one's actions. The nurse realizes the mistake and informs the health care provider so that corrective actions can be taken. Advocacy means to support and speak for a particular cause on behalf of the patient. Responsibility refers to a willingness to respect one's professional obligations and follow through on promises. The nurse is acting responsibly, but the principle of accountability is more relevant in this situation. Confidentiality is a principle that is followed when one keeps the patient's personal health information private. The nurse is not trying to protect any patient-related information.

A patient is scheduled for surgery. Before the surgery, the patient read the consent form and signed it. This is an example of which principle? A. Justice B. Autonomy C. Beneficence D. Nonmaleficence

B. Rationale Autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient's independence. Autonomy means freedom from external control. Justice refers to the promotion of open discussion whenever mistakes occur, or nearly occur, without fear of recrimination. Beneficence refers to taking positive actions to help others.

The nurse has been falsely accused of providing inadequate care to a patient by another nurse. The nurse has received praise in the past for providing quality care to patients. Which tort does this indicate? A. Libel B. Slander C. Malpractice D. Invasion of privacy

B. Rationale Because the nurse has received praise in the past for providing quality care to patients, the implication is that the nurse provides quality care. Another nurse accusing this nurse of providing inadequate patient care is indicative of slander, which occurs when one person speaks falsely about others. Libel refers to written defamation of character. Malpractice comprises actions performed below the standard of care. Invasion of privacy refers to unwanted intrusion into patients' personal affairs.

The nurse is caring for a patient who has a skin infection. After applying ointment, the nurse realizes that they mistakenly applied the wrong ointment. The nurse informs the health care provider. Which element of the decision-making process does the nurse's action demonstrate? A. Authority B. Autonomy C. Accountability D. Responsibility

C. Rationale The nurse is showing accountability for the action performed. Accountability means the individual is answerable for his or her actions. Authority refers to the legitimate power to give commands and make final decisions specific to a given position. Autonomy is freedom of choice and responsibility for the choices. Responsibility refers to an individual's duty to perform the activities assigned to him or her.