Fundamentals of Success Legal and Ethical Issues

A nurse initiates a visit from a member of the clergy for a client. How is the nurse functioning when initiating this visit? A. Interdependently B. Independently C. Dependently D. Collegially

Answer: B A. A nurse does not need a primary health-care provider's prescription to make a referral to a member of the clergy. An interdependent intervention requires a primary health-care provider's prescription associated with a parameter. B. When a nurse initiates a referral to a member of the clergy, the nurse is working independently. Nurses legally are permitted to diagnose and treat human responses to actual or potential health problems. C. A nurse can make a referral to a member of the clergy. This action is within the scope of nursing practice. D. The nurse can make a referral to a member of the clergy without collaborating with another professional health-care team member.

Which is the primary purpose of the American Nurses Association (ANA) Standards of Clinical Nursing Practice? A. Define the philosophy of nursing practice. B. Establish criteria for quality nursing practice. C. Identify the legal definition of nursing practice. D. Determine educational standards for nursing practice.

Answer: B A. A philosophy incoporates the values and beliefs about the phenomena of concern to a discipline. The ANA Standards of Clinical Nursing Practice reflect, not define, a philosophy of nursing. Each nurse and nursing organization should define its own philosophy of nursing. B. The ANA Standards of Clinical Nursing Practice describe the nature and scope of nursing practice and the responsibilities for which nurses are accountable. C. The laws of each state define the practice of nursing within the state. D. Educational standards are established by accrediting bodies, such as the National League for Nursing Accrediting Commission, the Commission on Collegiate Nursing Education, and state education departments.

A student nurse about to graduate is actively developing a personal ethical foundation for nursing practice. Place the following actions in the order in which they should progress. 1. Clarify personal values and beliefs. 2. Identify ethical issues when working. 3. Identify a personal ethical foundation. 4. Work continuously to improve ethical decision-making abilities. 5. Integrate one's personal ethical foundation within the ethics of the profession.

Answer: 1, 3, 5, 2, 4 1. A nurse must know oneself before helping others. The first step is to identify and explore personal values and beliefs. 2. Identifying ethical issues when working in the nursing profession facilitates nursing actions that preserve personal integrity while meeting the needs of clients without imposing personal values or beliefs onto clients or their family members. 3. Once values and beliefs are explored, then a basis for an ethical foundation of nursing practice can be identified for oneself. 4. A nurse's ethical decision-making abilities should never remain static. These abilities grow as one matures within the profession and as a variety of factors (e.g., new technology, evolving social policy) influence one's ethical foundation. 5. After a nurse identifies a personal ethical foundation, it should be compared to the ethics of the nursing profession (American Nurses Association Code of Ethics). This ensures that the nurse works within the standards of the nursing profession.

A client is scheduled to have surgery, and informed consent is to be obtained. Place the following steps in the order in which they should be performed. 1. The client is willing to sign the consent voluntarily. 2. The client signs the consent in the presence of the nurse. 3. The nurse determines that the client is alert and competent to give consent. 4. The primary health-care provider informs the client of the risks and benefits of the procedure.

Answer: 4, 3, 1, 2 1. Clients must give their consent voluntarily and without coercion. 2. The health-care provider witnessing the signing of the consent must ensure that the signature is genuine. 3. Clients must be competent to sign a consent form. The client must be alert, competent, and in touch with reality. Confused, sedated, unconscious, or minor clients may not give consent. Minor clients who are married, parents, emancipated, or serving in the United States military can provide a legal consent. 4. It is the responsibility of the primary health-care provider to include all the information necessary to make a knowledgeable decision. Clients have a legal right to have adequate and accurate information to make informed decisions.

When choosing a nursing school in the United States that awards an associate degree, a future student nurse should consider schools that have met the standards of nursing education established by which organization? A. Accreditation Commission for Education in Nursing B. North American Nursing Diagnosis Association C. Sigma Theta Tau International D. American Nurses Association

Answer: A A. Accreditation Commission for Education in Nursing (ACEN) is an organization that appraises and grants accreditation status to nursing programs that meet predetermined structure, process, and outcome criteria. B. The North American Nursing Diagnosis Association (NANDA) developed a constantly evolving taxonomy of nursing diagnoses to provide a standardized language that focuses on clients and related nursing care. C. Sigma Theta Tau International, Honor Society of Nursing, recognizes academic achievement. It does not accredit schools of nursing. D. The American Nurses Association (ANA) is the national professional organization for nursing in the United States. It does not accredit schools of nursing.

A primary health-care provider asks a nurse to witness informed consents by several clients. Which client identified by the nurse is unable to give an informed consent for surgery? Select all that apply. A. 16-year-old boy who is married B. 50-year-old woman who is confused C. 35-year-old woman who is depressed D. 50-year-old woman who does not speak English E. 94-year-old man who recently suffered the death of his spouse

Answer: B A. Legally, individuals younger than 18 years old can provide informed consent if they are married, pregnant, parents, members of the military, or emancipated. B. A person who is confused is unable to understand the risks and benefits associated with making an informed decision. In this situation, a person designated as a health-care proxy or legal guardian has to make decisions for the confused individual. C. A depressed person is capable of making health-care decisions until proven to be mentally incompetent. D. This person can provide informed consent after interventions ensure that the person understands the facts and risks concerning the treatment. E. This person is considered functionally competent and able to make decisions for himself. There is no indication that the client is impaired because of grieving.

When caring for a terminally ill client, a family member says, "I need your help to hasten my mother's death so that she is no longer suffering." Which should the nurse do based on the position of the American Nurses Association in relation to assisted suicide? A. Not participate in active euthanasia B. Participate based on personal values and beliefs C. Participate when the client is experiencing severe pain D. Not participate unless two primary health-care providers are consulted and the client has had counseling

Answer: A A. Nursing actions must comply with the law, and the law states that euthanasia is legally wrong. Euthanasia can lead to criminal charges of homicide or civil lawsuits for providing an unacceptable standard of care. B. A nurse's beliefs, values, or moral convictions should not be imposed on clients. In addition, nurses cannot participate in euthanasia. C. Compassion and good intentions are not an acceptable basis for actions beyond the scope of nursing practice. D. Nurses cannot legally be involved with euthanasia. In some states in the U.S., a primary health-care provider can prescribe a medication that can be taken by a client to cause death (e.g., Oregon, Washington, Vermont, Colorado, California, and the District of Columbia). The ANA, according to its Code for Nurses with Interpretive Statements, indicates that nurses should not participate in active euthanasia or assistive suicide.

Which is the main role of the American Nurses Association? A. Establish standards of nursing practice. B. Recognize academic achievement in nursing. C. Monitor educational institutions granting degrees in nursing. D. Prepare nurses to become members of the nursing profession.

Answer: A A. The American Nurses Association has established Standards of Care and Standards of Professional Performance. These standards reflect the values of the nursing profession, provide expectations for nursing practice, facilitate the evaluation of nursing practice, and define the profession's accountability to the public. B. Sigma Theta Tau International, Honor Society of Nursing, recognizes academic achievement and scholarship in nursing. C. The National League for Nursing Accrediting Commission, the Commission on Collegiate Nursing Education, and state education departments monitor educational institutions granting degrees in nursing. D. Schools of nursing award a diploma, associate degree, or baccalaureate degree in nursing after successful completion of the program. These graduates are eligible to take the licensing examination for entry into the practice of nursing.

A nurse is informed that a credentialing team has arrived and is in the process of assessing the quality of care delivered at the hospital. Which organization is associated with the credentialing of hospitals? A. The Joint Commission B. National League for Nursing C. American Nurses Association D. National Council Licensure Examination

Answer: A A. The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) evaluates health-care organizations' compliance with standards stipulated by The Joint Commission. Accreditation indicates that the organization has the capabilities to provide quality care. In addition, federal and state regularly agencies and insurance companies require accreditation by The Joint Commission. B. The National League for Nursing (NLN) fosters the development and improvement of nursing education and nursing service. C. The American Nurses Association (ANA) is the national professional organization for nursing in the United States. Its purposes are to promote high standards of nursing practice and to support the educational and professional advancement of nurses. D. In the United States, graduates of educational programs that prepare students to become Licensed Practice Nurses or Registered Professional Nurses must successfully complete the National Council Licensure Examination-PN (NCLEX-PN) and the National Council Licensure Examination-RN (NCLEX-RN), respectively, as part of the criteria for licensure.

A nurse must administer a medication. Which should the nurse do first? A. Verify the prescription for accuracy. B. Check the client's identification armband. C. Ensure the medication is in the medication cart. D. Determine the appropriateness of the prescribed medication.

Answer: A A. The administration of medications is a dependent function of the nurse. The primary health-care provider's prescription should be verified for accuracy. The prescription must include the name of the client, the name of the drug, the size of the dose, the route of administration, the number of times per day to be administered, and any related parameters. B. Although checking the client's identification armband is essential for the safe administration of a medication, it is not the first step when preparing to administer a medication to a client. C. Although ensuring that the medication is available may be done as a time-management practice, it is not the first step when preparing to administer a medication to a client. D. A nurse is legally responsible for the safe administration of medications; therefore, the nurse should assess if a medication prescription is reasonable. However, this is not the first step when preparing to administer a medication to a client.

A client with a prolonged history of smoking cigarettes is being considered for a lung transplant. Which element of ethical practice is associated with fair policies and procedures guiding allocation of organs for transplantation? A. Justice B. Fidelity C. Veracity D. Nonmaleficence

Answer: A A. The ethical principle of Justice refers to fairness and that all clients should be treated equally, impartially, and without prejudice regardless of individual factors. B. The scenario in the stem does not reflect fidelity. Fidelity refers to making only promises or commitments that can be kept. C. The scenario in the stem does not reflect veracity. Veracity refers to being truthful, which is essential to a trusting nurse-client relationship. D. The scenario in the stem does not reflect Nonmaleficence. Nonmaleficence refers to preventing harm, or removing a client from harm.

The licensure of Registered Professional Nurses protects which of the following? A. Nurses B. Clients C. Common law D. Health-care agencies

Answer: B A. Licensure does not protect nurses. Licensure only ensures that the individual has met the requirements to practice nursing. Earning a license to practice as a Licensed Practical Nurse or Registered Nurse is granted to an individual who passes the NCLEX-PN or NCLEX-RN examination, respectively, according to the licensure requirements for the state in which the license is issued. B. Licensure indicates that a person has met minimal standards of competency, thus protecting the public's safety. C. Licensure does not protect common law. Common law comprises standards and rules based on the principles established in prior judicial decisions. D. Licensure does not protect health-care agencies. The Joint Commission determines if agencies meet minimal standards of health-care delivery, thus protecting the public.

An older adult male is admitted to the hospital after sustaining a brain attack (cerebrovascular accident, stroke). Intravenous fluids, resuscitative medications, and mechanical ventilation are instituted in the emergency department. Eventually, testing indicates absence of brain functions. A nurse interviews the client's son and daughter and reviews the client's advance directives. Legally, which is the most likely outcome in this scenario? Client's Clinical Record Interview With Client's Daughter - Client's daughter stated, "I love my dad, and I don't want him to die." Daughter indicated that she has been the person caring for her father when he is ill and stated that she will do everything she can to keep her dad alive. Interview With Client's Son - Client's son stated, "I love my dad, too, but if there is no hope for recovery, why are we doing all these things? What is the point?" Son indicated that he knows that he and his sister disagree on what should be done. Client's Advance Directives - The client's Health Care Proxy identifies the son as his representative. A. The son will request that life-sustaining interventions be stopped. B. The daughter will legally be able to prevent the withdrawal of medical interventions. C. The nurse should refer this situation to the agency's ethics committee for consideration. D. The primary health-care provider should concur with another health-care provider to arrive at a course of action.

Answer: A A. The son, by law, as a result of the client's Health Care Proxy, can make health-care decisions for his father, including withdrawing all life-sustaining interventions. B. The daughter lacks legal authority to act on behalf of her father. C. This is unnecessary. Legally, this situation is not an ethical dilemma. D. This is unnecessary. There are legal documents that will dictate the future course of action.

A nurse working in a hospital administers a medication to the wrong client and is sued by the client. Under contract law, which liability occurs when the hospital is additionally identified as a defendant in the legal action? Select all that apply. A. Vicarious liability B. Borrowed servant C. Captain of the ship D. Respondeat superior E. Quasi-intentional tort

Answer: A, C, D A. Vicarious liability applies in this situation. Vicarious liability applies when accountability for a wrong is assigned to a person or entity that did not directly cause an injury but has a contractual relationship with the person who did cause the wrong. The nurse is still liable for his or her own actions. B. A borrowed servant does not apply to this situation. A borrowed servant applies when an employer directs a nurse to work for a second employer (e.g., agency nurse); the second employer is held accountable for the nurse's actions. C. The liability of Captain of the ship applies in this situation. The liability of Captain of the ship occurs when a health-care provider is held liable for a nurse who is working under the direction of the health-care provider. The nurse is still liable for his or her own actions. D. Respondeat superior refers to "Let the master answer" and applies in this situation. When an agency hires a nurse, the nurse functions as a representative of the institution and must perform within its policies and procedures; the hospital is responsible for the actions of the nurse. The nurse is still liable for his or her own actions. E. A quasi-intentional tort is not related to this situation. An example of a quasi-intentional tort is making false statements, verbally (slander) or in writing (libel), about another person that harm the person's reputation (defamation of character) or holds the person up to ridicule or contempt.

A student nurse is about to graduate from an accredited nursing program. Which does the student nurse understand is an action unrelated to a state Nurse Practice Act? Select all that apply. A. Setting guidelines for nurses' salaries in the state. B. Establishing reciprocity for licensure between states C. Determining minimum requirements to be licensed as a nurse D. Maintaining a list of nurses who can legally practice in the state E. Providing legal counsel for a nurse who is being sued for malpractice

Answer: A, D, E A. The salary of nurses is determined through negotiations between nurses or their representatives, such as a union or a professional nursing organization, and the representative of the agency for which they work. B. A state's Nurse Practice Act determines the criteria for reciprocity for licensure. C. A state's Nurse Practice Act stipulates minimum requirements required for a person to be licensed as a Registered Professional Nurse or Licensed Practical Nurse within the state. D. A state's Nurse Practice Act defines the criteria for licensure within the state. However, actual functions, such as maintaining a list of nurses who can legally practice in the state, usually are delegated to another official body, such as a State Board of Nursing or State Education Department. E. State Nurse Practice Acts do not provide legal counsel for a nurse who is sued for malpractice. A nurse should purchase malpractice insurance upon graduation from a nursing program or may be provided legal counsel by an employer.

A client is asked to participate in a medical research study. Which document should the nurse explain to the client because it protects the client's rights? A. Code of Ethics B. Informed Consent C. Nurse Practice Act D. Constitution of the United States

Answer: B A. A code of ethics is the official statement of a group's ideals and values. It includes broad statements that provide a basis for professional actions. B. Informed consent is an agreement by a person to accept a course of treatment or a procedure after receiving complete information necessary to make a knowledgeable decision. C. Nurse Practice Acts define the scope of nursing practice; they are unrelated to participation in research studies. D. The Constitution of the United States addresses broad individual rights and responsibilities. The rights related to nursing practice and clients include the rights of privacy, freedom of speech, and due process.

Which person requires a co-signature for a valid consent for surgery? A. 15-year-old mother whose infant requires exploratory surgery B. 40-year-old client in a home for developmentally disabled adults C. 90-year-old adult who wants more information about the risks of surgery D. 50-year-old unconscious trauma victim who needs insertion of a chest tube

Answer: B A. A mother may legally make medical decisions for her children, even if the mother is younger than 18 years of age. B. A person living in a protected environment, such as a home for developmentally disabled adults, may not have the mental capacity to make medical decisions and requires the signature of a court-appointed legal representative. This person can be a parent, sibling, relative, or unrelated individual. C. Older adults can make decisions for themselves as long as they understand the risks and benefits of the surgery and are not receiving medication that may interfere with cognitive ability. D. The insertion of a chest tube to inflate a lung is an emergency intervention to facilitate respiration and oxygenation. This emergency procedure is implemented to sustain life and does not require a signed consent if the client is incapacitated.

For which are state legislatures responsible? A. Standardized care plans B. Enactment of Nurse Practice Acts C. Accreditation of educational nursing programs D. Certification in specialty areas of nursing practice

Answer: B A. Nursing team members or an interdisciplinary team of health-care providers write standardized care plans. B. Every state has its own Nurse Practice Act that describes and defines the legal boundaries of nursing practice within the state. C. The National League for Nursing Accrediting Commission, the Commission on Collegiate Nursing Education, and state education departments are the major organizations accrediting nursing education programs in the United States. D. The American Nurses Association and other specialty organizations offer certification in specialty areas in nursing practice.

Nursing practice is influenced by the doctrine of respondeat superior. Which is the basic concept related to this theory of liability? A. Nurses must respond to the Supreme Court when they commit acts of malpractice. B. Health-care facilities are responsible for the negligent actions of the nurses whom they employ. C. Nurses are responsible for their actions when they have contractual relationships with clients. D. The law absolves nurses from being sued for negligence if they provide inappropriate care at the scene of an accident.

Answer: B A. This is unrelated to respondeat superior. Negligence and malpractice, which are unintentional torts, are litigated in local courts by civil actions between individuals. B. The ancient legal doctrine respondeat superior means "let the master answer." By virtue of the employer-employee relationship, the employer is responsible for the conduct of its employees. C. Individual responsibility is unrelated to respondeat superior. A nurse can have an independent contractual relationship with a client. When a nurse works for an agency, the contract between the nurse and client is implied. In both instances, the nurse is responsible for the care provided. D. This is unrelated to respondeat superior. Good Samaritan laws do not provide absolute immunity. Nurses must function as a reasonable prudent nurse would function in a similar situation. Nurses can be held responsible if there is gross departure from the normal standard of care or if there is willful wrongdoing on the nurse's part.

A nurse says, "If you do not let me do this dressing change, I will not let you eat dinner with the other clients in the dining room." Which legal term is related to this statement? A. Battery B. Assault C. Negligence D. Malpractice

Answer: B A. This statement is not an example of battery. Battery is the actual willful touching of another person that may or may not cause harm. B. This statement is an unjust threat. Assault is the threat to harm another person without cause. C. This statement is not an example of negligence. Negligence occurs when harm or injury is caused by an act of either commission or omission. D. This statement is not an example of malpractice. Malpractice is negligence by a professional person as compared with the actions of another professional person in a similar circumstance when a contract exists between the client and nurse.

For which primary reason is an expert nurse called to testify in a lawsuit regarding professional nursing malpractice? A. Strengthen the defense. B. Support the prosecution. C. Present standards of nursing care as they apply to the facts in the case. D. Make judgments associated with laws governing the practice of nursing.

Answer: C A. A nurse expert can testify for either the defense or the prosecution. B. A nurse expert can testify for either the prosecution or the defense. C. The American Nurses Association Standards of Clinical Nursing Practice are authoritative statements by which the national organization for nursing describes the responsibilities for which nurses are accountable. An expert nurse is capable of explaining these standards as they apply to the situation under litigation. These professional standards are criteria that help a judge or jury determine if a nurse committed malpractice or negligence. D. An expert nurse is not an authority in the law. The expert nurse's role is not to make judgments about the laws as they apply to the practice of nursing.

A nurse administers an incorrect dose of a medication to a client. Which is the primary purpose of documenting this event in an Incident Report? A. Record the event for future litigation. B. Provide a basis for designing new policies. C. Prevent similar situations from happening again. D. Ensure accountability for the cause of the accident.

Answer: C A. Although documentation of an incident may be used in a court of law, it is not the primary reason for an Incident Report. B. Providing a basis for designing new policies is not the primary reason for Incident Reports. New policies may or may not have to be written and implemented. C. Risk-management committees use statistical data about accidents and incidents to identify patterns of risk and prevent future accidents and incidents. D. Although nurses are always accountable for their actions, accountability for the cause of an incidence is the role of the courts.

A Registered Nurse witnesses an accident and assists the victim, who has a life-threatening injury. Which should the nurse do to meet an important standard of care when acting as a Good Samaritan at the scene of an accident? A. Seek consent from the injured party before rendering assistance. B. Implement every critical-care intervention necessary to sustain life. C. Stay at the scene until another qualified person takes over responsibility. D. Insist on helping because a nurse is the best-qualified person to provide care.

Answer: C A. Depending on the injured person's physical and emotional status, the person may or may not be able to provide consent for care. B. When a nurse helps in an emergency, the nurse is required to render care that is consistent with care that any reasonably prudent nurse would provide under similar circumstances. The nurse should not attempt interventions that are beyond the scope of practice. C. When a nurse renders emergency care, the nurse has an ethical responsibility not to abandon the injured person. The nurse should not leave the scene until the injured person leaves or another qualified person assumes responsibility. D. A nurse should offer assistance, not insist on assisting, at the scene of an emergency.

Which factor is unique to malpractice when comparing negligence and malpractice? A. The action did not meet standards of care. B. The inappropriate care is an act of commission. C. There is harm to the client as a result of the care. D. There is a contractual relationship between the nurse and client.

Answer: D A. There is a violation of standards of care with both negligence and malpractice. B. Negligence and malpractice both involve acts of either commission or omission. C. The client must have sustained injury, damage, or harm with both negligence and malpractice. D. Only malpractice is misconduct performed in professional practice, where there is a contractual relationship between the client and nurse that results in harm to the client.

When a nurse attempts to administer a medication to a client, the client refuses to take the medication because it causes diarrhea. The nurse provides teaching about the medication, but the client continues adamantly to refuse the medication. Which should the nurse do first? A. Discuss with a family member the need for the client to take the medication. B. Explain again to the client the consequences of refusing to take the medication. C. Document in the client's clinical record the client's refusal to take the medication. D. Notify the primary health-care provider of the client's refusal to take the medication.

Answer: C A. Discussing the situation with a family member without the client's consent is a violation of confidentiality. B. The client has been taught about the medication and adamantly refuses the medication. Further teaching at this time may be viewed by the client as badgering. C. Withholding the medication and documenting the client's refusal are the appropriate interventions. Clients have a right to refuse care. D. Notifying the primary health-care provider eventually should be done, but it is not the priority at this time.

Which of the following is responsible for ensuring that Registered Nurses are minimally qualified to practice nursing? A. American Nurses Association B. Sigma Theta Tau International C. National Council of State Boards of Nursing D. Constituent Leagues of the National League for Nursing

Answer: C A. The American Nurses Association (ANA) is the national professional organization for nursing in the United States. It fosters high standards of nursing. B. Sigma Theta Tau International, Honor Society of Nursing, recognizes academic achievement and leadership qualities, encourages high professional standards, fosters creative endeavors, and supports excellence in the profession of nursing. C. The National Council of State Boards of Nursing is responsible for the NCLEX examinations. Passing the NCLEX examination establishes competencies required to perform safely and effectively as a newly licensed nurse. Passing an NCLEX examination assists State Boards of Nursing in making licensure decisions. D. The National League for Nursing (NLN) is committed to promoting and improving nursing service and nursing.

A nurse completes an Incident Report after a client falls while getting out of bed unassisted. Which is the purpose of this report? A. Ensure that all parties have an opportunity to document what happened. B. Help establish who is responsible for the situation. C. Make data available for quality-control analysis. D. Document the situation on the client's chart.

Answer: C A. The nurse who identified or created the potential or actual harm completes the Incident Report. The report identifies the people involved in the incident, describes the incident, and records the date, time, location, actions taken, and other relevant information. B. Documentation should be as factual as possible and avoid accusations. Questions of liability are the responsibility of the courts. C. Incident Reports help to identify patterns of risk so that corrective action plans can take place. D. An Incident Report is not part of the client's clinical record, and reference to the report should not be made in the client's clinical record.

When a nurse is administering a medication to a confused client, the client says, "This pill looks different from the one I had before." Which should the nurse do? A. Explain the purpose of the medication. B. Ask what the other medication looked like. C. Check the original medication prescription. D. Encourage the client to take the medication.

Answer: C A. This intervention ignores the client's concern. Although this ultimately may be done, it is not the priority action. B. This action by itself is unsafe because the client is confused and the information obtained may be inaccurate. C. This is the safest intervention because it goes to the original source of the prescription. D. This action ignores the client's statement and is unsafe without first obtaining additional information.

When attempting to administer a 10 p.m. sleeping medication, the nurse assesses that the client appears to be asleep. Which should the nurse do? A. Withhold the drug. B. Notify the primary health-care provider. C. Awaken the client to administer the drug. D. Administer it later if the client awakens during the night.

Answer: C A. This is a violation of the primary health-care provider's prescription. Drug administration is a dependent nursing function. B. Notifying the primary health-care provider is unnecessary. C. Administering a medication is a dependent function of the nurse. The prescription should be followed as written if the prescription is reasonable and prudent. This medication was not a prn medication but rather a standing prescription. D. The drug should be administered as prescribed, not at a later time.

An anxious client repeatedly uses the call bell to get the nurse to come to the room. Finally, the nurse says to the client, "If you keep ringing, there will come a time I won't answer your bell." Which legal term is related to this statement? A. Slander B. Battery C. Assault D. Libel

Answer: C A. This is not an example of slander, which is a false spoken statement resulting in damage to a person's character or reputation. B. This is not an example of battery, which is the unlawful touching of a person's body without consent. C. This is an example of assault. Assault is a verbal attack or unlawful threat causing a fear of harm. No actual contact is necessary for a threat to be an assault. D. This is not an example of libel, which is a false printed statement resulting in damage to a person's character or reputation.

A client living in Oregon has been receiving hospice care in the home. One day, the client tells the nurse, "Dying takes forever. I hate it that I am a burden to my family. I can't stand this anymore. Can you help me end my life?" The nurse's personal ethical values do not include complying with this client's request. Which is the nurse's best response? A. "I will inform your primary health-care provider of your desire to die." B. "Your family members probably do not consider you a burden." C. "Let's talk a little more about your wanting to die." D. "Nurses cannot participate in assisted suicide."

Answer: C A. This statement eventually may be made, but at this time it is not the priority. By this response, the nurse is functioning as a client advocate without violating personal values against assisted suicide. In states such as Oregon, Washington, and Vermont, Colorado, and California and in the District of Columbia, primary health-care providers can prescribe medications that may be used by clients to cause their own deaths; this is called assisted suicide. Certain criteria must be met, depending on the state, such as being 18 years of age or older, having a terminal illness with fewer than 6 months to live, being capable of self-administering the medication, and meeting specific psychiatric criteria (e.g., counseling, no psychiatric diagnosis, exploration of palliative options). Nurses do not have the legal or ethical right or obligation to help clients die. The American Nurses Association Code of Ethics states that nurses should not participate in assisted suicide or euthanasia. B. This minimizes the client's concerns. Also, the nurse may or may not know if this is a true statement; the family may believe that caring for a dying family member is a burden. C. This statement is an open-ended question that encourages the client to discuss feelings and explore future options, including assisted suicide. D. Although this may be a true statement, it does not meet the client's physical or emotional needs. This statement focuses on the nurse rather than the client.

A client sustained a serious injury as a result of malpractice by a nurse. Several legal elements must be met to prove the nurse committed malpractice in a civil suit. Which statement is associated with the element of causation? Select all that apply. A. A nurse-client relationship existed between the nurse and the client. B. A nurse's omission or commission of an act failed to meet standards of care. C. A nurse's action or inaction was the immediate reason for the plaintiff's injury. D. A nurse should have known that the action or inaction could result in harm or injury to the client. E. A nurse's action or inaction that did not meet a standard of care resulted in a client experiencing pain, suffering, and disability.

Answer: C, D A. This statement reflects the element of duty, not causation. The element of duty is met when a nurse has a legal obligation to provide nursing care to the client. B. This statement reflects the element of breach of duty, not causation. The element of breach of duty is met when a nurse's action or inaction fails to meet standards of care established by a job description, agency policy or procedures, the state nurse practice act, and standards established by professional organizations. C. Causation relates to malpractice when a client's injury is directly the result of a nurse's action or inaction (proximate cause). D. Causation relates to malpractice when a nurse should have known that an action or inaction that is a breach of a nursing standard could result in harm or injury to a client (foreseeability). E. This statement reflects the element of damages, not causation. The element of damages is met when the plaintiff proves that physical, emotional, or financial harm or injury was the result of a standard of care not being met.

When considering legal issues, the word contract is to liable as standard is to which word? A. Rights B. Negligence C. Malpractice D. Accountability

Answer: D A. Although clients have a right to receive care that meets appropriate standards, the word right does not have the same relationship to the word standard as the relationship between the words contract and liable. B. The words standard and negligence do not have the same relationship as the words contract and liable. Negligence involves an act of commission or omission that a reasonably prudent person would not do. C. The words standard and malpractice do not have the same relationship as the words contract and liable. Malpractice is negligence by a professional person. D. Liable means a person is accountable for fulfilling a contract that is enforced by law. Accountable means a person is responsible (liable) for meeting standards, which are expectations established for making judgments or comparisons.

How is the nurse functioning when administering a drug that has prn as part of the prescription? A. Collegially B. Dependently C. Independently D. Interdependently

Answer: D A. Collegial or collaborative interventions are actions the nurse performs in conjunction with other health-care team members. B. Dependent interventions are those activities performed under a primary health-care provider's direction and supervision. C. Independent interventions are those activities the nurse is licensed to initiate based on knowledge and expertise. D. An interdependent intervention requires a primary health-care provider's prescription associated with a set parameter. The parameter, prn (whenever necessary), requires that the nurse use judgment when implementing the prescription.

When preparing to administer a medication, the nurse identifies that the dose is larger than the standard dose recommended by the manufacturer. Which should the nurse do? A. Inform the supervisor. B. Give the drug as prescribed. C. Give the average dose of the medication. D. Discuss the prescription with the primary health-care provider.

Answer: D A. It is unnecessary to call the supervisor in this situation. B. Giving the drug as prescribed may be unsafe for the client and may result in malpractice. C. Changing a medication prescription is not within the scope of nursing practice. D. Nurses have a professional responsibility to know or investigate the standard dose for prescribed medications being administered. In addition, nurses are responsible for their own actions regardless of whether there is a written prescription. The nurse has a responsibility to question and/or refuse to administer a prescription that appears unreasonable.

A faculty member of a nursing program is conducting an informational session for potential nursing students. Which information about licensure to practice nursing upon completion of a nursing program should the faculty member include in the session? A. "It is a responsibility of the American Nurses Association." B. "It is granted on graduation from a nursing program." C. "It is approved by the National League for Nursing." D. "It is required by law in each individual state."

Answer: D A. The American Nurses Association (ANA) Standards of Clinical Nursing Practice do not address licensure. B. When a person graduates from a school of nursing, the individual receives a diploma that indicates completion of a course of study; the diploma is not a license to practice nursing. C. The National League for Nursing (NLN) promotes nursing service and nursing education; it is not involved with icensure. D. The Nurse Practice Act in a state stipulates the requirements for licensure within the state.

A nurse changes a client's dry sterile dressing. How is the nurse functioning when performing this task? A. Interdependently B. Collaboratively C. Independently D. Dependently

Answer: D A. The changing of a dry sterile dressing is an interdependent action by the nurse when the primary health-care provider's prescription for wound care includes a parameter such as "change the sterile dressing whenever necessary." B. In this situation, the nurse is not working with other health-care professionals to implement a primary health-care provider's prescription. C. This intervention is not within the scope of nursing practice without a primary health-care provider's prescription. D. A nurse is not permitted legally to prescribe wound care. The nurse needs a prescription from a primary health-care provider to implement wound care.

A primary health-care provider prescribes out of bed to a chair as the activity level for a client. How is the nurse functioning when moving this client out of bed to a chair? A. Interdependently B. Collaboratively C. Independently D. Dependently

Answer: D A. The nurse is following the primary health-care provider's prescription to get the client out of bed. There are no restrictions or parameters in relation to the prescription. However, the nurse must use judgment before, during, and after a transfer if a client's condition changes. B. A nurse does not work collaboratively when moving this client out of bed. C. The responsibility to determine a client's activity level is not within the legal scope of nursing practice. D. Determining the extent of activity desirable for a client is within the primary health-care provider's, not a nurse's, scope of practice. Following activity prescriptions is a dependent function of the nurse.

A client's diet prescription is "clear liquids to regular as tolerated." How is the nurse functioning when progressing the client's diet to full liquid? A. Dependently B. Independently C. Collaboratively D. Interdependently

Answer: D A. This dietary prescription has parameters that exceed a simple dependent function of the nurse. B. Prescribing a diet for a client is outside the scope of nursing practice. C. Collaborative or collegial interventions are actions the nurse carries out in conjunction with other health-care team members. D. The primary health-care provider's prescription implies a progression in the diet as tolerated. The nurse uses judgment to determine the time of this progression, which is an interdependent action.

Identify the action that is an example of slander. Select all that apply. A. Volunteer telling another volunteer a client's age B. Discussing confidential information on an elevator used by visitors C. Personal care assistant sharing information about a client with another client D. Unit manager documenting a nurse's medication error in a performance appraisal E. Housekeeper who is angry at a nurse falsely telling another staff member that the nurse uses cocaine

Answer: E A. This is a violation of the client's right to confidentiality, not slander. B. This is a violation of a client's right to confidentiality, not slander. C. This is a violation of the client's right to confidentiality, not slander. D. This is not slander because it is a written, not spoken, statement and it documents true, not false, information. E. This is an example of slander. It is a malicious, false statement that may damage the nurse's reputation.