NCLEX Legal/Ethical Issues
Obtaining informed consent is the responsibility of A. The physician B. The RN manager C. The nurse D. The CNA
A. The physician Rationale: The physician is RESPONSIBLE for obtaining an informed consent.
11. An 87-year-old woman is brought to the emergency department for treatment of a fractured arm. On assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. What is the most appropriate nursing response? a. "Oh really I will discuss this situation with your son" b. "Let's talk about the ways you can manage your time to prevent this from happening" c. "Do you have any friends that can help you out until you resolve these important issues with your son?" d. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay.
11. D- The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with nonmedical personnel or the client's family or friends without the client's permission. Clients should be assured under a legal obligation. Option 1, 2, and 3 do not address the legal implications of the situation and do not ensure a safe environment for the client.
12. The nurse calls the health care provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the HCP, and the medication is due to administered. Which action should the nurse take? a. Contact the nursing supervisor b. Administer the dose prescribed c. Hold the medication until the HCP can be contacted d. Administer the recommended dose until the HCP can be located
12. A- If the HCP writes a prescription that requires clarification, the nurse's responsibility is to contact the HCP. If there is no resolution regarding the prescription because the HCP cannot be located or because the prescription remains as it was written after talking with the HCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.
13. The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate nursing action? a. Call the police b. Cut up the photograph and throw it away c. Call the nursing supervisor and report the incident d. Call the laboratory and ask for the individual's name who sent the photograph
13. C- Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. Sexually suggestive jokes, touching, pressuring a co-worker for a date, and open displays of or transmitting sexually oriented photographs or posters are examples of conducts that could be considered sexual harassment by another worker. If the nurse believes that he or she is being subjected to unwelcome sexual conduct, these concerns should be reported to the nursing supervisor immediately. Option 1 is unnecessary at this time. Options 2 and 4 are inappropriate initial actions.
2. A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? a. Obtain a court order for the surgical procedure b. Ask the EMS team to sign the informed consent c. Transport the victim to the operating room for surgery d. Call the police to identify the client and locate the family.
2. C- In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action
6. A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance obtaining a witness to the will. Which is the most appropriate response to the client? a. "I will sign as a witness to your signature." b. "You will need to find a witness on your own.' c. "Whoever is available at the time will sign as a witness for you." d. "I will call the nursing supervisor to seek assistance regarding your request."
6. D- Living wills, also known as natural death acts in some states, are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding living wills vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option 2 is nontherapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.
7. The nurse has made an error in a narrative documentation of an assessment finding on a client and obtains the client's record to correct the error. The nurse should take which action to correct the error? a. Documenting a late entry into the client's record b. Trying to erase the error for space to write in the correct data c. Using whiteout to delete the error to write in the correct data d. Drawing one line through the error, initialing and dating, and then documenting the correct information.
7. D- If the nurse makes an error in narrative documentation in the client's record, the nurse should follow agency policies to correct the error. This includes drawing one line through the error, initializing and dating the line, and then documenting the correct information. A late entry is used to document additional information not remembered at the initial time of documentation. Erasing data from the client's record and the use of whiteout are prohibited
8. Which identifies accurate nursing documentation notations? Select all that apply a. The client slept through the night b. Abdominal wound dressing is dry and intact without drainage c. The client seemed angry when awakened for vital sign measurement d. The client appears to become anxious when it is time for respiratory treatments e. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema
8. A, B, E- Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. The use of vague terms, such as seemed or appears is not acceptable because these words suggest that the nurse is stating an opinion.
9. A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right? a. Performing a procedure without consent b. Threatening to give a client a medication c. Telling the client that he or she cannot leave the hospital d. Observing care provided to the client without the client's permission
9. D- Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure without consent is an example of battery. Threatening to a give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.
A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action? 1. Administer the medication 2. Notify the prescriber 3. Call the pharmacist. 4. Refuse to administer the medication.
Answer #2 Rationale: The nurse should call the person who wrote the order for clarification. Administering the medication is incorrect because knowing the dose is outside the normal range and not questioning it could lead to client harm and liability for the nurse.
Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? 1. An unintentional tort 2. Assault 3. Invasion of Privacy 4. Battery
Answer #4 Rationale: Battery is the willful touching of a person without permission. Another name for an unintentional tort is malpractice. This situation is an intentional tort because the nurse executed the act on purpose.
A nursing student is employed and working as an unlicensed assistive personnel (UAP) on a busy surgical unit. The nurses know that the UAP is enrolled in a nursing program and will be graduating soon. A nurse asks the UAP if he has performed a urinary catheterization on clients while in school. When the UAP says yes, the nurses asks him to help her by doing a urinary catheterization on a post surgical client. What is the best response by the UAP? 1. "Let me get permission from the client first." 2. "Sure, which client is it?" 3. "I can't do it unless you supervise me." 4. "I can't do it. is there something else I can help you with."
Answer: 4 Rationale: A sterile invasive procedure that places the client at significant risk for infection is generally outside the scope of practice of a UAP. Even though the UAP is a nursing student, the agency job description should be followed.
A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action? A. refuse to float in the ICU B. call the hospital lawyer C. call the nursing supervisor D. report to the ICU and identify tasks that can be safely performed
Answer: D Rationale - floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.
A student nurse who is employed as a nursing assistant may perform any functions that she taught in school. A. True B. False
B. False Rationale: You may only perform functions that you are licensed to perform while on the job.
The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? A. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state B. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. D. The client cannot make changes in the advance directive once the client is admitted into the hospital.
C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. Rationale: A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.
Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.
C. Assess the client's point of view and prepare to articulate this point of view. Rationale: Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.
Miss Magu, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value
C. Prizing a value
The nurse is obligated to follow a physicians order unless: A. The order is a verbal order B. The order is illegible C. The order has not been transcribed D. The order is an error, violates hospital policy, or would be detrimental to the client
D. The order is an error, violates hospital policy, or would be detrimental to the client.
Which nursing actions could result in malpractice? Select all that apply 1. Learns about a new piece of equipment 2. Forgets to complete the assessment of a client 3. Does not follow up on client's complaints. 4. Charts client's drug allergies 5. Questions primary care provider about an illegible order
Answer: 2 and 3 Rationale: Standards of practice require a complete assessment. A nurse needs to be sure the client's needs have been met. They both can impact client safety and do not follow standards of care.
The primary care provider wrote a do-not-resuscitate (DNR) order. The nurse recognizes that which applies in the planning of nursing care for this client? 1. The client may no longer make decisions regarding his or her own health care. 2. The client and family know that the client will most likely die within the next 48 hours. 3. The nurses will continue to implement all treatments focused on comfort and symptom management. 4. A DNR order from a previous admission is valid for the current admission
Answer: #3 Rationale: A DNR order only controls CPR and similar life-saving treatments. All other care continues as previously ordered. Competent clients can still decide about their own care (including the DNR order.)
1. The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the incident report? a. The client fell out of bed b. The client climbed over the side rails c. The client was found lying on the floor d. The client became restless and tried to get out of bed.
1. C- The incident report should contain the client's name, age, and diagnosis. The report should contain a factual description of the incident, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options 1, 2, and 4 are interpretations of the situation and are not factual information as observed by the nurse.
10. Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive personnel (UAP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. Which legal tort has the UAP violated? a. Libel b. Slander c. Assault d. Negligence
10. B- Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (Libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or an offensive contact. Negligence involves the actions of professionals that fall below standard of care for a specific professional group
3. The nurse has just assisted a client back to bed after a fall. The nurse and health care provider have assessed the client and have determined that the client is not injured. After completing the incident report, the nurse should implement which action net? a. Reassess the client b. Conduct a staff meeting to describe the fall c. Document in the nurse's notes that an incident report was completed. d. Contact the nursing supervisor to update information regarding the fall
3. A- After a client's fall, the nurse must frequently reassess the client because potential complications do not always appear immediately after the fall. The client's fall should be treated as private information and shared on a "need to know" basis. Communication regarding the event should involve only the individuals participating in the client's care. An incident report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nursing supervisor has been made aware of the incident, the supervisor will contact the nurse if status update is necessary.
4. The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first? a. Call the hospital lawyer b. Refuse to float to the ICU c. Call the nursing supervisor d. Identify tasks that can be performed safely in the ICU
4. D- Floating is an acceptable legal practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Calling the hospital lawyer is a premature action.
5. The nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing clear liquid, in the antecubital area. Which is the most appropriate action by the nurse? a. Call security b. Call the police c. Call the nursing supervisor d. Lock the co-worker in the medication room until help is obtain
5. C- Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option 4 is an inappropriate and unsafe action.
As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the A. Nurse Practice Act (NPA). B. American Nursing Association (ANA) C. National Council for Lisensure Examinations D. State Board of Licensure
A. Nurse Practice Act (NPA).
A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role? 1. "The doctor has asked that you sign the consent form." 2. "Do you have any questions about the procedure?" 3. "What were you told about the procedure you are going to have?" 4. "Remember that you can change your mind and cancel the procedure."
Answer: #3 Rationale: This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)
The nurse's partner/spouse undergoes exploratory surgery at the hospital where the nurse is employed. Which practice is most appropriate 1, Because the nurse is an employee, access to the chart is allowed. 2. The relationship with the client provides the nurse special access to the chart. 3. Access to the chart requires a signed release form 4. The nurse can ask the surgeon to discuss the outcome of the surgery.
Answer: #3 Rationale: The only person entitled to information without written consent is the client and those providing direct care. The nurse has open access to information regarding assigned clients only.
A primary care provider prescribes on tablet, but the nurse accidentally administers two. After notifying the primary care provider, the nurse monitors the client carefully for untoward effects of which there are none. Is the client likely to be successful in suing the nurse for malpractice? 1. No, the client was not harmed 2.No, the nurse notified the primary care provider 3. Yes, a breach of duty exists 4. Yes, foreseeability is present
Answer: 1 Rationale: All elements such as duty, foreseeability causation, harm/injury and damages must be present for malpractice to be proven.
The nurse notices that a colleague's behaviors have changed during the past month. Which behaviors could indicate signs of impairment? Select all that apply 1. Is increasingly absent from the nursing unit during the shift. 2. Interacts well with others 3. "Forgets" to sign out for administration of controlled substances. 4. Offers to administer prn opiates for other nurse's clients 5. Is able to say "no" to requests to work more shifts.
Answer: 1, 3, 4 Rationale: Interacting with others (versus isolating self from others) and setting limits on the number of hours working are positive behaviors and not indicative of possible impairment. The other options are warning signs for impairment
Following a motor vehicle crash, a nurse stops and offers assistance. Which of the following actions are most appropriate? Select all that apply 1. The nurse needs to know the Good Samaritan Act for the state. 2. The nurse is not held liable unless there is gross negligence 3. After assessing the situation, the nurse can leave to obtain help. 4. The nurse can expect compensation for helping. 5. The nurse offers to help but cannot insist on helping.
Answer: 1,2,5 Rationale: The nurse is subject to the limitations of state law and should be familiar with the Good Samaritan laws in the specific state. Gross negligence would be described by the individual state law. Unless there is another equally or more qualified person present, the nurse needs to stay until the injured person leaves. The nurse should ask someone else to call or go for additional help. The same client rights apply at the scene of an accident as well as those in the workplace.
The nurse practice acts are an example of civil law. A. True B. False
Answer: False Rationale: Nurse practice acts fall under Statutory law
The nurse puts a restraint jacket on a client without the client's permission and without the physicians order. The nurse may be guilty of assault. A. True B. False
B. False Rationale: Battery is physical in nature. Assault is a threat.
The client's right to refuse treatment is an example of _________ laws.
civil
