NU270: Legal Issues (week 12)

The parents of a hospitalized 10-year-old ask the nurse if they can review the health care records of their child. What is the appropriate response from the nurse?

"I will arrange access for you to review the record after you put your request in writing." - Arranging access for the parents to review the record after they put their request in writing is in compliance with most health care institution policy and is the standard practice for most health institutions. Because the child is a minor, it is the parents' right to view the client's record. Therefore, the statements about the physician not giving the parents access to review the records and asking if the parents are questioning the care of their child are incorrect.

A client's estranged partner arrives to visit the client's newborn because he believes he is the child's father. How does the nurse respond to the visitor?

"Please wait at the nurse's station while I discuss your desire to visit with the client." - The neonate's mother has legal control over the child. Therefore, the nurse would consult with the mother to get permission for her estranged partner to see the baby. Even if the newborn is in the nursery, the nurse would not point out the infant to the visitor without the mother's permission. Regardless of the visitor's identification, the nurse needs the mother's permission. Privacy laws do not require denial of a client's presence in a hospital unless additional layers of security are required for the client's protection.

A nurse is performing an admission assessment on a client admitted with a pelvic fracture. Which statement by the client requires the nurse to seek more information from a legal standpoint?

"Sometimes my spouse gets so angry with me." - Legally, the nurse must further investigate the client's statement concerning the spouse's anger. This statement suggests that the client's injury might be caused by domestic abuse. The other statements are common and don't require further investigation, from a legal standpoint, by the nurse.

A nurse has administered 1 unit of glucose to the client as per order. What is the correct documentation of this information?

1 Unit of glucose - The nurse should write "1 Unit of glucose." The nurse cannot write "1 bottle" or "one U of glucose" because these are not the accepted standards. "1U" is an abbreviation that appears in the JCAHO "Do Not Use" list (see http://www.jcaho.com). It should be written as "1 Unit" instead of "1U" because "U" is sometimes misinterpreted as "zero" or "number 4" or "cc."

Which scenario is an example of certification?

A nurse who demonstrates advanced expertise in a content area of nursing through special testing - Certification is a voluntary process whereby a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the NLN Commission for Nursing Education Accreditation and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit health care agencies.

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign?

An open reduction of a fracture - Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent.

A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what?

Battery - All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.

A nurse was informed that a family member was involved in a car accident and transported to the emergency department in the same facility. What action by the nurse best demonstrates understanding of client privacy?

Calling the client information desk to find out the room number of the family member - Getting information from other health care providers violates client privacy. Health care workers must follow the same guidelines to accessing health information on people not assigned to their care.

A client has designated her daughter as a person to make healthcare decisions for the client if he is not able to do so. What type of advance directive is this considered?

Durable power of attorney (DPOA) for healthcare - A client may designate another person to be the DPOA for healthcare or healthcare proxy. This person has the authority to make healthcare decisions for the client if he or she is no longer competent or able to make these decisions. A general power of attorney does not give that designated person the ability to make healthcare decision. In DNR order, the client wishes to have no resuscitative action taken if he or she experiences a cardiac or respiratory arrest. A living will is a document that states a client's wishes regarding healthcare if he or she is terminally ill.

The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated?

Duty - Duty refers to an obligation to use due care. The nurse assessed the client and made appropriate interventions and notifications. Breach of duty is the failure to meet the standard of care. An example of breach of duty would be not performing assessments, appropriate interventions, and notifications of the health care provider. Causation is when the breach of duty caused the injury. An example of causation would be failure to perform assessment and appropriate interventions when providing client care, and this caused injury to the client. Damages are the harm or injury that occurred to the client. In this situation, it would be the death of the client.

When maintaining health care records for a client, the nurse knows that a health care record also serves as a legal document of evidence. What should the nurse do to ensure legally defensible charting?

Ensure that the client's name appears on all pages. - The nurse should ensure that the client's name appears on all pages to ensure legally defensible charting. The nurse should not leave spaces between entries and signature so that the document is legally acceptable. The nurse should use only abbreviations approved by the facility, and should not use abbreviations wherever possible. The nurse should record all the facts, but not any subjective interpretations, to ensure that the document is legal evidence.

Which statement about gonorrhea is correct?

Gonorrhea is a reportable sexually transmitted infection.

A client has signed a document indicating a wish not to be resuscitated. During morning rounds, the nurse finds the client without vital signs. What is the most appropriate action for the nurse to take?

Notify the physician that the client has no vital signs. - The client has signed a document indicating a wish not to be resuscitated. The other options are incorrect because the nurse should be aware of the client's "do not resuscitate" (DNR) status and should not need to go to the desk to confirm this. The nurse should notify the physician so the physician can pronounce the death and notify the family.

Which action by the nurse could result in the accrediting body withdrawing the health agency's accreditation?

Omitting clients' responses to nursing interventions - Omitting clients' responses to nursing interventions is correct because it does not fit the criteria for legally defensible charting. Recording nursing interventions, identifying nursing diagnoses or client needs, and documenting clients' health histories and discharge planning are all criteria for legally defensible charting and would demonstrate evidence of quality care.

A nurse and the facility have been named as defendants in a malpractice lawsuit. In addition to the nurse's attorney, whom else would be appropriate for the nurse to talk with about the case?

The agency's risk manager - A nurse who is named a defendant should work closely with an attorney while preparing the defense. With the exception of the nurse's attorney and the agency's risk manager, the nurse should not discuss the case with anyone, including anyone at the agency, the plaintiff, the plaintiff's lawyer, anyone testifying for the plaintiff, or reporters.

Professional regulations and laws that govern nursing practice are in place for which reason?

To protect the safety of the public - Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.

Which are examples of a nurse appropriately protecting a client's privacy? Select all that apply.

With the client's permission, the nurse explains the client's diagnosis to the client's spouse. The nurse moves the client from the emergency department waiting room to a private area to collect assessment data. - To prevent invasion of privacy, all client information is considered confidential and private; this includes name and all identifiers (e.g., social security number, address, date of birth). With the client's permission, the nurse may share information with the client's spouse. A client should be taken to a private, soundproof area to collect data. Unnecessary exposure of a client's body, taking photos of a client, and questioning a client's social life when it does not affect care planning are examples of invasion of privacy.

For which medication(s) will the nurse ask another nurse to witness the disposal of a partial dose in the pharmaceutical waste container? Select all that apply.

alprazolam hydrocodone meperidine - Federal law requires two nurses to witness and document the waste of all controlled substances in order to prevent diversion and misuse of these substances. Alprazolam, hydrocodone, and meperidine are controlled substances. These medications require the nurse to have another nurse witness the waste in a pharmaceutical waste container. Losartan and amlodipine are not controlled substances and do not require special procedures for the waste of a partial dose.

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

surrogate decision maker - A surrogate decision maker should be identified to give consent for the mentally incapacitated client. Infants, young children, people who are severely mentally handicapped or incapacitated, and people in a persistent vegetative state or coma do not have the capacity to participate in decision making about their healthcare. For such people, a surrogate decision maker must be identified to act on their behalf. The surgeon and the nurse are not eligible to give consent for the client.

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an):

durable power of attorney. - A durable power of attorney allows clients to designate another person to make decisions if they become incapacitated and cannot make decisions independently. Advanced estate planning typically involves estate tax reduction, Medicaid planning and/or special needs trust planning is for a client with a large estate. Exemplary representative and significant power are not related to health care.

A neonate requires surgical repair of a patent ductus arteriosus. The neonate's 16-year-old mother is present along with her parents, the neonate's grandparents. The neonate's mother states that she "isn't with the father anymore." The nurse must obtain informed consent for the surgery from

the neonate's mother because she's considered an emancipated minor. - Because the 16-year-old has given birth, she's considered an emancipated minor and may legally consent to the treatment. The neonate's grandparents have no legal authority to give consent for the neonate. The father doesn't have to consent to the treatment. The 16-year-old mother doesn't have to wait for a court order to declare her legal emancipation.

In which circumstance may the nurse legally and ethically disclose confidential information about a client?

A taxi driver's diagnosis of an uncontrolled seizure disorder to a state agency - A nurse may lawfully disclose confidential information about a client when the welfare of a person or group of people is at stake. A healthcare provider must inform the Department of Motor Vehicles that the taxi driver has an uncontrolled seizure disorder; disclosing the condition is in the best interest of public safety and the client's well-being. Confidentiality of HIV testing is required, but the client, who's HIV positive, should be encouraged to share the information with family. Many state legislatures require maintaining confidentiality of HIV testing. The nurse may not disclose a diagnosis of pancreatic cancer or a pregnancy because these situations don't affect the welfare of a group of people.

Which example may illustrate a breach of confidentiality and security of client information?

The nurse provides information over the phone to the client's family member who lives in a neighboring state. - Providing information over the phone to a family member without knowing whether or not the client wants that family member to know the information is a breach of confidentiality and security of client information. Providing information to a caregiver involved in the care of a client is not a breach of confidentiality, but providing information to a professional not involved in the care of the client is a breach in confidentiality. Client information should not be discussed in public areas, such as elevators or the cafeteria. Logging off a computer that displays client data is an appropriate method of protecting client confidentiality and information.

A client is about to undergo cardiac catheterization for which informed consent was obtained. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed?

Withhold the medication and notify the physician immediately. - The nurse should withhold the medication and notify the physician that the client does not understand the procedure. The physician then has the obligation to explain the procedure better to the client and determine whether or not the client understands. If the client does not understand, there cannot be a true informed consent. If the medication is administered before the physician explains the procedure, the sedation may interfere with the client's ability to clearly understand the procedure. The nurse may not just medicate the client and document the finding; the physician must be notified. The procedure does not need to be cancelled, only postponed until the client receives more education and is able to give informed consent.