Silvestri Chapter 07 Ed#543

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 007 (edited file)—"Ethical and Legal Issues" 10/14/08, Page 1 of 9, 0 Figure(s), 0 Table(s)14 Box(es)

7: Ethical and Legal Issues PRACTICE QUESTIONS 1. A nurse enters a client’s room and finds the client lying on the floor. The nurse checks the client and then calls the nursing supervisor and the physician to inform them of the occurrence. The nursing supervisor instructs the nurse to complete an incident report. The nurse completes the incident report, understanding that it allows the analysis of adverse client events through: 1. A method of promoting quality care and risk management 2. Determining the effectiveness of interventions in relation to outcomes 3. The appropriate method of reporting to local, state, and federal agencies 4. Providing clients with necessary stabilizing treatments Answer: 1 Rationale: Proper documentation of unusual occurrences, incidents, and accidents, and the nursing actions taken as a result of the occurrence, are internal to the institution or agency. Documentation on the incident report allows the nurse and administration to review the quality of care and determine any potential risks present. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Eliminate options 2 and 4 because incident reports are not routinely filled out for interventions or treatment measures. Eliminate option 3 because incident reports are not used to report occurrences to other agencies. Medical records are used for this purpose. Review the purpose of incident reports if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 419, 497. 2. A nurse observes that a client received pain medication 1 hour ago from another nurse, but that the client still has severe pain. The nurse has previously observed this same occurrence. Based on the nurse practice act, the observing nurse plans to do which of the following? 1. Talk with the nurse who gave the medication 2. Report the information to a nursing supervisor 3. Call the Impaired Nurse Organization 4. Report the information to the police Answer: 2 Rationale: Nurse practice acts require reporting the suspicion of impaired nurses. The Board of Nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the Board of Nursing. Option 1 may cause a conflict. Options 3 and 4 are inappropriate. Test-Taking Strategy: Use the principles related to following the channels of communication in a health care agency when answering this question. By reporting the information, the nurse alerts the institution to the potential problem and sets the stage for further investigation and appropriate

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 007 (edited file)—"Ethical and Legal Issues" 10/14/08, Page 2 of 9, 0 Figure(s), 0 Table(s)14 Box(es)

action. Review the actions to take regarding reporting the suspicion of an impaired nurse if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 407. 3. A client has died and a nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. The nurse’s appropriate action is to: 1. Provide information needed for decision making 2. Suggest a referral to a mental health professional 3. Show acceptance of liability of feelings 4. Remain with the family member without discussing funeral arrangements Answer: 4 Rationale: The family member is exhibiting the first stage of grief–denial. Option 1 may be an appropriate intervention for the bargaining stage. Option 2 may be an appropriate intervention for depression. Option 3 is an appropriate intervention for the acceptance or reorganization and restitution stage. Test-Taking Strategy: Use therapeutic communication techniques to direct you to option 4. Remember to address client and family feelings first. Review the grieving process and therapeutic communication techniques if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Caring Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, pp. 570-571. 4. A client arrives in the emergency room and is staggering, confused, and verbally abusive. The client complains of a headache from drinking alcohol and is asking for medication. The nurse explains to the client that the physician will need to perform an assessment before the administration of medication. When the client becomes verbally abusive, the nurse threatens to place the client in restraints. Which of the following can the client legally charge the nurse as a result of the nursing action? 1. Assault 2. Battery 3. Negligence 4. Invasion of privacy Answer: 1 Rationale: An assault occurs when a person puts another person in fear of a harmful or offensive contact. For this intentional tort to be actionable, the victim must be aware of the threat of harmful or offensive contact. Battery is the actual contact with one’s body. Negligence involves actions below the standards of care. Invasion of privacy occurs when the individual’s private affairs are unreasonably intruded into.

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Test-Taking Strategy: Use the process of elimination. Note the key word, threatens, in the question. This will direct you to option 1. Review the descriptions associated with each term in the options if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005), Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 413. 5. A nurse lawyer provides an education session to the nursing staff regarding client rights. A nurse asks the lawyer to describe an example that might relate to invasion of client privacy. A nursing action that indicates a violation of this right is: 1. Taking photographs of the client without consent 2. Telling the client that he or she cannot leave the hospital 3. Threatening to place a client in restraints 4. Performing a surgical procedure without consent Answer: 1 Rationale: Invasion of privacy takes place when an individual’s private affairs are intruded on unreasonably. Not allowing a client to leave the hospital constitutes false imprisonment. Threatening to place a client in restraints constitutes assault. Performing a surgical procedure without consent is an example of battery. Test-Taking Strategy: Use the process of elimination. Note the key words, invasion of client privacy. These words should direct you to option 1. Review those situations that include invasion of client privacy if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 413. 6. A nurse calls the physician of a client scheduled for a cardiac catheterization because the client has numerous questions regarding the procedure and has requested to speak to the physician. The physician is very upset, and arrives at the unit to visit the client after prompting by the nurse. The nurse is outside the client’s room and hears the physician tell the client in a derogatory manner that the nurse “doesn’t know anything.” The nurse plans to address the physician’s remark, understanding that the physician has violated which legal tort? 1. Libel 2. Slander 3. Assault 4. Negligence Answer: 2 Rationale: Defamation is a false communication or 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

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involves the actions of professionals that fall below the standard of care for a specific professional group. Test-Taking Strategy: Use the process of elimination and focus on the information in the question. You can easily eliminate options 3 and 4, first recalling the definitions of these terms. From the remaining options, recalling that slander constitutes verbal defamation will direct you to option 2. Review the torts identified in the options if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 414. 7. A nurse employed in a long-term care facility calls the physician regarding a new medication order because the dose prescribed is higher than the recommended dosage. The nurse is unable to locate the physician, and the medication is due to be administered. Which of the following actions does the nurse take? 1. Holds the medication until the physician can be contacted 2. Administer the dose prescribed 3. Administers the recommended dose until the physician can be located 4. Contacts the nursing supervisor 7. Answer: 4 Rationale: If the physician writes an order that requires clarification, it is the nurse’s responsibility to contact the physician for clarification. If there is no resolution regarding the order, because the physician cannot be located, or because the order remains as it was written after talking with the physician, the nurse should then contact the nurse manager or supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the order until clarification has been obtained. Test-Taking Strategy: Use the process of elimination. Eliminate options 2 and 3 first because they are similar and are unsafe actions. Holding the medication can result in client injury. The nurse needs to take action. Option 4 clearly identifies the required action in this situation. Review nursing responsibilities related to the physician’s orders if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 419. 8. A nurse enters a client’s room and finds the client sitting on the floor. The nurse checks the client thoroughly and then assists the client back to bed. The nurse completes an incident report and notifies the nursing supervisor and physician of the incident. Which of the following is the next nursing action regarding the incident? 1. Make a copy of the incident report for the physician 2. Place the incident report in the client’s chart

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 007 (edited file)—"Ethical and Legal Issues" 10/14/08, Page 5 of 9, 0 Figure(s), 0 Table(s)14 Box(es)

3. Document a complete entry in the client’s record concerning the incident 4. Document in the client’s record that an incident report has been completed Answer: 3 Rationale: The incident report is confidential and privileged information and should not be copied, placed in the chart, or have any reference made to it in the client’s record. The incident report is not a substitute for a complete entry in the client’s record concerning the incident. Test-Taking Strategy: Use the process of elimination. Eliminate options 2 and 4 first because they are similar. Recalling that incident reports should not be copied will direct you to option 3. Review nursing responsibilities related to incident reports if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 497. 9. A nursing graduate who recently passed NCLEX-PN is employed as a licensed practical nurse (LPN) in a local hospital. During orientation, the nurse educator asks the LPN about his or her understanding of the need to obtain professional liability insurance. The appropriate response by the LPN is: 1. “The hospitals liability insurance will cover my actions.” 2. “It is very expensive and not necessary.” 3. “Nurses are encouraged to have their own malpractice insurance.” 4. “The majority of suits are filed against physicians and the hospital.” Answer: 3 Rationale: Nurses need their own liability insurance for protection against malpractice lawsuits. Nurses erroneously assume that they are protected by an agency’s professional liability policies. Usually, when a nurse is sued, the employer is also sued for the nurse’s actions or inactions. Even though this is the norm, nurses are encouraged to have their own malpractice insurance. Test-Taking Strategy: Note that the issue of the question relates to “professional liability insurance.” Focusing on this issue should direct you to option 3. Review liability related to malpractice insurance if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, pp. 411-412. 10. A nurse witnesses an automobile accident and provides care at the scene of the accident to an open wound on a young child. The family is extremely grateful and insists that the nurse accept monetary compensation for the care provided to the child. Because of the family’s insistence, the nurse accepts the compensation to avoid offending the family. The child develops an infection and sepsis, and is hospitalized. The family files suit against the nurse who provided care to the child at the scene of the accident. The nurse understands that which of the following is accurate regarding immunity from this suit?

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1. The Good Samaritan law will protect the nurse 2. The Good Samaritan law will protect the nurse if the care given at the scene was not negligent 3. The Good Samaritan law will not provide immunity from suit if the nurse accepted compensation for the care provided 4. The Good Samaritan law protects laypersons and not professional health care providers Answer: 3 Rationale: A Good Samaritan law is passed by a state legislature to encourage nurses and other health care providers to provide care to a person when an accident, emergency, or injury occurs, without fear of being sued for the care provided. Called immunity from suit, this protection usually applies only if all the conditions of the law are met; for example, the health care provider receives no compensation for the care provided, and the care given is not willfully or wantonly negligent. Test-Taking Strategy: Read the question carefully and note the key words, accept monetary compensation. This will direct you to option 3. Additionally, options 1, 2, and 4 are similar. Review the Good Samaritan law if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, pp. 411-412. 11. A client is brought to the emergency room after a serious accident, is unconscious, and is bleeding profusely. Surgery is required immediately to save the client’s life. In regard to informed consent for the surgical procedure, which of the following is the best action? 1. Try calling the client’s spouse to obtain telephone consent before the surgical procedure 2. Transport the client to the operating room immediately, as required by the physician, without obtaining an informed consent 3. Ask the friend who accompanied the client to the emergency room to sign the consent form 4. Call the nursing supervisor to initiate a court order for the surgical procedure Answer: 2 Rationale: Generally, there are only two instances in which the informed consent of an adult client is not needed. One instance 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 instance is when the client waives the right to give informed consent. Options 1, 3, and 4 are inappropriate. Test-Taking Strategy: Use the process of elimination. Option 3 can be easily eliminated first. Note the key words, surgery is required immediately. Options 1 and 4 would delay treatment and should be eliminated. Review the issues surrounding informed consent if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills References: Brent, N. (2001). Nurses and the law (2nd ed.). Philadelphia: W.B. Saunders, p. 210.

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Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 416. 12. A nurse arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for the children. The nurse has never worked in the pediatric unit. Which of the following is the appropriate nursing action? 1. Refuse to float to the pediatric unit 2. Call the hospital lawyer 3. Call the nursing supervisor 4. Report to the pediatric unit and identify tasks that can be safely performed Answer: 4 Rationale: Floating is an acceptable legal practice used by hospitals to solve their understaffing problems. Legally, a nurse cannot refuse to float unless a union contract guarantees that the nurse can only work in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountered with this situation, the nurse should identify potential areas of harm to the client. Test-Taking Strategy: Use the process of elimination. Options 1 and 2 can be eliminated first because they are inappropriate. From the remaining options, eliminate option 3 because it is premature to call the nursing supervisor. Review nursing responsibilities related to floating if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, pp. 418-419. 13. A nurse enters a client’s room and notes that the client’s lawyer is present and that the client is preparing a living will. The living will requires that the client’s signature be witnessed, and the client asks the nurse to witness the signature. Which of the following is the appropriate nursing action? 1. Sign the living will as a witness to signature only 2. Sign the will clearly identifying credentials and employment agency 3. Decline from signing the will 4. Call the hospital lawyer before signing the will Answer: 3 Rationale: Living wills are required to be in writing and signed by the client. The client’s signature either must be witnessed by specified individuals or notarized. Many states prohibit any employee, including a nurse in a facility where the declarer is receiving care, from being a witness. Test-Taking Strategy: Use the process of elimination. Options 1 and 2 are similar and should be eliminated first. From the remaining options, option 3 is the appropriate action. Review legal implications associated with wills if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills

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Reference: Brent, N. (2001). Nurses and the law (2nd ed.). Philadelphia: W.B. Saunders, p. 217. 14. An older woman is brought to the emergency room. When caring for the client, the nurse notes old and new ecchymotic areas on both arms and buttocks. The nurse asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her daughter frequently hits her if she gets in the way. Which of the following is the appropriate nursing response? 1. “I promise I will not tell anyone but let’s see what we can do about this.” 2. “I have a legal obligation to report this type of abuse.” 3. “Let’s talk about ways that will prevent your daughter from hitting you.” 4. “This should not be happening, and if it happens again you must call the emergency room.” Answer: 2 Rationale: Confidential issues are not to be discussed with nonmedical personnel or with the person’s family or friends without the client’s permission. Clients should be assured that information is kept confidential, unless it places the nurse under a legal obligation. The nurse must report situations related to child or elderly abuse, gunshot wounds, stabbings, and certain infectious diseases. Test-Taking Strategy: Use the process of elimination. Option 4 can be eliminated first because this action does not protect the client from injury. Options 1 and 3 are similar and should be eliminated next. Review the nursing responsibilities related to reporting obligations if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Fundamental Skills References: Brent, N. (2001). Nurses and the law (2nd ed.). Philadelphia: W.B. Saunders, p. 288. Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 433. 15. A client tells the nurse of his decision to refuse external cardiac massage. Which of the following would be the appropriate initial nursing action? 1. Notify the physician of the client’s request 2. Document the client’s request in the client’s record 3. Conduct a client conference to share the client’s request 4. Discuss the client’s request with the family Answer: 1 Rationale: External cardiac massage is one type of treatment that a client can refuse. The appropriate initial action is to notify the physician because a written “Do Not Resuscitate” (DNR) order from the physician must be present. The DNR order must be reviewed or renewed on a regular basis per agency policy. Test-Taking Strategy: Use the process of elimination. Note the key words, appropriate initial action. Although options 2, 3, and 4 may be appropriate, remember that first a written physician’s order is necessary. Review DNR procedures if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment

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Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills References: Brent, N. (2001). Nurses and the law (2nd ed.). Philadelphia: W.B. Saunders, p. 257. Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 410. 16. Select all correct guidelines related to narrative documentation. ___Use a blue-colored ink pen ___Date and time entries ___Document subjective information completely ___Sign and title each entry ___Do not leave blank spaces on documentation forms ___Avoid judgmental and evaluative statements Answers: Date and time entries Sign and title each entry Do not leave blank spaces on documentation forms Avoid judgmental and evaluative statements Rationale: The nurse uses a black-colored ink pen to document because black ink allows the chart to be duplicated with adequate readability for long-term storage. The nurse always dates and times entries and signs and titles each entry. The nurse provides objective, factual, and complete documentation and avoids subjective, judgmental, and evaluative statements. Quotes are used to relate what the client actually said. The nurse avoids leaving blank spaces on documentation forms, because this allows for an area in which notes can be entered by others at a later time. Recording of information on the client’s record must be sequential. Test-Taking Strategy: Read each item carefully. Think about the legal responsibilities related to documentation to select the correct guidelines. Review these guidelines if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Communication and Documentation Content Area: Fundamental Skills Reference: Harkreader, H., & Hogan, M.A. (2004). Fundamentals of nursing: Caring and clinical judgment (2nd ed.). Philadelphia: W.B. Saunders. pp. 219-221.