Saunders Comprehensive Review for the NCLEX-RN® Examination EIGHTH EDITION: CHAPTER 6 Ethical and Legal Issues ; With Practice Q&A.

Priority Concepts C H A P T E R 6 Ethical and Legal Issues Ethical Principles Autonomy: Respect for an individual’s right to self-determination Nonmaleficence: The obligation to do or cause no harm to another Ben ...

Priority Concepts C H A P T E R 6 Ethical and Legal Issues Ethical Principles Autonomy: Respect for an individual’s right to self-determination Nonmaleficence: The obligation to do or cause no harm to another Beneficence: Examples of Negligent Acts ▪ Medication errors that result in injury to the client ▪ Intravenous administration errors, such as incorrect flow rates, failure to monitor a flow rate that results in injury to the client, infiltration, or phlebitis ▪ Falls that occur as a result of failure to provide safety to the client ▪ Failure to use aseptic technique when indicated ▪ Failure to check equipment for proper functioning Client’s Rights When Hospitalized ▪ Right to considerate and respectful care ▪ Right to be informed about diagnosis, possible treatments, and likely outcome, and to discuss this information with the health care provider ▪ Right to know the names and roles of the persons who are involved in care ▪ Right to consent or refuse a treatment ▪ Right to have an advance directive ▪ Right to privacy ▪ Right to expect that medical records are confidential ▪ Right to review the medical record and to have information explained ▪ Right to expect that the hospital will provide necessary health services Laws and Standards American Hospital Association Issued Patient’s Bill of Rights American Nurses Association Developed the Code of Ethics for Nurses, which defines the nurse’s responsibility for upholding client’s rights Rights for the Mentally Ill ▪ Right to be treated with dignity and respect ▪ Right to communicate with persons outside the hospital ▪ Right to keep clothing and personal effects with them ▪ Right to religious freedom ▪ Right to be employed ▪ Right to manage property 173 ▪ Right to execute wills ▪ Right to enter into contractual agreements ▪ Right to make purchases ▪ Right to education ▪ Right to habeas corpus (written request for release from the hospital) ▪ Right to an independent psychiatric examination ▪ Right to civil service status, including the right to vote ▪ Right to retain licenses, privileges, or permits ▪ Right to sue or be sued ▪ Right to marry or divorce ▪ Right to treatment in the least restrictive setting ▪ Right not to be subject to unnecessary restraints ▪ Right to privacy and confidentiality ▪ Right to informed consent ▪ Right to treatment and to refuse treatment ▪ Right to refuse participation in experimental treatments or research Adapted from Stuart G: Principles and practice of psychiatric nursing, ed 10, St. Louis, 2013, Mosby; Varcarolis, E: Essentials of psychiatric mental health nursing: a communication approach to evidence-based care, ed 3, St. Louis, 2017, Saunders. Violations and Invasion of Client Privacy Mentally or Emotionally Incompetent Clients ▪ Declared incompetent ▪ Unconscious ▪ Under the influence of chemical agents such as alcohol or drugs ▪ Chronic dementia or other mental deficiency that impairs thought processes and ability to make decisions Box 6-9 Uses or Disclosures of Personal Health Information ▪ Compliance with legal proceedings or for limited law enforcement purposes ▪ To a family member or significant other in a medical emergency ▪ To a personal representative appointed by the client or designated by law ▪ For research purposes in limited circumstances ▪ To a coroner, medical examiner, or funeral director about a deceased person ▪ To an organ procurement organization in limited circumstances ▪ To avert a serious threat to the client’s health or safety or the health or safety of others ▪ To a governmental agency authorized to oversee the health care system or government programs Maintenance of Confidentiality ▪ Not discussing client issues with other clients or staff uninvolved in the client’s care Social Networking and Health Care Examples of Occurrences That Need to Be Reported ▪ Accidental omission of prescribed therapies ▪ Circumstances that led to injury or a risk for client injury ▪ Client falls ▪ Medication administration errors Telephone Prescription Guidelines Components of a Medication Prescription Do’s and Don’ts Documentation Guidelines: Narrative and Information Technology ▪ Date and time entries. ▪ Provide objective, factual, and complete documentation. Practice Questions 16. 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 primary health care provider, and completes an occurrence report. Which statement should the nurse document on the occurrence report? 1. The client fell out of bed. 2. The client climbed over the side rails. 3. The client was found lying on the floor. 4. The client became restless and tried to get out of bed. 17. 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? 1. Obtain a court order for the surgical procedure. 2. Ask the EMS team to sign the informed consent. 3. Transport the victim to the operating room for surgery. 4. Call the police to identify the client and locate the family. 18. The nurse has just assisted a client back to bed after a fall. The nurse and primary health care provider have assessed the client and have determined that the client is not injured. After completing the occurrence report, the nurse should implement which action next? 1. Reassess the client. 2. Conduct a staff meeting to describe the fall. 3. Contact the nursing supervisor to update information regarding the fall. 4. Document in the nurse’s notes that an occurrence report was completed. 19. 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 best action? 1. Refuse to float to the ICU based on lack of unit orientation. 2. Clarify the ICU client assignment with the team leader to ensure that it is a safe assignment. 3. Ask the nursing supervisor to review the hospital policy on floating. 4. Submit a written protest to nursing administration, and then call the hospital lawyer. 20. The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? 1. Call security. 2. Call the police. 179 3. Call the nursing supervisor. 4. Lock the coworker in the medication room until help is obtained. 21. A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client? 1. “I will sign as a witness to your signature.” 2. “You will need to find a witness on your own.” 3. “Whoever is available at the time will sign as a witness for you.” 4. “I will call the nursing supervisor to seek assistance regarding your request.” 22. The nurse has made an error in documentation of the dose administered of an opioid pain medication in the client’s record. The nurse draws 1 mg from the vial and another registered nurse (RN) witnesses wasting of the remaining 1 mg. When scanning the medication, the nurse entered into the medication administration record (MAR) that 2 mg of hydromorphone was administered instead of the actual dose administered, which was 1 mg. The nurse should take which action(s) to correct the error in the MAR? Select all that apply. 1. Complete and file an occurrence report. 2. Right-click on the entry and modify it to reflect the correct information. 3. Document the correct information and end with the nurse’s signature and title. 4. Obtain a cosignature from the RN who witnessed the waste of the remaining 1 mg. 5. Document in a nurse’s note in the client’s record detailing the corrected information. 23. Which identifies accurate nursing documentation notation(s)? Select all that apply. 1. The client slept through the night. 2. Abdominal wound dressing is dry and intact without drainage. 3. The client seemed angry when awakened for vital sign measurement. 4. The client appears to become anxious when it is time for respiratory treatments. 5. The client’s left lower medial leg wound is 3 cm in length without redness, drainage, or edema. 24. A nursing instructor delivers a lecture to nursing students regarding the issue of clients’ rights and asks a nursing student to identify a situation that 180 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? 1. Performing a procedure without consent 2. Threatening to give a client a medication 3. Telling the client that he or she cannot leave the hospital 4. Observing care provided to the client without the client’s permission 25. Nursing staff members are sitting in the lounge taking their morning break. An assistive personnel (AP) 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. The registered nurse should inform the AP that making this accusation has violated which legal tort? 1. Libel 2. Slander 3. Assault 4. Negligence 26. An older woman is brought to the emergency department for treatment of a fractured arm. On physical 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. Which is the most appropriate nursing response? 1. “Oh, really? I will discuss this situation with your son.” 2. “Let’s talk about the ways you can manage your time to prevent this from happening.” 3. “Do you have any friends who can help you out until you resolve these important issues with your son?” 4. “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.” 27. The nurse calls the primary health care provider (PHCP) regarding a new medication prescription, because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the PHCP, and the medication is due to be administered. Which action should the nurse take? 1. Contact the nursing supervisor. 2. Administer the dose prescribed. 3. Hold the medication until the PHCP can be contacted. 4. Administer the recommended dose until the PHCP can be located. 28. 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 initial nursing action? 1. Call the police. 2. Cut up the photograph and throw it away. 3. Call the nursing supervisor and report the occurrence. 181 4. Call the laboratory and ask for the name of the individual who sent the photograph.