Chapter 06 Legal and Ethical Issues PDF

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Chapter 06: Legal and Ethical Issues Huber: Leadership & Nursing Care Management, 6th Edition MULTIPLE CHOICE 1. A staff nurse is facing a dilemma between meeting clinical ethical standards and meeting

organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to focus on: a. doing the right thing and taking the right action. b. meeting clinical standards before organizational goals. c. meeting organizational goals before clinical standards. d. referring indecisive staff members for additional training. ANS: A

Although the domain of clinical ethics is the care of clients, the domain of organizational ethics is a facility’s business-related activities. Together, clinical and organizational ethics reflect a health care facility’s concern that, whether related to the continuum of care or the continuum of services related to that care, ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 2. One mechanism that ensures autonomy in the nursing profession is the: a. American Nurses Association (ANA). b. Department of Health Professionals. c. Nursing Code of Ethics. d. Professional Regulatory Board. ANS: C

American Nurses Association’s (ANA) Nursing’s Social Policy Statement: The Essence of the Profession (2010, p. 25) indicates “competence is foundational to autonomy,” with the profession ensuring nursing competence through professional regulation of nursing practice via standards and ethical codes of practice, legal regulation of nursing practice via state licensure requirements and law pertaining to criminal and civil wrongdoing, and self-regulation in which all nurses retain personal accountability for their own practice (Cooper, 2014). DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager

believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the: a. ANA. b. current federal defense attorney. c. state nurse practice act.

d. policy and procedure manual of the unit. ANS: C

Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The major responsibility for upholding patient care standards belongs to the: a. chief executive officer of the facility. b. nurse manager. c. on-call physician. d. staff nurse providing patient care. ANS: B

Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The nursing manager has assumed responsibility for ensuring that tasks within her department

are delegated legally and are performed appropriately. In so doing, she has accepted which of the following nursing roles? a. Ethical b. Ombudsman c. Paralegal d. Supervisor ANS: D

Supervision includes monitoring the tasks performed, ensuring that functions are performed in an appropriate fashion, and ensuring that assigned tasks and functions do not exceed competency or require a license to perform. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The court has found that a registered nurse (RN) harmed a patient by violating his rights. The

nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a: a. civil act. b. criminal act. c. critical wrong. d. quality breach. ANS: A

By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The most common source of legal liability for nurse managers is a(n): a. medical malpractice suit. b. organizational nursing issue. c. tort. d. vicarious liability. ANS: C

In nursing, harm related to clinical practice commonly arises from negligent acts or omissions (unintentional torts) and a variety of intentional acts (intentional torts), such as invasion of privacy or assault and battery. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. On admission, the patient was found to have a blood glucose level of 218. The RN knows that

except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse’s actions are an example of: a. breach of contract. b. common negligence. c. intentional malpractice. d. medical oversight. ANS: B

Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians’ orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment (Cooper, 2014). DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. On admission, the patient was found to have a blood glucose level of 218. The RN knows that

except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse’s actions, the admitting hospital may be found to be: a. a judicial risk.

b. an ostensible authority. c. indemnified. d. vicariously liable. ANS: D

If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 10. On admission, the patient was found to have a blood glucose level of 218. The RN knows that

except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Being aware of the hospital policy for medication administration, the patient’s blood glucose level presented the nurse with a(n): a. assessment option. b. clinical choice. c. ethical dilemma. d. moral decision. ANS: C

Ethical dilemmas require that decisions be made about what is right and wrong in situations in which an individual has to make a choice between equally unfavorable alternatives. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Physiological Adaptation 11. A patient who is not fully informed about his or her health status is an example of a violation

of which ethical principle? Autonomy Justice Utilitarianism Confidentiality

a. b. c. d.

ANS: A

Autonomy refers to the client’s right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which ethical principle is violated when there are insufficient community resources to meet

the needs of low-income families? a. Nonmaleficence b. Autonomy c. Beneficence

d. Justice ANS: D

Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. “To do good for others” is an example of which ethical principle? a. Nonmaleficence b. Fidelity c. Beneficence d. Confidentiality ANS: C

Beneficence means doing good for clients and providing benefit balanced against risk. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A new RN is observed breaking sterile technique by the perioperative nurse. This is an

example of a violation of which ethical principle? a. Autonomy b. Justice c. Nonmaleficence d. Confidentiality ANS: C

Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 15. A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for “happy

hour” earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for: a. maleficence. b. melange. c. nonmaleficence. d. nonmelange. ANS: A

Maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

16. The nurse on a medical unit is caring for a 19-year-old with complications from a congenital

heart defect. The client’s mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother? a. Discuss personal information that the client shared with the nurse in confidence. b. Provide the mother with any information required for continuity of care. c. Explain that client confidentiality prevents the nurse from disclosing information. d. Ask the client if he gives permission for the nurse to share information with the mother. ANS: D

It is the nurse’s legal and ethical duty to protect the adult “child’s” autonomy and not simply accept a parent’s intervention, without lawful authority, just because it may seem easier at the moment. The nurse must obtain permission from the client before sharing information with the mother. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. The definition of veracity is: a. being loyal and faithful to commitments and accountable for responsibilities. b. the norm of telling the truth and not intentionally deceiving or misleading clients. c. a prohibition of disclosure of information. d. a right of limited physical or informational inaccessibility. ANS: B

Veracity is the norm of telling the truth and not intentionally deceiving or misleading clients. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. Nurse managers are able to respond better to ethical dilemmas when they have access to the

organization’s: mission and vision. patient safety plan. medical staff bylaws. ethics committee.

a. b. c. d.

ANS: D

It is critical that nurses and administrators have access to and inclusion on the health care organization’s ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

1. Which ethical principle is violated when the RN tells the hospital accountant that the patient is

HIV-positive? (Select all that apply.) Beneficence Veracity Confidentiality Autonomy Fidelity

a. b. c. d. e.

ANS: A, C

Beneficence means “doing good for clients and providing benefit balanced against risk.” The hospital accountant had no need to know; therefore, there was no benefit for the patient for him to be told. Confidentiality prohibits disclosures of information gained in certain relationships to third parties without the consent of the original source of the information. Without the patient giving express consent, the hospital accountant has no need for this information, and it is a breach of confidentiality. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. An elderly client becomes confused after surgery. He is in a room farthest away from the

nurse’s station. The client has been trying to get out of bed several times during the shift. The nurse documents this very well. The client falls out of bed and breaks his hip. Who can possibly be held negligent? (Select all that apply.) a. Client’s wife b. Nurse manager c. Pharmacist d. Staff RN ANS: B, D

It is possible that the nurse and nurse manager could be held negligent. The nurse could be held negligent for not moving the patient closer to the nurse’s station, calling the physician or nurse practitioner for medications or change in medications, or obtaining an order for a vest restraint. The nurse manager may be held negligent because of 24-hour accountability for the care of patients on his or her unit and possible lack of supervision. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. Which of the following are examples of intentional torts that may occur in the health care

field? (Select all that apply.) Slip and fall in the hospital cafeteria Patient restrained by the neck utilizing the nurse’s arm Ovary removal against the patient’s signed consent Restraining a patient without a physician’s order Hospital-acquired pressure ulcer

a. b. c. d. e.

ANS: B, C, D

Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. To establish legal liability on the grounds of malpractice, the injured party must prove which

of the following? (Select all that apply.) A duty of care was owed to the injured party. An agreement was made to assume another party’s liability. There was a breach of duty. Causation was present. Actual harm or damages were suffered by the plaintiff.

a. b. c. d. e.

ANS: A, C, D, E

These four elements are required to establish legal liability on the grounds of malpractice. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following patient-related events may be considered as examples of common

negligence allegations in a nursing malpractice suit? (Select all that apply.) a. Staffing levels in the medical unit b. Patient fall with injury c. Heparin error d. Failure to utilize rapid response team with change in vital signs e. Failure to ensure telemetry monitor is on the correct patient ANS: B, C, D, E

Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians’ orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. The nurse manager in a large emergency department utilizes agency nursing for staffing.

Which of the following should the nurse manager do to help the facility avoid corporate liability? (Select all that apply.) a. Assume that the agency has reviewed the license status of the individual. b. Ensure that those who report to them remain competent and qualified and have current licensure. c. Report incorrect mixes of staff for effectively meeting the health care needs of clients. d. Assign the staff members to the role of mentor and educator. ANS: B, C

Nurse managers can help the facility avoid corporate liability by, among other things, ensuring that those who report to them remain competent and qualified and have current licensure. Nurse managers should also report dangerously low staffing levels, incorrect mixes of effective staff, and incompetent, illegal, or unethical practices. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the

medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply.) a. Justice b. Autonomy c. Veracity d. Confidentiality ANS: B, C

Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Professional safeguards that protect the nurse from being wrongfully accused of malpractice

include which of the following? (Select all that apply.) Code of Ethics Statute of...