Unit 1 - Ethics Flashcards
It is determined that a staff nurse has a drug abuse problem. What approach to the staff nurse’s addiction should be taken as an initial intervention?
1 Counseled by the staff psychiatrist 2 Dismissed from the job immediately Correct3 Referred to the employee assistance program 4 Forced to promise to abstain from drugs in the future
3
Referred to the employee assistance program
Referral to the employee assistance program is a nonpunitive approach that attempts to help the nurse as an individual and as a professional. Counseling by the staff psychiatrist may be necessary for long-term therapy but is not the initial approach. Dismissing the nurse from the job immediately is a punitive nontherapeutic response that offers no chance of rehabilitation. The client has an addiction problem; promises will not keep the client from abusing drugs.
Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.
A nurse fails to act in a reasonable, prudent manner. Which legal principle is most likely to be applied?
1 Malice 2 Tort law 3 Malpractice 4 Case law
3
Malpractice
Malpractice is the unskilled or faulty treatment by a professional that causes injury or harm to a client. It can result from a lack of professional knowledge or skill that can be expected in others in the profession, or from a failure to exercise reasonable care or judgment in the application of professional knowledge, experience, or skill. Malice is the desire or intent to inflict injury, harm, or suffering. Tort law is a wrongful act, not including a breach of contract of trust, that results in injury to another person and for which the injured person is entitled to compensation. Case law is law established by judicial decisions in particular cases instead of by legislative action.
Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.
A client requires emergency cardiac surgery. The leader nurse wants to make the client aware of the situation and wants the client to decide what should be done. Which ethical model does the leader nurse follow here? 1 Autonomy model 2 Paternalistic model 3 Social justice model 4 Patient-benefit model
1) Autonomy Model
The autonomy model facilitates making decisions for competent clients. In the paternalistic model the managers decide what is best for their team. The social justice model considers broad social issues and is accountable to the overall institution. The patient-benefit model uses substituted judgment, that is, what the client would want for himself or herself if capable of making these issues known.
A nurse concludes that clients who receive intravenous (IV) fluids rather than total parenteral nutrition for gastrointestinal problems lose weight for what reason?
1 Lack of bulk in the diet 2 Deficient carbohydrate intake 3 Insufficient intake of water-soluble vitamins 4 Increasing concentrations of electrolytes in the cells
2) Deficient carbohydrate intake
Intravenous fluids supply minimal calories; a client receiving only intravenous fluids will lose weight and become malnourished. Lack of bulk in the diet is not related to weight; lack of bulk in the diet results in constipation. Vitamins are not related to weight loss. Intracellular electrolytes are not related to weight loss.
A registered nurse is educating a nursing student about assault. What information should the registered nurse provide?
1) “Assault refers to any action of intentional touching without consent.”
2) “A procedure performed without the consent of the client is considered assault.”
3) “Assault refers to any action that places a client in apprehension of harmful contact without consent.”
4) “Threatening a client before performing a medical procedure is not considered assault.”
3) “Assault refers to any action that places a client in apprehension of harmful contact without consent.”
Assault does not require actual physical contact. Any action that places the client in apprehension of a harmful contact without consent is considered to be assault. Battery refers to any action of intentional touching without consent. Medical procedures performed without the consent of the client are considered to be battery.
A nursing team leader identifies that a nurse is coming to work after drinking alcohol. What is the most appropriate way for the team leader to approach this ethical situation?
1) Counsel the nurse about the problem.
2) Ignore the problem until it happens again.
3) Notify the nurse manager about the problem.
4) Resolve the problem by sending the nurse home.
3) Notify the nurse manager about the problem.
The assessment phase of problem solving consists of collecting data. The next step involves exploring options to address the problem; this is best accomplished in collaboration with the nurse manager. Counseling the nurse about the problem is not the role of a nurse; the nurse who has been drinking needs professional counseling. Ignoring the problem until it happens again is unsafe; clients may be placed in jeopardy. Resolving the problem by sending the nurse home delays addressing the problem.
In order to prolong a hospitalization stay, the nurse documents in a client’s electronic health record (EHR) that there are no signs of recovery. However, in reality, the client appears to be cured of the illness. What legal implication does the nurse’s action have?
1) The nurse may be charged with libel.
2) The nurse may be charged with slander.
3) The nurse may be charged with malpractice.
4) The nurse may be charged with invasion of privacy.
1)The nurse may be charged with libel.
Written defamation of character is known as libel. The nurse may be charged with libel because he or she makes false entries in the client’s medical records. Speaking falsely about another individual amounts to slander. Malpractice occurs if nursing care falls below the professional standards of care. If the nurse divulges a client’s medical information to unauthorized personnel, this action is an invasion of privacy.
A nurse manager in charge of a unit overhears two nurses in a hall filled with visitors discussing a client on the unit who has AIDS. What should be the nurse manager’s initial action?
1) Place an incident report in each nurse’s personnel record.
2) Note the situation and intervene if it happens again.
3) Inform the nurse who is in the role of supervisor for the shift.
4) Have a conference with the nurses and talk about the need for confidentiality.
4)Have a conference with the nurses and talk about the need for confidentiality.
Breach of confidentiality violates the client’s right to privacy. This situation must be explored with nurses immediately to prevent it from happening again. Placing an incident report in each nurse’s personnel record may be done eventually, but it is not the initial intervention. Reports should not be placed in personnel records without an individual’s knowledge. Noting the situation and intervening if it happens again is irresponsible, because the nurses may violate another client’s right to privacy in the future. Although informing the nurse who is in the role of supervisor for the shift may be done eventually, it is the responsibility of the nurses’ immediate supervisor (the unit’s nurse manager) to intervene immediately.
The family of an older adult who is aphasic reports to the nurse manager that the primary nurse failed to obtain a signed consent before inserting an indwelling catheter to measure hourly output. What should the nurse manager consider before responding?
1) Procedures for a client’s benefit do not require a signed consent.
2) Clients who are aphasic are incapable of signing an informed consent.
3) A separate signed informed consent for routine treatments is unnecessary.
4) A specific intervention without a client’s signed consent is an invasion of rights.
3) A separate signed informed consent for routine treatments is unnecessary.
This is considered a routine procedure to meet basic physiologic needs and is covered by a consent signed at the time of admission. The need for consent is not negated because the procedure is beneficial. This treatment does not require special consent.
A visitor from a room adjacent to a client asks the nurse what disease the client has. The nurse responds, “I cannot discuss any client’s illness with you.” What legal issue supports the nurse’s response?
1) Libel
2) Slander
3) Negligence
4) Invasion of privacy
4) Invasion of privacy
The release of information to an unauthorized person, such as gossiping about a client or unwanted intrusion into private family matters, constitutes invasion of privacy. Libel occurs when a person writes false statements about another person that may injure the individual’s reputation. Slander occurs when a person verbally defames, detracts from, or maligns another’s reputation. Negligence is a careless act of omission or commission that results in injury to another person.
The nurse is preparing a client for epidural anesthesia. Which client statement would cause the nurse to stop the placement of the epidural catheter?
1) “I’m not exactly sure how an epidural works.”
2) “I understand that the epidural might or might not take my pain away.”
3) “I signed the consent form for an epidural at my last clinic appointment.”
4) “I’m aware that the epidural could cause my contractions to slow down.”
1) “I’m not exactly sure how an epidural works.”
A description of the various anesthetic techniques and what they entail is essential to informed consent, even if the woman received information about analgesia and anesthesia earlier in her pregnancy. Nurses play a significant role in the informed consent process by clarifying and describing procedures or by acting as the woman’s advocate and asking the primary healthcare provider for further explanation. There are three essential components of an informed consent. First, the procedure and its advantages and disadvantages must be thoroughly explained. Second, the woman must agree with the plan of labor pain management as explained to her. Third, her consent must be given freely without coercion or manipulation from the healthcare provider.
The nurse manager uses operant conditioning when managing the staff by providing positive reinforcement to motivate them to repeat constructive behavior. Which leadership theory is reflected in this practice?
1) Hierarchy of needs
2) Transformational theory
3) Situational contingency theory
4) Organizational behavior (OB) modification
4)Organizational behavior (OB) modification
OB modification theory is applied by providing positive reinforcement to the staff to motivate them to repeat constructive behaviors in the workplace. Awareness of the hierarchy of needs can be used to understand what motivates staff; for example, the need for security will override social needs. Transformational theory does not utilize operant conditioning for motivation. Situational contingency theory is applied to consider the challenge of a situation and encourages an adaptive leadership style to complement the issue being faced.
A client is scheduled for skin cancer surgery and has not signed the consent form. Which situation will cause the nurse to legally delay signing the operative consent?
1) Ambivalent feelings are present and acknowledged.
2) A sedative type of medication has been given recently.
3) A complete history and physical has not been performed and recorded.
4) A discussion of alternatives with two primary healthcare providers has not occurred.
2) A sedative type of medication has been given recently.
Sedation may interfere with the client’s knowledge of the consent form. Many clients face contradictory feelings regarding their impending surgery, but their consent is legal unless they withdraw the consent. A complete history and physical examination are needed before surgery, but they do not affect the legality of consent. A second opinion is not required for a consent to be legal.
What professional responsibility does the nurse display as a client’s advocate?
1
The nurse protects the client’s human and legal rights and provides assistance in asserting said rights.
2
The nurse actively collaborates with other healthcare professionals to follow the best treatment plan for a client.
3
The nurse explains concepts and facts about health, describes the reason for routine care activities, and demonstrates procedures.
4
The nurse establishes an environment for collaborative client-centered care to provide safe, quality care with positive client outcomes.
1
The nurse protects the client’s human and legal rights and provides assistance in asserting said rights.
As a client’s advocate, the nurse protects the client’s human and legal rights and provides assistance in asserting these rights. Autonomy is an essential element of professional nursing that helps the nurse to actively collaborate with other healthcare professionals to follow the best treatment plan for a client. As an educator, the nurse explains concepts and facts about health, describes the reason for routine care activities, and demonstrates procedures to the client and family members. As a manager, the nurse establishes an environment for collaborative client-centered care to provide safe, quality care with positive client outcomes.
A nurse notes that a famous client has received an incorrect dose of medication due to the malfunction of the intravenous (IV) device, but does not inform the primary healthcare provider. Instead the nurse tells a colleague that the medication could not be given due to the client’s inappropriate behavior. The nurse then updates media personnel about the client’s health status. What legal charges may be brought up against the nurse? Select all that apply. 1 Libel 2 Assault 3 Slander 4 Malpractice 5 Invasion of privacy
3) Slander
4) Malpractice
5) Invasion of Privacy
Speaking falsely about a person is known as slander. In the given situation, the nurse misinforms the colleague about the client’s behavior. This action may damage the client’s reputation. Malpractice occurs when nursing care falls below the professional standards of care due to negligent acts. Because the nurse does not inform the primary health care provider about the incorrect medication dosage, the nurse may be charged with malpractice. Because the nurse informs media personnel about the client’s health status, the nurse may be charged with invasion of privacy. The nurse will not be charged with libel because he or she did not document false information in the client’s records. Because the nurse did not threaten the client or place him or her in physical or psychological danger, charges of assault will not be brought up.
A nurse assisting in a research study calculates the risk-benefit ratio and concludes that there were no harmful effects associated with a survey of diabetic clients. This researcher was applying which principle? 1 Human dignity 2 Human rights 3 Beneficence 4 Utilitarianism
3
Beneficence
Beneficence is defined as the promotion of well-being and abstaining from the injuring of others as well as doing good and being kind and charitable. In this situation, the possible benefits outweigh the possible harm for the clients participating in a research study. Human dignity and human rights are underlying principles of research ethics but are not directly related to the risk-benefit ratio here. Utilitarianism relates to the ethical doctrine that virtue is based on utility, and that conduct should be directed toward promoting the greatest good for the greatest number of people.
Which decision-making strategy involves systematic collection and summarization of opinions and judgments on a particular issue from the respondents? 1 Focus group 2 Brainstorming 3 Delphi technique 4 Normal group technique
3
Delphi technique
The Delphi technique is a decision-making strategy that involves systematic collection and summarization of opinions and judgments on a particular issue from respondents in order to achieve consensus among the team members and the leader. The purpose of a focus group strategy is to explore issues, identify problems, and generate information. Brainstorming strategy can be an effective method for generating a large volume of creative and innovative ideas irrespective of criticism. Normal group technique strategy gives opportunity to the group members to provide input into the decision-making process.
A registered nurse is educating a nursing student about risk management methods to ensure that appropriate nursing care is provided to a client by identifying and eliminating potential hazards. What information should the registered nurse provide? Select all that apply.
1
“If an incident occurs, document in the client’s medical record that an occurrence report has been filed.”
2
“Ensure that the three principles of The Joint Commission’s Universal Protocol are adhered to before starting a surgery on a client.”
3
“Refrain from depending on the use of electronic monitoring devices completely because they are not always reliable.”
4
“File an occurrence report in case of an error in technique when administering medication intravenously (IV).”
5
“Document that the healthcare provider was contacted, the information that was conveyed, and the response in the occurrence report.”
2
“Ensure that the three principles of The Joint Commission’s Universal Protocol are adhered to before starting a surgery on a client.”
3
“Refrain from depending on the use of electronic monitoring devices completely because they are not always reliable.”
4
“File an occurrence report in case of an error in technique when administering medication intravenously (IV).”
The nurse should ensure that the three principles of the protocol are adhered to before starting surgery. This is done to prevent an incorrect surgery. The nurse should not rely on electronic monitoring devices completely because they are not always reliable. Constant assessment of a client is essential to help document the accuracy of electronic monitoring. The nurse should file an occurrence report in case of an error in technique when administering medication intravenously (IV) to the client. This is done to prevent recurrence of the error and to alert hospital authorities about the situation. The nurse should never document in the client’s medical record that an occurrence report has been filed, because this report is confidential and is kept separated from other medical records. The nurse should document that the healthcare provider was contacted, what information was conveyed and the healthcare provider’s response. This helps to defend against a lawsuit. However, this information should not be documented in the occurrence report.
A parent objects to the child’s getting vaccinated because she believes that vaccinations can cause autism. However, a nurse gives the child the vaccination injection against the wishes of the mother. What legal charge may be brought against the nurse?
1 Assault 2 Battery 3 Invasion of privacy 4 False imprisonment
2) Battery
Battery is any intentional touching without consent. Because the nurse has administered the injection without obtaining consent, he or she is liable for a charge of battery. Assault is any action that places a person in apprehension of harmful or offensive contact without consent. Invasion of privacy involves unwanted intrusion into the private affairs of a client. False imprisonment means unjustified restraint of a person without a legal warrant.
A registered nurse is educating a nursing student about abortion-related issues. Which statement provided by the nursing student post-teaching needs correction?
1
“If a woman is in her first trimester, she may end her pregnancy according to state regulations.”
2
“In the third trimester when the fetus becomes viable, the state’s interest is to protect the fetus.”
3
“If the fetus is over 28 weeks old, the state requires viability tests before conducting abortions.”
4
“In the second trimester, the state enforces regulation regarding the person performing the abortion and the abortion facility.”
1
“If a woman is in her first trimester, she may end her pregnancy according to state regulations.”
A woman may end her pregnancy in the first trimester without state regulation because the risk of natural mortality from abortion is less than regular childbirth. In the third trimester when the fetus becomes viable, the state’s interest is to protect the fetus. Thus, the state forbids abortion unless it is required to save the mother. If the fetus is over 28 weeks of gestational age, then some states require viability tests before conducting abortions. In the second trimester, the state enforces regulations for the person performing the abortion because it has an interest in protecting maternal health.
A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. What should the nurse explain regarding informing the client’s parents?
1
They need to know about and sign a consent form for testing and treatment.
2
They will not be contacted, because treatment at the clinic is confidential.
3
They will be notified when the insurance company is billed for testing and treatment.
4
They will remain uninformed if the adolescent ensures that her sexual contacts will come for testing.
2
They will not be contacted, because treatment at the clinic is confidential.
Federal law allows family planning clinics to maintain minors’ confidentiality, although individual states may have different regulations; there is a concern that these teenagers will not seek or continue treatment if they fear disclosure. To maintain confidentiality, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Most family planning clinics receive funding and charge on a sliding scale based on income, thus encouraging adolescents to seek treatment. Telling the client that her parents will not be notified as long as she ensures that her sexual contacts come in for testing could be viewed as coercion; if the STI is reportable, follow-up of sexual partners is indicated, but the adolescent is not responsible for ensuring that they report for testing.
In what instances can a minor give consent for himself or herself for medical treatment? Select all that apply.
1
The minor can give consent for his or her siblings.
2
The minor can give consent for any venereal disease.
3
The minor can give consent if he or she is lawfully married.
4
The minor can give consent for a drug or substance abuse.
5
The minor can give consent for an abortion
2
The minor can give consent for any venereal disease.
3
The minor can give consent if he or she is lawfully married.
4
The minor can give consent for a drug or substance abuse.
A minor can give consent for himself or herself for medical treatment if he or she has any venereal disease. A minor can give consent for himself or herself for medical treatment if he or she is lawfully married. A minor can give consent for himself or herself for any drug or substance abuse issues. A minor cannot give consent for his or her siblings. A minor can give consent for pregnancy-related issues, except abortions.
