ANM Ethical and Legal Standards 2 — Questions and Answers
Question 1: A nurse manager discovers that a staff nurse has been documenting medication administration before actually giving the medications. What is the most appropriate first action?
- Immediately terminate the nurse's employment
- Report the incident to the state board of nursing without investigation
- Conduct a thorough investigation and review patient records for harm (Correct answer)
- Counsel the nurse privately and allow the behavior to continue under monitoring
Correct answer: Conduct a thorough investigation and review patient records for harm
A thorough investigation must occur first to determine if patient harm resulted and to gather facts before any disciplinary action.
Question 2: Which legal doctrine holds hospitals liable for the negligent acts of their employed nurses?
- Res ipsa loquitur
- Respondeat superior (Correct answer)
- Contributory negligence
- Assumption of risk
Correct answer: Respondeat superior
Respondeat superior ('let the master answer') holds employers vicariously liable for employees' negligent acts committed within the scope of employment.
Question 3: A competent adult patient refuses a blood transfusion on religious grounds despite a life-threatening hemorrhage. The nurse manager should ensure staff:
- Override the refusal because the situation is life-threatening
- Administer the transfusion and document patient protest
- Respect the refusal, document it, and explore alternative treatments (Correct answer)
- Seek an emergency court order to force treatment
Correct answer: Respect the refusal, document it, and explore alternative treatments
Competent adults have the legal and ethical right to refuse any treatment, including life-saving interventions, and staff must respect this decision.
Question 4: Under HIPAA, which situation represents a permitted disclosure of protected health information (PHI) without patient authorization?
- Sharing records with the patient's employer upon request
- Disclosing information to a spouse without the patient's consent
- Reporting a gunshot wound to law enforcement as required by state law (Correct answer)
- Providing records to the patient's attorney without a subpoena
Correct answer: Reporting a gunshot wound to law enforcement as required by state law
HIPAA permits disclosure of PHI without authorization when required by law, such as mandatory reporting of gunshot wounds to law enforcement.
Question 5: An ANM notices a pattern of near-miss medication errors on the unit but no actual patient harm has occurred. Ethically, the ANM is obligated to:
- Wait for an actual error before taking action to avoid unnecessary alarm
- Report only errors that cause patient harm per hospital policy
- Investigate and address the system issues causing near-misses proactively (Correct answer)
- Inform the risk management team only if a sentinel event occurs
Correct answer: Investigate and address the system issues causing near-misses proactively
The ethical principle of nonmaleficence requires proactive identification and correction of hazardous conditions before harm occurs.
Question 6: A nurse asks the ANM for guidance on a patient who has a Do Not Resuscitate (DNR) order but whose family is demanding resuscitation. The ANM should advise:
- Follow the family's wishes since they are the legal next of kin
- Resuscitate the patient to avoid legal liability from the family
- Honor the DNR order as it reflects the competent patient's documented wishes (Correct answer)
- Place a temporary hold on the DNR until family disagreement is resolved
Correct answer: Honor the DNR order as it reflects the competent patient's documented wishes
A valid DNR order reflects the patient's autonomous decision and must be honored; family preferences do not override a competent patient's documented directives.
Question 7: Which element is NOT required to prove nursing negligence in a malpractice lawsuit?
- A duty of care existed between the nurse and patient
- The nurse intended to cause harm to the patient (Correct answer)
- The nurse breached the standard of care
- The breach caused measurable patient damages
Correct answer: The nurse intended to cause harm to the patient
Negligence does not require intent to harm; the four elements are duty, breach, causation, and damages — intent is an element of intentional torts, not negligence.
ANM Ethical and Legal Standards 2
A nurse manager discovers that a staff nurse has been documenting medication administration before actually giving the medications.
What is the most appropriate first action?