NACE Ethical and Legal Principles 2 — Questions and Answers
Question 1: A patient with terminal cancer has a Do-Not-Resuscitate (DNR) order. The patient goes into cardiac arrest. What is the nurse's appropriate action?
- Begin CPR and call a code
- Provide comfort measures only (Correct answer)
- Contact the family for permission to resuscitate
- Ignore the DNR because the situation is urgent
Correct answer: Provide comfort measures only
A valid DNR order means resuscitative efforts should not be initiated. The nurse should provide comfort measures and ensure the patient's dignity.
A Do-Not-Resuscitate (DNR) order is a legally binding medical order that directs healthcare providers not to perform CPR if the patient's heart stops or breathing ceases. The nurse must honor this order regardless of personal feelings. Comfort measures include pain management, oxygen for comfort, suctioning, and emotional support for the patient and family.
Question 2: Which situation represents a breach of patient confidentiality under HIPAA?
- Discussing patient status with the treatment team during rounds
- Sharing patient information with the patient's designated healthcare proxy
- Discussing a patient's diagnosis in the hospital elevator with a colleague (Correct answer)
- Reporting a communicable disease to the health department
Correct answer: Discussing a patient's diagnosis in the hospital elevator with a colleague
Discussing patient information in a public area like an elevator where unauthorized individuals may overhear is a HIPAA violation.
HIPAA (Health Insurance Portability and Accountability Act) of 1996 protects patient health information (PHI). Discussing PHI in public areas such as elevators, cafeterias, or hallways where unauthorized persons may overhear constitutes a breach.
Question 3: A nurse makes a medication error that does not harm the patient. What is the nurse's legal and ethical obligation?
- Document the error only if asked by a supervisor
- Report the error through the facility's incident reporting system (Correct answer)
- Keep the information confidential to avoid liability
- Wait to see if the patient develops symptoms before reporting
Correct answer: Report the error through the facility's incident reporting system
All medication errors, regardless of whether harm occurred, must be reported through the facility's incident reporting system to improve safety and prevent future errors.
Medication error reporting is both a legal and ethical obligation. The Joint Commission and most state boards of nursing require reporting all errors. Incident reports serve multiple purposes: they trigger immediate patient assessment, enable root cause analysis, identify system failures, and contribute to quality improvement.
Question 4: A nurse suspects that a coworker is diverting controlled substances. What is the most appropriate first action?
- Confront the coworker directly
- Ignore the situation to avoid conflict
- Report the concern to the nurse manager or supervisor (Correct answer)
- Search the coworker's belongings for evidence
Correct answer: Report the concern to the nurse manager or supervisor
Suspected drug diversion should be reported to the nurse manager or supervisor who can initiate a proper investigation while protecting patient safety.
Drug diversion is the transfer of a controlled substance from its intended use to an unauthorized person. Nurses have a legal obligation to report suspected diversion. Signs include frequent bathroom breaks, volunteering to administer narcotics, patients reporting inadequate pain relief, and discrepancies in controlled substance counts.
Question 5: Which action by a nurse constitutes abandonment of a patient?
- Refusing an assignment due to lack of competency in the specialty area
- Leaving the unit at the end of a scheduled shift after giving proper report
- Accepting a patient assignment and then leaving without transferring care to another nurse (Correct answer)
- Requesting reassignment due to a conflict of interest
Correct answer: Accepting a patient assignment and then leaving without transferring care to another nurse
Patient abandonment occurs when a nurse accepts responsibility for a patient and then leaves without ensuring continuity of care through proper transfer to another qualified nurse.
Patient abandonment is defined as the withdrawal of nursing services without ensuring that equivalent services are available. Key elements: the nurse-patient relationship must be established through acceptance of the assignment, the nurse must leave or fail to provide care, and the patient must potentially suffer harm.
Question 6: What distinguishes an advance directive from a power of attorney for healthcare?
- An advance directive requires a lawyer; a power of attorney does not
- An advance directive specifies treatment wishes; a healthcare power of attorney designates a decision-maker (Correct answer)
- There is no difference between the two documents
- A power of attorney is only valid after the patient dies
Correct answer: An advance directive specifies treatment wishes; a healthcare power of attorney designates a decision-maker
An advance directive documents specific treatment preferences, while a healthcare power of attorney designates a person to make healthcare decisions when the patient cannot.
Advance directives and healthcare powers of attorney serve complementary but distinct roles. A living will specifies the patient's wishes regarding specific treatments such as mechanical ventilation, tube feeding, and resuscitation. A durable power of attorney for healthcare designates a trusted individual to make medical decisions when the patient lacks capacity.
NACE Ethical and Legal Principles 2
A patient with terminal cancer has a Do-Not-Resuscitate (DNR) order.
The patient goes into cardiac arrest.
What is the nurse's appropriate action?