NACE Ethical and Legal Principles 5 — Questions and Answers
Question 1: A nurse floated to an unfamiliar unit is assigned a patient requiring specialized care the nurse is not competent to provide. The most appropriate action is to:
- Attempt the care using general nursing knowledge
- Refuse the assignment and leave the unit
- Notify the charge nurse of the competency limitation and request assistance or reassignment (Correct answer)
- Document the concern and proceed with care
Correct answer: Notify the charge nurse of the competency limitation and request assistance or reassignment
Nurses are legally and ethically obligated to practice within their competence and must communicate limitations to the charge nurse to ensure patient safety.
Question 2: A patient's durable power of attorney for healthcare (DPAHC) designates a spouse as surrogate decision-maker. The patient is now unconscious. The adult children disagree with the spouse's decision. Who has legal authority?
- The majority vote of the adult children
- The attending physician
- The spouse designated in the DPAHC (Correct answer)
- The hospital ethics committee
Correct answer: The spouse designated in the DPAHC
The legally designated healthcare proxy in a DPAHC holds decision-making authority over all family members who are not designated.
Question 3: Which action by a nurse constitutes assault (as opposed to battery)?
- Performing a procedure after the patient says 'stop'
- Threatening to restrain a patient if they do not comply with treatment (Correct answer)
- Touching a patient without consent
- Administering medication the patient refused
Correct answer: Threatening to restrain a patient if they do not comply with treatment
Assault is the threat or act that causes a person to fear imminent harmful contact; battery is the actual unauthorized contact.
Question 4: When charting a medication error, the nurse should:
- Document what was given and the patient's response, and file a separate incident report (Correct answer)
- Omit the error from the chart to avoid liability
- Write 'medication error — see incident report' in the chart
- Only complete the incident report and not document in the chart
Correct answer: Document what was given and the patient's response, and file a separate incident report
The medical record must objectively reflect the care provided and the patient's response; a separate incident report is filed for quality improvement purposes.
Question 5: A nurse overhears a colleague tell a patient 'You'll be sorry if you keep refusing your medications.' This statement is an example of:
- Libel
- Assault (Correct answer)
- Slander
- Battery
Correct answer: Assault
This verbal threat causes the patient to fear imminent harm or unpleasant consequences, constituting assault.
Question 6: The ethical principle of justice is most clearly demonstrated when a nurse:
- Keeps a promise made to a patient
- Advocates for equitable distribution of healthcare resources among patients (Correct answer)
- Provides accurate information to support informed consent
- Acts to prevent harm to a vulnerable patient
Correct answer: Advocates for equitable distribution of healthcare resources among patients
Justice in nursing ethics refers to fair, equitable treatment and distribution of resources, regardless of personal characteristics.
Question 7: A nurse is asked by a physician to witness an informed consent signature for a complex surgical procedure the nurse did not observe being explained. The nurse should:
- Sign as a witness since the physician is responsible for the explanation
- Refuse to sign and inform the physician that the nurse did not witness the explanation (Correct answer)
- Ask the patient to summarize what was explained before signing
- Countersign and note 'explanation given by physician' in the chart
Correct answer: Refuse to sign and inform the physician that the nurse did not witness the explanation
A witness signature attests that the signer observed the consent process; signing without having witnessed it is legally and ethically fraudulent.
NACE Ethical and Legal Principles 5
A nurse floated to an unfamiliar unit is assigned a patient requiring specialized care the nurse is not competent to provide.
The most appropriate action is to: