Nursing Acceleration Challenge Exam I PN-RN Ethical and Legal Principles Questions and Answers 1 — Questions and Answers
Question 1: A competent 80-year-old client with end-stage chronic obstructive pulmonary disease (COPD) has a living will that explicitly states they do not want mechanical ventilation. The client develops acute respiratory failure and becomes lethargic. The client's family insists that 'everything be done' to save them. Which action by the nurse demonstrates proper legal and ethical practice?
- Ask the provider to request an ethics committee consultation to mediate the conflict.
- Follow the family's wishes, as the client is no longer able to clearly communicate.
- Honor the client's advance directive and advocate for comfort care measures. (Correct answer)
- Initiate mechanical ventilation as requested by the family until the client is stable.
Correct answer: Honor the client's advance directive and advocate for comfort care measures.
A living will is a legal advance directive that outlines a competent client's wishes for medical treatment at the end of life. The nurse has an ethical and legal obligation to honor these documented wishes. The principle of autonomy dictates that the client's right to self-determination be respected. The nurse's primary role is to advocate for the client's wishes, which in this case involves providing comfort care rather than initiating unwanted life-sustaining treatment.
Question 2: A nurse is caring for a client who is verbally refusing a prescribed antipsychotic medication. The nurse proceeds to crush the medication, mix it in applesauce, and administer it to the client without their knowledge. This action constitutes which of the following intentional torts?
- Assault
- Malpractice
- Negligence
- Battery (Correct answer)
Correct answer: Battery
Battery is the intentional and wrongful physical contact with a person without their consent. Administering medication to a competent client who has refused it, especially through concealment, is a form of unwanted touching and a violation of the client's right to autonomy. Assault is the threat of harmful contact, while negligence and malpractice are unintentional torts related to failing to meet the standard of care.
Question 3: Which of the following actions by a nurse represents a violation of the Health Insurance Portability and Accountability Act (HIPAA)?
- Giving a verbal report to the oncoming nurse in a private room.
- Accessing the electronic health record of a neighbor who is a patient on a different unit. (Correct answer)
- Calling a client's designated emergency contact to provide an update, with the client's permission.
- Placing a paper chart in a holder on the outside of the client's room door with the name visible.
Correct answer: Accessing the electronic health record of a neighbor who is a patient on a different unit.
Accessing the protected health information (PHI) of any individual for whom the nurse is not providing direct care is a serious HIPAA violation. This action is often referred to as 'snooping' and is prohibited, regardless of the nurse's personal relationship with the individual. Access to PHI is based on a 'need-to-know' basis for the purpose of treatment, payment, or healthcare operations.
Question 4: The ethical principle of beneficence requires a nurse to take what type of action?
- Ensuring all clients have equal access to available resources.
- Respecting a client's decision to refuse a necessary medical procedure.
- Taking positive actions to help others and promote the well-being of clients. (Correct answer)
- Telling the truth to a client about their diagnosis, even if it is distressing.
Correct answer: Taking positive actions to help others and promote the well-being of clients.
Beneficence is the ethical principle of acting for the good and welfare of others. It involves taking positive, proactive steps to help clients, such as providing effective pain management, offering emotional support, or educating them to promote health. Ensuring equal access relates to justice, respecting a client's decision relates to autonomy, and truth-telling relates to veracity.
Question 5: An RN delegates the task of obtaining routine vital signs on a stable client to an unlicensed assistive personnel (UAP). The UAP later reports to the RN that the client's blood pressure is 188/102 mmHg. What is the RN's most critical next step?
- Document the vital signs as reported by the UAP.
- Instruct the UAP to notify the charge nurse of the finding.
- Personally reassess the client's blood pressure and overall condition. (Correct answer)
- Tell the UAP to retake the blood pressure in 30 minutes.
Correct answer: Personally reassess the client's blood pressure and overall condition.
While tasks can be delegated, the RN retains full accountability for the nursing process, which includes assessment, interpretation, and intervention. When an abnormal finding is reported, the RN must personally validate the data, perform a focused assessment on the client, and then decide on the appropriate action, such as notifying the provider. Delegating assessment or clinical judgment is not appropriate.
Question 6: A nurse witnesses a healthcare provider explaining a surgical procedure to a client who speaks a different language, using the client's 12-year-old grandchild as an interpreter. Which ethical principle is most immediately compromised in this situation?
- Fidelity
- Autonomy (Correct answer)
- Justice
- Nonmaleficence
Correct answer: Autonomy
The principle of autonomy requires that a client give informed consent, which is predicated on their ability to fully understand the information presented. Using a minor, untrained family member as an interpreter does not guarantee that complex medical information, risks, and alternatives are conveyed accurately. This compromises the client's ability to make a truly informed decision, thus violating their autonomy.
Nursing Acceleration Challenge Exam I PN-RN Ethical and Legal Principles Questions and Answers 1
A competent 80-year-old client with end-stage chronic obstructive pulmonary disease (COPD) has a living will that explicitly states they do not want mechanical ventilation.
The client develops acute respiratory failure and becomes lethargic.
The client's family insists that 'everything be done' to save them.
Which action by the nurse demonstrates proper legal and ethical practice?