(Ch. 23)Legal Implications in Nursing Practice

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autonomy
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refers to the commitment to include clients in decisions about all aspects of care
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beneficence
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refers to taking positive actions to help others; encouraging the good for others
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nonmaleficence
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is the avoidance of harm or hurt; the commitment to provide least harmful interventions
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justice
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refers to fairness; ex. ranking recipients according to need
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fidelity
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refers to the agreement to keep promises; obligation to follow through
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fidelity
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the standard the encourages you to monitor the client’s response to the plan?
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code of ethics
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first written by the ANA, a set of guiding principles that all members of profession accept
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The American Nurses Association (ANA)
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established the first code of nursing ethics decades ago and reviews and revises the code regularly, to reflect changes in practice
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advocacy
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refers to the support of a cause; safeguard the client’s right to physical and auditory privacy
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responsibility
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refers to willingness to respect obligations and follow through on promises; reliable
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accountability
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refers to the ability to answer for one’s own actions
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(1) any competent individual 18+ years for himself or herself; (2) any parent for his or her emancipated minor; (3) any guardian for his or her ward; (4) any adult for the treatment of his or her minor brother or sister, if in an emergency and parents aren’t present; (5) any grandparent for a minor grandchild, if in an emergency and parents aren’t present
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Statutory Guidelines for Legal Consent: ADULTS
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ADA HIPPA EMTALA Mental Health Parity Advance Directives Uniform Anatomical Gift Restraints are all examples of what?
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FEDERAL Statutory Issues in Nursing Practice
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Licensure Good Samaritan Laws Public Health Laws The Uniform Determination of Death Act Physician-Assisted Suicide are all examples of what?
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STATE Statutory Issues in Nursing Practice
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criminal and civil
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types of statutory laws?
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criminal law
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prevent harm to society and provides punishment for crimes
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civil laws
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protect the rights of individual persons within our society and encourage fair treatment among people
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(1) for his or her child and any child in his or her legal custody; (2) lawfully married or emancipated; (3) pregnancy excluding abortions; (4) venereal disease; (5) drug or substance abuse; (6) unemancipated may not consent to abortions w/o consent of parent, self-consent granted by court, specific consent given by court
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Statutory Guidelines for Legal Consent for Medical Treatment: MINORS
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California in 2004
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became the first state to adopt legislation mandating a fixed nurse to patient ratio
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Standards of Care
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legal guidelines for nursing practice & acceptable nursing care that are set by every state (ANA standards, Joint Commission accredited hospitals)
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Emergency Medical Treatment and Active Labor Act
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“patient dumping” is the act of clients’ being transferred from private hospitals to public hospitals with appropriate screening and stabilization. This act provides an appropriate medical screening within the hospital capacity
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1989 Webster vs. Reproductive Health Services
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some states require viability tests before conducting abortions if the fetus is more than 28 weeks’ gestational age
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statutory laws
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laws passed by the state legislature or Congress (ex. Nurse Practice Acts)
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feminist ethcis
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inequality between people and sexist; proposes that principles distract you from dealing with larger issues of the community; propose that the natural human urge to be influenced by relationships is a positive value
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Mental Health Parity Act
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forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits
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advance directives
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living wills and Durable Power of Attorney for Health Care
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living wills
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written document of client’s wishes in illness or terminal condition
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Durable Power of Attorney for Health Care
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legal document designing person(s) to make health care decisions when client is unable to make them
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ethics of care
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a philosophy that focuses on understanding relationships, especially personal narratives; focusing on client/family and nurse/client relationships
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regulatory or administrative law
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defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing
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regulatory or administrative law
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the duty to report incompetent or unethical nursing conduct
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Nurse Practice Acts
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describe and define the legal boundaries and scope of nursing practice within each state
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common law
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results from judicial decisions made in courts when individual legal cases are decided (ex. informed consent and the client’s right to refuse treatments)
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Health Insurance Portability and Accountability Act
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allows employees to change jobs w/o losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group insurance
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consensus building
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an act of discovery in which “collective wisdom” guides a group in the best possible direction when a solution to an ethical dilemma is not guaranteed
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The Uniform Determination of Death Act – cardiopulmonary standard
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requires irreversible cessation of circulatory and respiratory function
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The Uniform Determination of Death Act – whole brain standard
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requires irreversible cessation of all functions of the entire brain, including the stem
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tort
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a civil wrong made against a person or property
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intentional torts
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willful act that violate another’s rights
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genetic screening
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alerts a client to a condition that is not yet evident but that is certain to develop in the future
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quasi-intentional torts
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acts where intent is lacking but volitional action and direct causation occur
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defamation of character
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publication of false statements that result in damage to a person’s reputation (malice, slander)
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unintentional torts
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negligence and malpractice
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negligence
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conduct below standard of care; it’s for the protection of others against an unreasonably great risk of harm
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malpractice
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“professional negligence” when nursing care falls below a standard of care
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malpractice
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(1) the nurse owed a duty to a client (2) the nurse didn’t carry out that duty (3) the client was injured (4) the nurse failed to carry out the duty and caused the injury
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Public Health Laws
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protection of the public’s health, advocating for the rights of people, regulating heath care and health care financing, and ensuring professional accountability for the care provider
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Public Health Laws
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describes the reporting laws for communicable diseases, school immunizations, and laws intended to promote health and reduce health risks in communities; reporting suspected abuse or neglect
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Good Samaritan Laws
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encourage health care professionals to assist in emergencies
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utilitarianism
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system of ethics proposes that the value of something is determined by its usefullness
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deontology
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Immanuel Kant defines actions as right or wrong and not looking at consequences to prove that right or wrong
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values clarification
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tolerating differences, which sometimes become the key in the search for resolution of ethical dilemmas
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consequentialism and teleology
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what is utilitarianism also known as?
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deontology and utilitarianism
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both provide guidance, but it does not guarantee agreeement
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consensus building
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as a strategy, it promotes respect and agreement rather than a particular philosophy or moral system itself
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ethics committee
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provides education, policy recommendations, and case consultation; established by health care institutions to support the processing of ethical dilemmas
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quality of life
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helps a client and family decide on the merits of a certain risky intervention (such as an organ transplant or experimental drug management or DNR discussions)
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futile
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refers to something that is “useless; hopeless; serving no useful purpose”
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the process of value clarification
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helps you to explore values and feelings and to decide how to act on personal beliefs
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relationships
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the ethic of care philosophy suggests that ethical dilemmas can best be solved by attention to what?
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Americans with Disability Act
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this act protects an HIV-positive individual who does not have acquired immunodeficiency syndrome (AIDS)
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Patient Self Determination Act
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requires health care institutions to provide written information to clients concerning the clients’ rights under state law to make decisions, including the right to refuse treatment and formulate advance directives
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Required Request laws
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laws that mandate that at the time of admission to a hospital, a qualified health care provider has to ask each client over age 18 whether the client is an organ or tissue donor
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Health Insurance Portability and Accountability Act
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this law provides rights to clients and protects employees
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The Community Health Accreditation Program
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requires institutions to have guidelines for determining the number (staff ratios) of nurses required or give care to a specific number of clients
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written protest
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a document that is made in the case that a nurse accepts the assignment of caring for more clients than is reasonable to ensure that if a client suffers an injury because of inattention, the shows the nurse was attempting to act responsibly
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risk management
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is a system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs
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functions of the entire brain
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The legal definition of death that facilitates organ donations is the cessation of:
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a living will
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is invoked only when the client has a terminal condition or is in a persistent vegetative state
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advocacy, responsibility, accountability, and confidentiality
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basic principles in code of ethics
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the choices involved do not appear to be clearly right or wrong
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a health care issue often becomes and ethical dilemma because:
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responsibility of floating
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informing the supervisor and make a written protest to nursing administrators
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State Nurse Practice Acts
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the scope of nursing is legally defined by; and determines the boundaries within each state
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issues in bioethics
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quality of life, genetic screening, futile care, allocation of scarce resources: access to care and the nursing shortage
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Roe vs. Wade
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U.S. Supreme Court ruled that there is a fundamental right to privacy, which includes a woman’s right to have an abortion
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A nurse is caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (Select all that apply.) A. Information provided by the head nurse B. Policies and procedures of the employing hospital C. State Nurse Practice Act D. Regulations identified in The Joint Commission’s manual E. The American Nurses Association standards of nursing practice
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B. Policies and procedures of the employing hospital C. State Nurse Practice Act D. Regulations identified in The Joint Commission’s manual E. The American Nurses Association standards of nursing practice Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.
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A nurse is sued for failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) A. The nurse represents the plaintiff. B. The defendant must prove injury, damage, or loss. C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury.
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C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage.
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A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse’s employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? A. The nurse’s automobile insurance B. The nurse’s homeowner’s insurance C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence D. The Patient Care Partnership, which may grant immunity from suit if the injured party consents
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C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence The Good Samaritan law holds the health care provider immune from liability as long as he or she functions within the scope of his or her expertise.
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A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? A. Family member B. Surgeon C. Nurse D. Nurse manager
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B. Surgeon The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.
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A woman who is a Jehovah’s Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman’s anemia. The woman’s husband refuses to allow the nurse to give his wife the blood. What is the nurse’s responsibility? A. Obtain a court order to give the blood B. Coerce the husband into giving the blood C. Call security and have the husband removed from the hospital D. Abide by the husband’s wishes and inform the health care provider
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D. Abide by the husband’s wishes and inform the health care provider Adult patients such as those who are Jehovah’s Witnesses are able to refuse treatment for personal religious reasons.
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The nurse notes that an advance directive is on a patient’s medical record. Which statement represents the best description of an advance directive guideline the nurse will follow? A. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. C. The patient cannot make changes in the advance directive once admitted to the hospital. D. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
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B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.
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A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nursing manager because this action is a violation of which act? A. Mental Health Parity Act B. Patient Self-Determination Act (PSDA) C. Health Insurance Portability and Accountability Act (HIPAA) D. Emergency Medical Treatment and Active Labor Act
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C. Health Insurance Portability and Accountability Act (HIPAA) The Privacy Rule of HIPAA requires that patient information be protected from unnecessary publication.
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Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) A. Taking or selling controlled substances B. Refusing to provide health care information to a patient’s child C. Reporting suspected abuse and neglect of children D. Applying physical restraints without a written physician’s order
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A. Taking or selling controlled substances D. Applying physical restraints without a written physician’s order The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a health care provider based on Joint Commission and Medicare guidelines.
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The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient’s message board in the patient rooms. The nurse also lists the patients’ medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient’s family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? A. Discussing patient conditions in the nursing report room at the change of shift B. Allowing nursing students to review patient charts before caring for patients to whom they are assigned C. Posting medical information about the patient on a message board in the patient’s room D. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
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C. Posting medical information about the patient on a message board in the patient’s room Posting the medical condition of a patient on a message board in the patient’s room is not necessary for the patient’s treatment. Doing so can result in this information being accessed by persons who are not involved in the patient’s treatment.
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The patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient’s toes have become pale and cold but forgets to document this because one of the nurse’s other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) A. Failure to document a change in assessment data B. Failure to provide discharge instructions C. Failure to follow the six rights of medication administration D. Failure to use proper medical equipment ordered for patient monitoring E. Failure to notify a health care provider about a change in the patient’s condition
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A. Failure to document a change in assessment data E. Failure to notify a health care provider about a change in the patient’s condition The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.
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A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? A. Health Insurance Portability and Accountability Act (HIPAA) B. Americans with Disabilities Act (ADA) C. Patient Self-Determination Act (PSDA) D. Emergency Medical Treatment and Active Labor Act (EMTALA)
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D. Emergency Medical Treatment and Active Labor Act (EMTALA) The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.
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You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient’s medical record. What is the first nursing action to take? A. Give the family the record B. Give the patient the record C. Discuss the issues that concern the family with them D. Call the nursing supervisor
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C. Discuss the issues that concern the family with them Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how to best address their concerns.
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A home health nurse notices significant bruising on a 2-yearold patient’s head, arms, abdomen, and legs. The patient’s mother describes the patient’s frequent falls. What is the best nursing action for the home health nurse to take? A. Document her findings and treat the patient B. Instruct the mother on safe handling of a 2-year-old child C. Contact a child abuse hotline D. Discuss this story with a colleague
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C. Contact a child abuse hotline Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.
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A new graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which of the statements below indicates the new graduate understands ways to remain involved professionally? (Select all that apply.) A. “I am thinking about joining the health committee at my church.” B. “I need to read newspapers, watch news broadcasts, and search the Internet for information related to health.” C. “I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing.” D. “Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses.
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A. “I am thinking about joining the health committee at my church.” B. “I need to read newspapers, watch news broadcasts, and search the Internet for information related to health.” Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees at all levels of their career, not just when they have experience. Nurses have a powerful voice in the legislature.
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You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. What is the best nursing action to take first? A. Call the nursing supervisor to discuss the situation B. Discuss the problem with a colleague C. Leave the nursing unit and go home D. Say nothing and begin your work
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A. Call the nursing supervisor to discuss the situation Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.

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