Ethics & Legal

Question 1

Can nurses give their opinions to clients?

Answer 1

No. Never give your opinion or advice on what the nurse would do in the client’s situation.

Nurses provide non-judgemental care.

Question 2

What is an advance directive?

Answer 2

A legal document in which a client specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.

It includes both:

• living will
• health care power of attorney/health care proxy

Question 3

What is a living will?

Answer 3

A type of advance directive that has written instructions on what the client would like done with their health if they are unable to make their own decisions.

Question 4

What is a health care power of attorney/health care proxy?

Answer 4

A type of advance directive that designates a person the client has declared to make health care decisions if the client isn’t able to.

Question 5

What is informed consent?

Answer 5

A document for invasive surgery or a procedure that the client signs:

• the HCP explains the risks
• the client signs the form and the nurse can sign as a witness
• if the client doesn’t understand the procedure or risks, the nurse informs the HCP

If it’s an emergency, the informed consent does not need to be signed.

Question 6

What does it mean when a nurse is a “witness” for informed consent?

Answer 6

As a witness, the nurse confirms that the client was with it mentally to understand the procedure and risks; And that the nurse confirmed the identity of the client.

Question 7

What should the nurse do if the client does NOT understand the risks of the procedure?

Answer 7

Contact the HCP to let them know.

Question 8

What type of medications are held before the client signs the informed consent?

Answer 8

Any meds that could sedate the client.

If the client gets a sedative (such as an opioid), the client may not be cognitively aware of what they are signing.

Question 9

What does the nurse do if the client doesn’t speak English while providing care?

Answer 9

• get an interpreter
• provide written information in the client’s native language

Question 10

In what kind of situations is the informed consent by an adult NOT needed when dealing with minors?

(minors are <18 years old)

Answer 10

1. treatment for drug abuse
2. treatment for sexually transmitted diseases or getting contraceptives

Question 11

Define:

Emancipated minor

Answer 11

A person < 18 years old and has been deemed to make their own medical decisions by a judge.

Question 12

What situations would a minor be considered emancipated?

(minors are <18 years old)

Answer 12

• in the military
• married
• pregnant
• deemed by a court to be emancipated for other reasons

Question 13

Define:

Health Insurance Portability and Accountability Act

(HIPAA)

Answer 13

A confidentiality law that states that a health care team member can’t talk about clients except to those that are directly involved in the care.

Question 14

What is a hand-off report?

Answer 14

When one nurse gives a report to another nurse about the client.

It needs to be thorough and in-person is best.

Question 15

What does SBAR stand for?

Answer 15

• Situation
• Background
• Assessment
• Recommendation

It is a way to communicate with others on the healthcare team, especially the HCP when there is a problem with a client.

Question 16

What does it mean to be an advocate for the client?

Answer 16

• to respect client’s wishes
• to teach about how to care for themselves
• to speak up when client is unable to
• to get an interpreter if needed

Question 17

What are client rights?

Answer 17

A list of rights the client has when being cared for by a health professional.

Question 18

What are the most common and important client rights?

Answer 18

1. right to receive care
2. right to refuse care
3. right to least restrictive care
4. right to have visitors
5. right to privacy

Question 19

What is the Nurse Practice Act?

(NPA)

Answer 19

• defines the nurse’s scope of practice
• protects the public from harm

Each state and province has its own NPA.

Question 20

What is the Hospital Policies and Procedures?

Answer 20

A document that gives more detail on how and what the nurse is allowed to do when caring for clients.

Question 21

What is Evidence-Based Practice?

(EBP)

Answer 21

Used to make safe and informed decisions about client care and standards of care.

Many policies are based on published national standards which are based on EBP.

Question 22

What are the 4 points that make up evidence-based practice (EBP)?

Answer 22

1. what the client prefers
2. the experience and expertise of the nurse
3. what the research shows
4. availability of resources

Question 23

What is Quality Improvement?

Answer 23

Collecting data to make sure clients are being cared for properly.

A common quality improvement project is hand-washing practices by the staff.

Question 24

What is the Good Samaritan Law?

Answer 24

States that the nurse (or other health care professional) can stop to help people in a medical emergency without being sued.

Question 25

What are 2 ways that show a client is an **organ donor**?

Answer 25

**Organ donation is:** 1. indicated on the driver's license or state ID 2. indicated on the advance directive

Question 26

What **age** must a client be in order to be an organ donor?

Answer 26

**18** years old

Question 27

What are the reasons a client can **_NOT_** be an organ donor?

Answer 27

If they have: * cancer * an infectious disease

Question 28

Who should the nurse **refer** the family member to if the client has died and the family member is upset about the decision that the client decided to be an organ donor?

Answer 28

An organ donor expert.

Question 29

What is an **ethical principle**?

Answer 29

A guiding principle for giving care in a way that benefits the client.

Question 30

What is the **Code of Ethics**?

Answer 30

A document that explains the ethical principles.

Question 31

What is an **ethical dilemma**?

Answer 31

A situation in which there is a **choice to be made between two options. Neither option resolves the situation** in an ethically acceptable way for either party. ## Footnote Refer these situations to an ethical dilemma committee.

Question 32

# Define: Ethical principle: **Veracity**

Answer 32

To tell the truth.

Question 33

Give an **example** of when veracity would be used with a client?

Answer 33

* the client asks why they are taking a certain medication and the nurse is reluctant about saying what it's for * the nurse **tells the truth** about which medication the client is taking

Question 34

# Define: Ethical principle: **Fidelity**

Answer 34

Do what you promise.

Question 35

Give an **example** of when fidelity would be used with a client?

Answer 35

* the client asks for some pain medicine * the nurse then tells the client that they will go get it for them * to show fidelity is to come back and actually give the pain medicine * you did what you promise

Question 36

# Define: Ethical principle: **Beneficence**

Answer 36

To do good.

Question 37

Give an **example** of when beneficence would be used with a client?

Answer 37

* the client needs teaching about a certain diet for their disease * to show beneficence is to teach the client about the diet and make sure the client understands

Question 38

# Define: Ethical principle: **nonmaleficence**

Answer 38

Do no harm.

Question 39

Give an **example** of when nonmaleficence would be used with a client?

Answer 39

* the client needs to talk about their diagnosis and the nurse recognizes that the client needs to open up and talk * to show nonmaleficence is to use therapeutic communication with the client

Question 40

# Define: Ethical principle: **Justice**

Answer 40

To be fair.

Question 41

Give an **example** of when justice would be used with a client?

Answer 41

To show justice is to spend adequate time with all the clients under the nurse's care.

Question 42

# Define: Assault

Answer 42

A **threat or to put the client in fear** that harm will occur (not touching yet). ## Footnote Example: the nurse tells the client if they don't take their meds, they won't give them a bath later.

Question 43

# Define: Battery

Answer 43

To touch the client against their will. ## Footnote Example: the client has an order to get a foley placed, but the client refuses. The nurse puts the foley in despite the client's rejection.

Question 44

What does **duty to warn and protect** mean?

Answer 44

When the nurse is legally allowed to **notify the police or relatives** if the client is making threats of death or harm to themselves or others.

Question 45

What should the nurse do if an **error** occurs with the client?

Answer 45

* determine if the client is stable or unstable * tell the HCP and await further instructions

Question 46

What is an **incident report**?

Answer 46

A form that gets filled out and submitted that **describes an error or unusual event**. ## Footnote Anyone can fill out an incident report including a client, family members, or health team members.

Question 47

Can an **incident report** be filed or mentioned in the client's medical record/file?

Answer 47

**No.** * don't put incident reports in the client's file * don't mention that an incident report was filed ## Footnote The incident report is used by the hospital's risk assessment team to recognize and intervene appropriately to errors.

Question 48

What are some **common** reasons an incident report is filled out?

Answer 48

* the wrong medication was given * a client fell * needle stick injury to the nurse * didn't implement a prescription * a visitor got injured

Question 49

What are some examples of **unsafe practices** that would be reported to the nurse supervisor?

Answer 49

* drug abuse by another co-worker * unsafe staff assignments such as: * too many clients to care for * not trained to care for clients with a particular problem

Question 50

# Define: malpractice/negligence

Answer 50

When the **nurse should have done something or didn't do something and it resulted in harm** to the client. ## Footnote It is also called not following the **standards of care**.

Question 51

What are some common **situations** of malpractice/negligence?

Answer 51

* giving the wrong med * falls * not using sterile technique * burns from hot water or faulty equipment * didn't report changes in condition to the HCP * didn't monitor the client * didn't give a complete report to the new nurse coming on

Question 52

What is **mandatory reporting**?

Answer 52

When the nurse is **legally required to report** when abuse, certain infections or domestic violence has occurred or is suspected in a client. ## Footnote Reporting can be to the police, adult/child protective services or health department.

Question 53

What is a **voluntary admission**?

Answer 53

When the client **agrees to be admitted** for care.

Question 54

What is an **involuntary admission**?

Answer 54

When the client **does not agree to be admitted** for care. ## Footnote The HCP has determined that the client is a harm to themselves or someone else or a judge has deemed the client incompetent to make the individual decision to be admitted.

Question 55

What is **Against Medical Advice**? | (AMA)

Answer 55

When a voluntary **client is discharged even though the HCP has advised against leaving**.

Question 56

What does **DNR** stand for?

Answer 56

Do Not Resuscitate

Question 57

# Define: Libel and Slander

Answer 57

**Sharing information that is detrimental to a person's reputation** (has to be malacious and false). * **Libel:** done in writing * **Slander:** done verbally

Question 58

# Define: False Imprisonment

Answer 58

**Using restraints or seclusion to a voluntarily committed client against their will** and who is **NOT** an immediate danger to themsleves or others. ## Footnote Examples are hiding clothes or personal belongings so the client can't leave.

Question 59

What types of **gifts** can a nurse accept from a client?

Answer 59

The nurse cannot accept any personal gifts from the client. ## Footnote Food, beverages or flowers for the entire unit would be OK to accept.

Question 60

Can the nurse use **social media** to keep in touch with a client?

Answer 60

The nurse should **NOT** use social media with any clients. ## Footnote This action breaks the professinal boundary.

Question 61

# Define: Ethical Principle: **Autonomy**

Answer 61

Respect decisions made by the client.

Question 61

Give an **example** when autonomy would be used with a client?

Answer 61

Allowing the client to **perform their own ADLs** (activities of daily living) even though the nurse believes they can do it faster or better.