Deck 1: Ethical Issues in Nursing

Question 1

A group of nurses are discussing the emerging concern of Physician Assisted Suicide (PAS). Based on American Nurses Association (ANA), what priority action should a nurse take if a physician asks for assistance in ending one's life?

A) Refer the physician for psychiatric treatment.
B) Involve the physician in a discussion relative to expressed feelings.
C) Assume that the physician is making a joke and quietly ignore the comment.
D) Ask the physician how long he/she has felt this way.

Answer 1

B

Question 2

Which statement, made by a staff nurse, would the nurse manager evaluate as evidence of good understanding of the concept of patient self-determination as it applies to consent?

A) "States' rights with regard to patient self-determination are applied equally across the country."
B) "The competency of the patient does not affect medical consent."
C) "The primary focus should be on what the patient wants relative to medical treatment and care."
D) "Self-determination principles apply to death and dying issues and have little impact on consent."

Answer 2

C

Question 3

The nurse working in an emergency room is taking care of a patient who is unresponsive with a confirmed terminal medical diagnosis of metastatic cancer. There is no documentation relative to advance directives and the patient has been placed on life support. Family members arrive shortly afterward asking the nurse to remove the patient from life support. What actions should the nurse take?

A) Comply with the family's request.
B) Limit visitation between the patient and the family until a decision has been made.
C) Ask the family members if they can provide legal documentation of advance directives.
D) Contact the nursing supervisor providing information relative to the patient's status.
E) Inform the emergency room physician of the family's request and concern.

Answer 3

C, D, E

Question 4

A group of nurses are discussing the concept of substituted judgment. Which option would the nurse identify as best describing this type of legal decision?

A) Family members should be included in this decision.
B) The assistance of ethics committees is critical in providing this type of decision.
C) Use of subjective information to arrive at a judgment.
D) Family members express their beliefs for the incompetent patient in order to determine care based on prior interactions when the patient was competent.
E) The use of substitute judgment denies any right of appeal.

Question 5

A nurse is taking care of an incompetent patient who is admitted to a medical-surgical unit for treatment. Which notation on the medical record would the nurse identify as indicating the best form of substituted judgement?

A) Court order is present.
B) Durable power of attorney for health care (DPAHC).
C) Physician directive.
D) Common law power of attorney.

Question 6

A nurse works in a state where Physician Orders for Life-Sustaining Treatment (POLST) is enforced. How would the nurse explain POLST to a patient?

A) This process represents informed consent to be assumed for all medical procedures and treatments.
B) POLST is a scoring tool used to determine cardiac risk.
C) POLST provides communication relative to seriously ill patients' wishes concerning specified medical treatments.
D) It takes the place of a living will in emergency situations.

Question 7

A nurse is taking care of a terminally ill patient who is seeking to use new experimental medication. Which legal law would the nurse determine to be applicable to this patient request?

A) Natural Death Act
B) Right to Try Law
C) Advance directives
D) Common-law concept

Question 8

The nurse is reviewing the Patient Determination Act of 1990. What principles should the nurse understand as being the basis for this act?

A) State law is not changed relative to the enforcement of this act.
B) Economic costs should not play a role in healthcare decisions.
C) Educated patients will be better able to participate in the process leading to improved decision-making outcomes.
D) Providing written material to patients is sufficient to encourage self-determination.
E) Creation of new rights available to patients.

Question 9

A nurse is caring for a patient who wants to enact a living will after being admitted for a 23-hour observation post outpatient surgery for a benign tumor removal. It has been over 4 hours since the procedure which was done under local anesthesia. There is no significant medical history noted. Which action should the nurse take in order to assist the patient?

A) Sign the document for this competent patient.
B) Do not serve as a witness to this document.
C) Refuse to sign the document as the patient has received pain medication 15 minutes ago.
D) Contact the physician immediately.
E) Tell the patient that due to the effects of anesthesia, the patient should refrain from making any legal/ethical decisions.

Question 10

A nurse is working in a long-term care facility where the notation of "allow natural death" is noted on a patient's chart. What should the nurse include in the plan of care for this patient?

A) Playing music to help increase patient comfort.
B) Administer pain medication as needed to provide patient comfort.
C) Administering Epinephrine via parenteral route during code.
D) Chest compressions will be started if the patient stops breathing.
E) Maintain oxygen support via mask.

Question 11

A nurse walking down the medical unit hears a patient gasp and goes into the room to find that the patient is not breathing and unresponsive. The patient is not assigned to this nurse and there is no indication in the room regarding the patient's code status. What priority action should the nurse perform?

A) Look at the patient's armband to determine patient's age.
B) Reposition the patient in the bed and insert the backboard.
C) Ring the call bell and seek clarification on code status.
D) Activate a code by pressing the emergency button.

Question 12

The nurse is preparing an educational class to improve communication by members of the healthcare team who interact with patients who have health literacy issues concerning obtaining informed consent. What method would be most effective for the nurse to use so as to help enhance communication?

A) Refer the participants to an online website for review of available resources.
B) Update all patient information forms within the hospital to stated health literacy standards.
C) Encourage the use of drawings to deliver information.
D) Use shared decision making as the framework for communication.

Question 13

A nurse is working with a pregnant patient who has been referred to the clinic for genetic testing based on a family history of genetic illnesses. The patient states, "why should have the test done because I am not going to terminate the pregnancy." How should the nurse respond to this patient comment?

A) Whether or not to have the test is ultimately your decision, but having adequate knowledge to make that decision is important.
B) Provide information about the reliability of genetic testing.
C) Obtain an obstetrical history from the patient.
D) Inquire about patient's insurance status to determine if the patient has to pay out of pocket for testing.

Question 14

An individual is brought into the emergency room by law enforcement for observation and treatment and placed under arrest. Which nursing action would be appropriate related to the concept of informed consent?

A) The nurse obtains information related to patient allergies.
B) The nurse draws a blood sample to determine an alcohol level.
C) The nurse asks law enforcement officers to restrain the patient.
D) The nurse refuses to care for the patient.

Question 15

A group of nurses are discussing subject involvement in a clinical research trial. Which action would the nurses indicate as being required in order to be compliant with an Institutional Review Board (IRB)?

A) Informed consent is implied once the subject agrees to participate in a research study.
B) The nurse tells a subject involved in a clinical research trial that they cannot terminate the agreement.
C) Provide a listing of all subjects' names who are involved in the research study and circulate to hospital departments.
D) Contact information provided to subjects in case any problems arise.

Question 16

The patient self-reports that she is a female escort and the nurse documents this as her occupation in the medical record. The nurse has been sued for defamation after charting that the patient is a prostitute. What is the nurse's best defense in this case?

A) Define the contributing factors.
B) Provide hearsay evidence.
C) Prove that the statement is true.
D) No defense exists for defamation.

Question 17

A 4-year-old child developed a seizure disorder that may be related to a medication error that occurred 3 years ago. What is true of the statute of limitations in this case?

A) Depending upon the state, the statute of limitations might not begin to be calculated until the child reaches the age of majority.
B) Since the incident occurred over 2 years ago, the statute of limitations has expired.
C) There is no statute of limitations on medication errors that occur in children prior to the age of 2.
D) The statute of limitations in this case won't begin to be calculated until the child reaches the age of 13.

Question 18

A group of nurses are discussing concepts related to products liability. In which situations would the nurses identify that the manufacturer of a drug designated as unavoidably unsafe be held liable for injuries to a patient receiving the drug?

A) The information printed in the drug information sheet accompanying the medication was wrong.
B) The physician prescribed the medication after being told that problems with the drug had been corrected.
C) The physician did not educate the patient about the risks of the medication.
D) The nurse did not educate the patient about the risks of the drug.
E) The nurse was not warned of risks by the pharmacist.

Question 19

A group of nursing students are discussing legal/ethical concepts related to standards of care. In given situations, the nature and degree of reasonable care expected of people providing care may differ. Which factor would the nursing students identify that would cause a difference in the delivery of care?

A) The individual's understanding of the law
B) The individual's sense of ethical responsibility
C) The individual's sense of societal obligations
D) The individual's status as a professional

Question 20

A group of nursing students are discussing legal considerations related to standards of care. Which scenarios would the nursing students identify as reflecting the "two schools of thought" doctrine?

A) The nurse manager insists that standards are uniform and all nurses must act in the same manner.
B) The hospital policy and procedures manual lists both local and national nursing care quality standards.
C) The nurse expert witness in a case describes two methods of providing the intervention in question.
D) An honest error in judgment prevented a nurse from providing quality care.
E) Nurses on one unit vary in their choice of ways to deliver quality care.

Question 21

A group of nurses in an organization are discussing methods that can be used to improve patient outcomes. Which option would the nurses identify as providing best practice to advance patient outcomes?

A) Develop a monthly newsletter focusing on patient outcome information.
B) Perform chart checks on a routine basis.
C) Develop an ad hoc committee to review patient outcomes.
D) Have nurses participate as members in the hospital ethics committee.

Question 22

A nurse is reviewing the policy and procedure for application of restraints in a long-term care facility. Which statement would the nurse identify as being correct?

A) Chemical restraints are preferable to physical restraints.
B) Use of restraints increases the need to monitor the resident.
C) Restraints should be used for all residents at risk for falls.
D) They are expressly forbidden by federal laws.
E) The least restrictive restraint possible should be used.

Question 23

A group of nurses are reviewing the concept of quasi-intentional torts as applied to a long-term care facility. Which scenario would the nurses identify as being indicative of this legal consequence?

A) The resident is restrained to a chair in the day room to prevent wandering.
B) The nursing assistant slaps a resident's hand when the resident pinches another resident.
C) The local newspaper publishes pictures of residents enjoying a holiday presentation by children.
D) The nursing home provides a list of names and clothing sizes to a local group who wishes to purchase birthday gifts for residents.
E) A resident wanders away from the facility and is found 2 miles away.

Question 24

A nurse is considering that financial exploitation has occurred when interviewing a patient and his caregiver. Which observation by the nurse would indicate that financial exploitation has occurred?

A) The caregiver encourages the elder person who wishes to continue to work in the family business.
B) The caregiver has the patient sign power of attorney papers by saying they are required by the government.
C) The caregiver allows the patient to pay for incidentals necessary for care.
D) The caregiver takes the patient's Social Security check to the bank for deposit.

Question 25

A group of nurses are reviewing patient coverage relative to the Social Security Act of 1953. Which person would the nurse identify as being covered by this law?

A) A 16-year-old whose father died in a motor vehicle accident
B) A 30-year-old woman who has become blind secondary to diabetic retinopathy
C) A 70-year-old man who is retired from a job he held for 30 years
D) A 34-year-old person who files for unemployment after losing her job
E) A 45-year-old woman who suffered a myocardial infarction

Question 26

A group of nurses are discussing state legislation regulations regarding health maintenance organizations (HMOs) and delivery of patient care. Which statement would the nurses identify as being accurate?

A) States have allowed patients who receive substandard care to successfully bring suit against HMOs.
B) States have mandated how many HMOs will operate within the state.
C) States have mandated that all citizens be covered by HMOs if that is the desire of the citizen.
D) States have set the premiums that enrollees pay for HMO coverage.

Question 27

A group of nurses are discussing the use of restraints for patients in acute care settings. Which options reflect a general criterion that a nurse can use for restraining a patient?

A) The patient's threat to harm another patient
B) The patient's refusal to take psychotropic medications as prescribed
C) The patient's inability to care for himself or herself
D) The patient's verbally abusive but nonthreatening behavior toward others
E) The patient's immediate ability to harm self

Question 28

A nurse working in the acute care setting is preparing to use equipment while performing morning assessment of patients. Which option reflects the nurse's duty regarding use of equipment?

A) Nurses have no responsibility for use or maintenance of equipment.
B) The nurse is required to select the proper equipment and to use it correctly.
C) Nurses should modify equipment so that it meets the particular patient's requirements.
D) Nurses are responsible for cleaning and repairing equipment so that it can be used readily.

Question 29

A group of nurses are discussing fall prevention on the medical unit. Which option reflects the nurse's duty to prevent patient falls?

A) To assess the patient for risk for falls.
B) Perform continuous observation of patients.
C) Make sure that side rails on all beds are raised at all times.
D) Provide minimal assistance.

Question 30

A nurse has been assigned to take care of a patient who doesn't speak English. Which person would the nurse select to be the best choice as an interpreter for a non-English-speaking patient?

A) The patient's daughter who is bilingual
B) The patient's neighbor who is bilingual
C) A hospital housekeeper who is bilingual
D) A hospital-provided interpreter

Question 31

The news reports that a nurse "contracted over the telephone" to distribute narcotics. Would that action taken by a nurse considered to be a contract?

A) Yes, the contract agreement can be verbal or written.
B) No, contracts must fulfill a lawful purpose.
C) Yes, if something of value, like money, is offered as compensation.
D) Yes, if both parties understand the agreement.

Question 32

A nurse has been hired by a clinical facility and signed a contract. Which option indicates consideration with regard to the legal elements of the contract as it relates to the nurse?

A) The nurse agrees to work for specific wages.
B) The nurse agrees to work at an immunization clinic from October through December.
C) The assertion that the nurse is legally able to enter into a contract is implied.
D) A description of the type of work expected by the facility wishing to employ the nurse is provided.

Question 33

A group of nurses are discussing types of legal contracts in the clinical setting. Which nursing scenario indicates an implied contract has been initiated?

A) A nurse has made an oral agreement with the nurse manager to work an extra shift.
B) Signature of the nurse entered on the electronic medical record chart indicates a legal contract between the nurse and the patient.
C) A new nurse signs paperwork with Human Resources to start employment process.
D) Nurses write their names down on a document to indicate that they have attended a continuing education conference.
E) Nurses on the unit are focused on providing quality of care to all patients.

Question 34

A group of nurses are reviewing the purpose of the Americans with Disabilities Act. Which legal concept would the nurses indicate as supportive of the purpose of the act?

A) Autonomy
B) Fairness
C) Right to work
D) Equality

Question 35

A nurse has requested reasonable accommodation from the nurse manager based on needing more flexibility in her work schedule. The nurse's attendance record indicates several call ins during the prior month. The nurse is asking to be able to start shift work approximately two hours start of the shift. The nurse has previously asked for consideration based on a medical diagnosis of anxiety. How should the nurse manager respond?

A) Obtain medical documentation of the confirmed diagnosis and submit to Human Resources.
B) Ask the nurse for additional information relative to nurse's concern.
C) Compromise and allow the nurse to being shift work 30 minutes later.
D) Consider this to be a reasonable accommodation.
E) Transfer the nurse to a different unit.

Question 36

A group of nurses are discussing Title 1 provisions of the American Disabilities Act. Which scenario would the nurses identify as representing undue hardship for the hospital?

A) Paying for monthly cell phone use for all hospital employees so as to enhance communication network
B) Short staffing occurring in the hospital due to outbreak of influenza
C) Providing voluntary physical examinations for all employees as part of the employee health program
D) Hiring individuals of the same religion in a faith-based facility

Question 37

A nurse executive has requested that additional budgetary funds be allocated to support staff seeking a baccalaureate degree in nursing or specialty certification. Which information should this nurse executive provide during discussions of this funding?

A) "Education at the BSN level, when coupled with specialty certification, has been shown to reduce adverse patient outcomes."
B) "Research shows decreased morbidity and mortality of patients when nurses' educational status is beyond minimum licensure attainment."
C) "Practical experience alone is the basis for improved patient outcomes."
D) Higher failure-to-rescue rates
E) "If our nursing staff is educated at a higher level and are certified we will see fewer lawsuits for negligence and malpractice."

Question 38

A group of nursing students are discussing potential impact for malpractice/negligence litigation in their professional career. Which statement made by the nursing students indicates understanding of the importance of maintaining professional liability insurance?

A) Professional liability insurance should be provided to nurses by the facility as part of their work agreement.
B) Nurses who work in specialty areas are more likely to require professional liability insurance regardless of performance practice.
C) Securing liability insurance does not increase the potential for poor nursing judgment.
D) Liability insurance increases the likelihood for settlement of claims despite nursing performance.

Question 39

A group of nurses are reviewing the decision of legal action in which a patient brought suit against a hospital for injuries sustained in a fall. The case went to trial and the jury found for the hospital. Which legal precedent would the nurses select if the patient were to take this same suit and evidence to another trial court in hopes of a different decision?

A) Stare decisis
B) Res judicata
C) Doctrine of precedent
D) None needed as this is an example of a landmark decision.

Question 40

During a jury trial, the presence of a nurse-patient relationship is questioned. What kind of question is this and who would determine it?

A) Law to be determined by the jury
B) Fact to be determined by the jury
C) Fact to be determined by the judge
D) Law to be determined by the judge