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.

Accepted Answer

The ANA Code of Ethics for Nurses states that a nurse's primary commitment is to the patient's well-being and life. Therefore, if a physician asks for assistance in ending one's life, a nurse should involve the physician in a discussion relative to expressed feelings. This will allow the nurse to understand the physician's perspective, as well as explore possible alternatives for managing feelings of hopelessness and despair. Referring the physician for psychiatric treatment or assuming the comment is a joke may be premature or inappropriate actions without first exploring the physician's perspective. Asking the physician how long he/she has felt this way may not be the most helpful in addressing the immediate concern.

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."

Accepted Answer

The statement "The primary focus should be on what the patient wants relative to medical treatment and care" shows a good understanding of the concept of patient self-determination as it relates to consenting to medical treatment. Patient self-determination involves the right to make decisions about their medical care based on their own beliefs, values, and preferences. The patient's wishes should be the primary consideration in obtaining informed consent. The other options either contain inaccurate information or do not directly relate to the concept of consent.

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.

Accepted Answer

The nurse should ask the family for any legal documentation of advance directives (C), contact the nursing supervisor to inform them of the situation (D), and inform the emergency room physician of the family's request and concerns (E). These steps ensure that the decision is made in accordance with legal and ethical guidelines.

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.

Accepted Answer

The answer of A group of nurses are discussing the...

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.

Accepted Answer

A durable power of attorney for health care (DPAHC) is a legal document that designates an individual to make healthcare decisions on behalf of an incompetent patient. This document allows for the best form of substituted judgement as the designated individual can make decisions based on the patient's wishes and values. A court order, physician directive, or common law power of attorney may also be present, but these may not necessarily reflect the patient's wishes and values.

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.

Accepted Answer

The correct explanation of POLST is that it provides communication relative to seriously ill patients' wishes concerning specified medical treatments. It is not about informed consent for all medical procedures and treatments or a scoring tool for cardiac risk. While it can be similar to a living will, it is not meant to take the place of one 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

Accepted Answer

The Right to Try Law allows terminally ill patients the opportunity to try experimental medication that has not yet been fully approved by the FDA. This law was created to provide patients with more options in treating their illnesses, especially when other treatments have failed. The nurse would need to understand this law and follow the proper procedures to ensure that the patient's request for experimental medication is addressed appropriately.

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.

Accepted Answer

The Patient Self-Determination Act of 1990 emphasizes the importance of informing patients about their rights to make decisions regarding their own healthcare, including the right to accept or refuse medical treatment. It does not change state laws regarding healthcare decisions but reinforces the importance of patient education and autonomy in healthcare decision-making.

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.

Accepted Answer

As a nurse, it is not appropriate to serve as a witness to a living will as it can be viewed as a conflict of interest. The patient should seek an independent witness who is not involved in their care.

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.

Accepted Answer

"Allow natural death" means that the patient will not be resuscitated in the event of cardiac or respiratory arrest. Therefore, choices C and D are not appropriate. The nurse should focus on providing comfort measures such as administering pain medication as needed (B) and maintaining oxygen support via mask (E). Playing music (A) may also be a comfort measure, but it is not essential to the plan of care for a patient with a do-not-resuscitate (DNR) order in place.

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.

Accepted Answer

The best choice is to activate a code by pressing the emergency button. The patient is unresponsive and not breathing, indicating an emergency situation. The nurse should not waste precious time trying to determine the patient's age or repositioning the patient. Seeking clarification on code status through the call bell would also waste precious time. The emergency button should be pressed to alert the entire medical team and initiate appropriate emergency interventions.

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.

Accepted Answer

Using shared decision making as the framework for communication would be the most effective method for improving communication with patients who have health literacy issues concerning obtaining informed consent. Shared decision making involves actively involving the patient in the decision-making process by providing them with information, exploring their values and preferences, and jointly making a decision that aligns with their needs and values. This approach can help improve patient understanding of the care being provided and improve their overall satisfaction with the healthcare experience. The other options are not as effective as they do not actively involve the patient in the communication process or provide a framework for improving 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.

Accepted Answer

The nurse should acknowledge the patient's autonomy in decision-making while emphasizing the importance of having adequate knowledge to make an informed decision about a potentially life-altering situation. The nurse can provide information about the benefits and limitations of genetic testing in order to help the patient make an informed decision.

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.

Accepted Answer

The nurse drawing a blood sample to determine an alcohol level is appropriate as it is a standard procedure that may be required for medical evaluation and legal purposes, and it does not require informed consent in emergency situations where the patient is under arrest.

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.

Accepted Answer

The requirement to provide contact information to subjects is a necessary component of informed consent and compliance with the IRB. Informed consent must be obtained before a subject participates in research, and they must be provided with contact information in case they experience any adverse effects or have any questions or concerns. Option A is incorrect because informed consent must be explicit and not implied, and Option B is incorrect because subjects always have the right to withdraw from a research study at any time. Option C is also incorrect because the privacy of research subjects must always be protected.

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.

Accepted Answer

The best defense for defamation is to prove that the statement made was true. In this case, if the nurse can provide evidence to support that the patient indeed self-reported as a female escort, then the statement would not be considered defamatory.

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.

Accepted Answer

Depending on the state, the statute of limitations in medical malpractice cases involving minors may not begin to run until the child reaches the age of majority (usually 18 years old). This is known as the "minority tolling rule." Therefore, even though the incident occurred over 2 years ago, the statute of limitations may not have expired yet.

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.

Accepted Answer

The answer of A group of nurses are discussing concepts...

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

Accepted Answer

The individual's status as a professional would cause a difference in the delivery of care, as professionals are held to a higher standard of care due to their education, training, and specialized knowledge. Their actions may be judged according to professional standards, whereas non-professionals may be judged according to common sense.

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.

Accepted Answer

The answer of A group of nursing students are discussing...

Quiz 1: Ethical Issues in Nursing

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?

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 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 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 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 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?

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

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?

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?

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 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) ?

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 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 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 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?