Description
Legal and Ethical Issues in Nursing 5th Edition Guido Wacker Ginny Test Bank
- ASIN:B00BR5MVZE
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Guido
Chapter 8
Learning Objective 8.1 Define informed consent, comparing and contrasting it with consent.
- The nurse is preparing a patient for a procedure. The patient has signed a consent form, but states, “I don’t really know anything about this procedure. I wonder if there is something else I could do instead?” How should the nurse proceed?
- Continue with the preparation as consent may not be revoked.
- Have the patient document the question in writing since the original consent was written.
- Stop the preparation as the patient can revoke consent at any time.
- Try to convince the patient to go through with the procedure.
Answer: 3
Rationale: The patient always retains the right to verbally revoke consent at any time during the course of treatment. The nurse should not attempt to talk the patient into a procedure. The preparation should be stopped and the physician notified.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.2 Describe means of obtaining informed consent, including expressed, implied, oral, written, complete, and partial.
- The patient presents to the Emergency Department with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent protects these health care providers?
- Expressed
- Implied
- Oral
- Partial
Answer: 2
Rationale: Implied consent is consent that may be inferred the patient’s conduct or that may be legally presumed in emergency situations. Because this patient presented to the ED, consent is implied. Expressed consent is consent given direct words, written or oral. “Partial” is not a type of consent.
Nursing Process: Assessment
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.3 Compare and contrast standards of informed consent.
- As a result of shared medical decision making a patient undergoes a surgical procedure, which results in paralysis. What must the patient prove to bring a successful malpractice suit based on informed consent? Choose all answers that are correct.
- Since the decision making was shared no malpractice suit is possible.
- The procedure’s known risk of paralysis was not explained to the patient.
- It was the procedure that caused the harm.
- There is no way to assess the amount of damage to the patient.
- The patient had no part in the decision to operate.
Answer: 2, 3
Rationale: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the health care provider breached responsibility to know and disclose risks, that a reasonable person would not have taken the risk, that the undisclosed risk caused the harm, and that the plaintiff suffered injury for which damages can be assessed.
Nursing Process: Diagnosis
Client Need: Safe, effective care environment
Cognitive Level: Analysis
Learning Objective 8.4 Describe four exceptions to informed consent.
- Which circumstance may be an exception to obtaining informed consent?
- The physician feels the disclosure of information might cause the patient to commit suicide.
- The patient is deaf.
- The patient has signed a waiver at the suggestion of the primary nurse.
- The patient is physically unable to sign the consent form.
Answer: 2
Rationale: The courts recognize emergency situations, therapeutic privilege, patient waiver, and prior patient knowledge as four exceptions to the need for informed consent. Therapeutic privilege exists when the health care provider believes the disclosure of information poses immediate and serious harm to the patient. The patient must initiate a waiver; it cannot be suggested staff. The fact that the patient is deaf or is physically unable to sign the consent form does not remove the requirement to obtain consent.
Nursing Process: Evaluation
Client Need: Safe, effective care environment
Cognitive Level: Analysis
Learning Objective 8.5 Describe who has responsibility for obtaining informed consent.
- The patient scheduled for an above-the-knee amputation for a gangrenous toe received preoperative medication 20 minutes ago. When the transfer team arrives to take the patient to the operating suite, the nurse overhears the patient say, “I’ll be so glad to get rid of my sore toe. I was afraid they would have to take my whole foot.” What action should be taken the nurse?
- Continue the transfer, as the patient is not reliable since narcotics have been administered.
- Check to see if the patient signed consent for the above-the-knee amputation.
- Remind the patient that the surgery is to remove his lower leg, not just his toe.
- Stop the transfer and notify the surgeon of the patient’s comment.
Answer: 4
Rationale: The nurse should advocate for the patient stopping the transfer and contacting the surgeon. The other options are based upon the assumption that the patient understands the procedure, which may not be correct.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Analysis
Learning Objective 8.6 Describe types of consent forms in use in health care settings.
- The state now mandates a detailed consent for all hospitals receiving state funding. Which information should the committee designing this form include? Choose all that apply.
- Signature of the competent patient or a legal representative
- Name and full description of the proposed procedure
- Name of the person or persons to perform the procedure
- Date and time the procedure is scheduled
- Estimated cost of the procedure
- Description of risks and alternatives of the proposed procedure, including no treatment
Answer: 1, 2, 3, 6
Rationale: A detailed consent form should include: signature of the competent patient or a legal representative; name and full description of the proposed procedure; name of the person or persons to perform the procedure; description of risks and alternatives of the proposed procedure, including no treatment; description of probable consequences of the proposed procedure; and signatures of one or two witnesses according to state law.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.7 Analyze whose signature must be obtained to ensure informed consent.
- In which instance can a 13-year-old patient give consent for treatment?
- When the parents are not readily available
- If the child is consenting to treatment for a venereal disease
- If the child is consenting to treatment for an emergency surgery
- Under no circumstances can a 13-year-old give valid consent.
Answer: 2
Rationale: The law recognizes a minor’s right in some circumstances, including treatment for venereal diseases. An attempt to reach parents must be made even if they are not readily available. A 13-year-old cannot give consent for surgery even in an emergency.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
- In which instance is the performance of nonemergency medical treatment for a minor permissible without parental consent?
- The state has a family consent doctrine and a twin brother signs the form.
- The state has a family consent doctrine and an adult sister signs the form.
- The proposed treatment has only a minor risk of complication.
- The state has no family consent doctrine and the patients are out of state.
Answer: 2
Rationale: By definition of the family consent doctrine, the qualified people who can provide consent for a minor include a grandparent, adult brother or sister (not the same-age twin), or adult aunt or uncle. The risk of complications is irrelevant to the tenets of this doctrine.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.8 Describe one’s right to refuse consent for medical care.
- In which case might the state deny a patient’s right of refusal for medical treatment?
- A competent adult refuses a blood transfusion based on religious belief.
- The patient has an illness that poses a threat to public health if left untreated.
- The patient refuses treatment to slow the advancement of an inoperable brain tumor.
- The patient’s insurance refuses to pay if treatments are refused.
Answer: 2
Rationale: In most instances, the competent adult patient has right of refusal for treatment of any illness or condition unless that illness or condition is a threat to public health if left untreated. This is true even if the refusal could cost the patient’s life. Insurance reimbursement is not a factor in whether a patient has the right to refuse treatment.
Nursing Process: Assessment
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.9 Describe the patient’s right to either consent to or deny consent for research.
- A nursing faculty has included a requirement that students participate as research subjects as a part of their course grade. Does this requirement meet the guidelines for research participants’ rights?
- No, the individual must be given the choice to participate or not.
- Yes, if the participation is outlined as a course requirement in the syllabus.
- Yes, as long as there is no physical risk to the students.
- Probably, depending upon university regulations on course content.
Answer: 1
Rationale: The rights of a person involved in research include the right to refuse to participate without penalty. The university requirements and/or the syllabus cannot supersede these rights. These rights are in effect whether there is physical risk or not.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.10 Discuss the issue of health care literacy as it pertains to informed consent.
- Which patient(s) would the nurse consider to be at risk for not understanding informed consent information because of health illiteracy? Select all that apply.
- A 50-year-old who works in a manufacturing plant
- A 23-year-old who works at a fast-food restaurant
- A 35-year-old immigrant from China
- A 19-year-old high school graduate
- A 77-year-old who has long-standing diabetes mellitus
Answer: 1, 2, 3, 4, 5
Rationale: The nurse should consider all of these patients to be at risk for health illiteracy until proven otherwise. Many people who manage day-to-day life without difficulty and who read and write well are illiterate regarding health information and medical terminology.
Nursing Process: Assessment
Client Need: Safe, effective care environment
Cognitive Level: Analysis
Learning Objective 8.11 Discuss the various issues that arise with informed consent and genetic testing.
- The patient has tested positive for a gene associated with breast cancer. Can this patient be denied life insurance based upon this finding?
- No, the Genetic Information Nondiscrimination Act of 2008 prohibits this denial.
- Yes, unless she is currently serving in the military.
- Only if the life insurance is provided her employer
- Yes, there is currently no legislation prohibiting this denial.
Answer: 4
Rationale: The Genetic Information Nondiscrimination Act of 2008 prevents discrimination from health insurers and employers, but does not cover life insurance, disability insurance, and long-term care insurance policies. There is currently no legislation prohibiting this denial. The patient’s military service and whether life insurance is provided her employer are not factors in this case.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Application
Learning Objective 8.12 Describe advance directives, including living wills, natural death acts, and durable power of attorney for health care and do-not-resuscitate directives.
- What is assured once an adult patient executes a living will?
- The directions of the document will be followed, even if the patient makes a verbal request that directly contradicts the provisions of the document.
- The document is legally binding and all health care providers will abide its provisions.
- In order to revoke the document, the patient must sign a subsequent living will.
- The health care providers who abide the document cannot be charged with criminal negligence associated with the patient’s death.
Answer: 4
Rationale: The patient’s expressed wishes always take precedence over the document, and the patient can verbally revoke the living will. The living will allows for the provider to honor the wishes of the patient without the risk of criminal negligence. However, the presence of a living will does not always mean it will be followed all health care providers.
Nursing Process: Planning
Client Need: Safe, effective care environment
Cognitive Level: Analysis
Learning Objective 8.13 Discuss the purpose of the Physician Order for Life-Sustaining Treatment and its implementation.
- For which group was the Physician Order for Life-Sustaining Treatment (POLST) form first developed?
- Emergency medical service providers
- Emergency department physicians
- Insurance providers
- Critical care unit staff
Answer: 1
Rationale: The POLST documents were first developed to provide guidance to emergency medical service providers. They were not designed for ED physicians, insurance providers, or critical care unit staff.
Nursing Process: Assessment
Client Need: Safe, effective care environment
Cognitive Level: Comprehension
Learning Objective 8.14 Discuss legal issues surrounding assisted suicide.
- Which nurse action is appropriate according to the American Nurses Association’s stance on assisted suicide and active euthanasia?
- The nurse helps withdraw treatments that are life-saving.
- The nurse declines the patient’s request to help with the suicide plan.
- The nurse goes to the pharmacy and procures medication the patient intends to use to commit suicide.
- The nurse tells the patient that suicide is a sin.
Answer: 2
Rationale: The ANA opposes nurses’ participation either in assisted suicide or active euthanasia because they violate the ethical traditions embodied in the Code of Ethics for Nurses. The nurse should decline the patient’s request. Withdrawal of life-saving treatments can be construed as active euthanasia. The ANA is opposed to the nurse obtaining lethal doses of medication for the purpose of suicide or euthanasia. The nurse may procure and/or administer medication for pain control. The nurse should never pass judgment on the patient’s belief system.
Nursing Process: Implementation
Client Need: Safe, effective care environment
Cognitive Level: Analysis