osborn ch04 tif step6 rev

8/11/2019 Osborn Ch04 Tif Step6 Rev

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[Osborn] chapter 4

Learning Objectives [Number and Title ]

Learning Objective 1 Explain how ethical theories and principles influence nursing practice in aclinical setting.

Learning Objective 2 Identify and apply the steps of the MO!L "odel in ethical decision"a#ing.

Learning Objective $ %o"pare and contrast the three distinct structures that ethics co""itteesde"onstrate in health care institutions.

Learning Objective & Explain how the state nurse practice act governs and guides nursing

practice.

Learning Outco"e ' (istinguish a"ong the types of laws that typically affect nursing practice)

co""on* civil* tort* contract* and cri"inal.

Learning Objective + Identify the six ele"ents of "alpractice law as described in the chapter.

Learning Objective , (iscuss the i"portance of standards of care and how they are

differentiated between internal and external standards.

Learning Objective - (istinguish between regional and national nor"s.Learning Objective Identify the three "ost co""on intentional torts and the three "ost

co""on /uasi0intentional torts seen in health care settings and explain thedefenses against the".

Learning Objective 1 Explain the doctrine of infor"ed consent as it relates to the use of i"pliedconsent in nursing settings.

Learning Objective 11 Explain actions that the nurse "ay ta#e to avoid or prevent possibleliabilities.

Osborn, et al., Test Item Filefor Medical-Surgical Nursing:

Preparation for Practice Copyright 2010 by Pearson Education, Inc.


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1. ! patient cries /uietly while undergoing a painful treat"ent. he nurse reali3es the treat"ent is

painful4 however* it is necessary for the patient5s healing and recovery. 6hich ethical principle does

this situation exe"plify7

1. 8on"aleficence

2. 9aternalis"$. :eracity

&. espect for others

%orrect !nswer) 8on"aleficence

ationale) Even though the principle of non"aleficence states that a person should do no har"* the

focus of the projected treat"ent or procedure is on the conse/uences of the benefits to the patient andnot on the har" that occurs at the ti"e of the intervention. 9aternalis" allows one to "a#e decisions

for another. :eracity is the concept that individuals should always tell the truth. espect for others

ac#nowledges the right of individuals to "a#e decisions and to live by those decisions.

%ognitive Level) !naly3ing

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2. he health care tea" is confronted with an ethical dile""a surrounding one patient and the types ofcare available. he tea" decides to apply ethical principles to deter"ine the best course of action for

this patient. his is an exa"ple of which type of ethical theory7

1. 9rinciplis"

2. (eontological

$. eleological&.


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$. ! patient as#s the nurse to pro"ise hi" that nothing bad will happen to hi" while he is under

anesthesia for a surgical procedure. he patient is creating a conflict in which of the following ethical

principles of the nurse7

1. ?idelity

2. espect for others$. 9aternalis"

&. :eracity

%orrect !nswer) ?idelity

ationale) ?idelity "eans #eeping one5s pro"ises or co""it"ents. he patient is putting the =nurse in

the "iddle> of a potentially conflicting situation. he nurse cannot pro"ise that nothing bad willhappen to the patient during anesthesia. espect for others ac#nowledges the right of individuals to

"a#e decisions and to live by these decisions. 9aternalis" allows one person to "a#e decisions for

another. :eracity is the concept that one should always tell the truth.


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&. ! health care provider is reviewing the steps ta#en to address an ethical issue with a patient. 6ithin

which of the following steps of the MO!L "odel is this health care provider wor#ing7

1. Loo# bac# and evaluate.

2. Massage the dile""a.

$. Outline the options.&. !ct by applying the selected option.

%orrect !nswer) Loo# bac# and evaluate.

ationale) he health care provider is loo#ing bac# and evaluating. his is the process of reviewing

and reexa"ining whether desired outco"es were attained and whether new options need to be

i"ple"ented. Massage the dile""a "eans that the issues are identified. Outline the options "eans theoptions are fully exa"ined* including those that are less realistic. !ct by applying the selected option

refers to i"ple"entation of the chosen option to resolve the dile""a.

%ognitive Level) !naly3ing8ursing 9rocess) I"ple"entation

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'. he health care tea" is "a#ing a list of the ways to resolve the issue of whether or not to continue

life support for a patient. he step of the MO!L "odel that the tea" is currently engaged in would

be)

1. Outline the options.

2. !pply the chosen option.$. esolve the dile""a.

&. Massage the dile""a.

%orrect !nswer) Outline the options.

ationale) he second step in the MO!L "odel is outline the options* where the "e"bers of the

health care tea" "a#e a list of all ways to resolve the ethical dile""a of continuing life support.!pplying the chosen option "eans the action chosen would be i"ple"ented. esolve the dile""a is

the third step in which ethical principles are applied to each of the identified options. Massage the

dile""a is the first step in the "odel and is where all of the issues are identified.



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7/34

+. he fa"ily of a ter"inally ill patient tells the nurse that a certain level of care is to be provided to

the patient. he health care staff is /uestioning the value of providing the care and believes so"ethingelse should be done. 6hich of the following should be done first for this situation7

1. Massage the dile""a.2. Outline the options.

$. esolve the dile""a.

&. !pply an option to resolve the dile""a.

%orrect !nswer) Massage the dile""a.

ationale) ! new health0care0related issue has surfaced. he fa"ily wants one course of action* andthe health care professionals want another. he ethical issue needs to be "assaged* identified* and

defined before the options can be outlined. he tea" is not prepared to resolve the dile""a or apply

any solutions until the actual dile""a is defined.



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8/34

,. ! patient is having a difficult ti"e deciding whether or not to accept an experi"ental treat"ent for a

health proble". he health care tea" is planning to discuss this patient5s issue at the next co""ittee

"eeting. he co""ittee structure that would support this patient5s dile""a is the)

1. !utono"y "odel.

2. 9atient benefit "odel.$. ;ocial justice "odel.

&. !ccountability "odel.

%orrect !nswer) !utono"y "odel.

ationale) he autono"y "odel supports ethical decision "a#ing for the co"petent patient. he

patient benefit "odel facilitates decision "a#ing for the inco"petent patient. he social justice "odelconsiders broad social issues that "ay arise within an organi3ation. he accountability "odel is not an

identified ethics co""ittee structure.

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-. ! patient* agreeing to receive care for a ter"inal illness* is experiencing the side effect of confusion

fro" the treat"ent. If the health care providers follow the patient benefit "odel of ethical care* which

of the following would be done7

1. (eter"ine if the patient would want to be confused and then either proceed or stop the

treat"ent.2. %ontinue with the treat"ent because the patient "ade the decision.

$. %ontinue the treat"ent because other patients "ight find out that the hospital does not

provide re/uired care.&. ?ind health care providers willing to provide the care even though the patient is confused.

%orrect !nswer) (eter"ine if the patient would want to be confused and then either proceed or stop

the treat"ent.

ationale) he patient benefit "odel uses substituted judg"ent* which ta#es into consideration what

the patient would want done if capable of "a#ing the decision. he staff should deter"ine if the

patient would want to be confused and then either proceed or stop the treat"ent. %ontinuing with thetreat"ent does not ta#e into consideration the patient5s change in "ental status and is a decision that

would be "ade if following the autono"y "odel. %ontinuing with the treat"ent because of otherpatients5 /uestioning the hospital5s ability to provide care would be an outco"e fro" i"ple"enting the

social justice "odel. ?inding health care providers willing to provide the care even though the patient

is confused is not an exa"ple of an ethics co""ittee decision.

%ognitive Level) !pplying

8ursing 9rocess) I"ple"entation

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. 6hile providing care to a patient* an ethical issue is discovered. he nurse* recalling a si"ilar

situation fro" attending ethical grand rounds* provides an intervention that resolves the dile""a

without further action re/uired. 6hich of the following types of ethical co""ittee structure helped thenurse and patient resolve the ethical dile""a7

1. ;ocial justice "odel2. @lend of autono"y and patient benefit "odels

$. !utono"y "odel

&. 9atient benefit "odel

%orrect !nswer) ;ocial justice "odel

ationale) he social justice "odel considers broad social issues* and "any ethics co""ittees holdethical grand rounds based on this structure. In ethical grand rounds* broad issues are reviewed and

discussed* which helps nurses "a#e /uic# and co"petent decisions about the sa"e issue in the future.

here is no evidence to suggest that the patient was incapable of "a#ing a decision* which the patient

benefit "odel would support. he autono"y "odel facilitates decision "a#ing for a co"petentpatient4 however* in this situation* the nurse used infor"ation gained fro" an ethical grand rounds

progra".



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1. he nurse received an update fro" the state board of nursing about a new continuing education

re/uire"ent. 6hich of the following should the nurse do with this infor"ation7

1. 9lan to learn "ore about the re/uire"ent to be in co"pliance.

2. 8othing. It is only fro" the board of nursing.

$. %ontact the !"erican 8urses !ssociation about the re/uire"ent.&. !s# a health care provider if the re/uire"ent is necessary to nursing practice.

%orrect !nswer) 9lan to learn "ore about the re/uire"ent to be in co"pliance.

ationale) he state board of nursing is an exa"ple of an ad"inistrative law agency. !d"inistrative

laws are enacted through the decisions and rules of ad"inistrative agencies* which are specific

governing bodies charged with i"ple"enting selected legislation. he nurse practice act is an exa"pleof statutory law. ;tatutory laws are those rules and regulations enacted by the legislative branch of the

govern"ent. 6hen statutory laws are enacted* ad"inistrative agencies are given the authority to

i"ple"ent the specific intentions of the statutes* creating rules and regulations that enforce the

statutory law. he nurse needs to plan to learn "ore about the re/uire"ent. he nurse should notignore the notice. he nurse does not need to contact the !"erican 8urses !ssociation or as# a health

care provider if the re/uire"ent is necessary.


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11. ! nurse is found to have a che"ical0dependency issue. his infor"ation is to be co""unicated to

the)

1. ;tate board of nursing.

2. !"erican 8urses !ssociation.$. 9olice.

&. ;chool of nursing fro" which the nurse graduated.

%orrect !nswer) ;tate board of nursing.

ationale) he state board of nursing should be notified because the act "ay also include infor"ation

on how to help nurses affected by addictions. he !"erican 8urses !ssociation is not going toprovide help for nurses with addictions. he police should not be notified unless the nurse participated

in so"e illegal activity. he school of nursing fro" which the nurse graduated does not need to be

infor"ed of the nurse5s che"ical0dependency issue.

%ognitive Level) !pplying


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12. ! patient says that he doesn5t want the nurse to re"ove the 9I%% line fro" his ar" because the lastti"e he had one* the doctor told hi" that it was so"ething that only a doctor can do. 6hich of the

following would be the "ost appropriate response to this patient7

1. =he nurse practice act for this state includes this s#ill as a nursing activity and I have been

trained on the correct way to re"ove it.>

2. =I will get the doctor.>$. =!re you refusing to have the 9I%% line re"oved7>

&. =I can tal# you through re"oving it yourself.>

%orrect !nswer) =he nurse practice act for this state includes this s#ill as a nursing activity and I havebeen trained on the correct way to re"ove it.>

ationale) he nurse has had an expansion of her role and has been trained on the activity. he correct

response is to explain that the activity is covered within the nurse practice act and the nurse has beenfound co"petent to perfor" the activity. It is not necessary for the nurse to get the doctor* nor should

the nurse confront the patient by assu"ing the patient refuses to have the line re"oved. al#ing thepatient through the procedure to re"ove the line hi"self is not a viable safe option.

%ognitive Level) !pplying8ursing 9rocess) I"ple"entation

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1$. ! patient is telling the nurse "anager that she believes a wrongful act occurred when she was

given the wrong "edication. he law to address this issue would be considered)

1. ort.

2. %o""on.

$. %ivil.&. %ri"inal.

%orrect !nswer) ort.

ationale) ! tort is a wrongful act co""itted against another person or the person5s property. hese

wrongful acts result in an injury or har"* thereby constituting the basis for a clai" by the injured

party. !lthough so"e torts are cri"es punishable by i"prison"ent* the pri"ary ai" of tort lawis toprovide relief for the da"ages incurred and to deter others fro" co""itting the sa"e har"s. he

injured person "ay sue for an injunction to prevent the continuation of the tortuous conduct or for

"onetary da"ages. %o""on law is derived fro" principles rather than rules and regulations.

%o""on law is based on justice* reason* and co""on sense. It represents law "ade by judges throughdecisions in specific cases. %ivil law begins with abstract rules* which judges "ust then apply to cases.

%ri"inal law is public law that involves the prosecution by the govern"ent of a person for an act thathas been classified as a cri"e.

%ognitive Level) !naly3ing8ursing 9rocess) !ssess"ent


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14. ! patient5s personal health infor"ation was provided to another individual without the patient5s

per"ission. he nurse reali3es this breach of infor"ation would be addressed by which of the

following types of laws7

1. ort

2. %ivil$. %o""on

&. %ontract

%orrect !nswer) ort

ationale) ! tort is a wrongful act co""itted against another person or the person5s property. !n

exa"ple of a tort action is a breach of confidentiality. %ivil law is defined as laws "ade fro" abstractrules and applied to situations. %o""on law is a syste" of law derived fro" the decisions of judges.

%ontract law addresses the issues about agree"ents "ade between two parties.


%lient 8eed) ;afe* Effective %are Environ"entLO) '




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1'. ! patient tells the nurse that he had "oney in the top drawer of his bedside table that is now

"issing. Ae is phoning his attorney and plans to press charges. he nurse reali3es this patient is

planning to i"ple"ent which of the following types of law7

1. %ri"inal

2. ort$. %o""on

&. %ontract

%orrect !nswer) %ri"inal

ationale) %ri"inal law involves the prosecution by the govern"ent of a person for an act that has

been classified as a cri"e. he patient is clai"ing that "oney was stolen* which is a cri"e. ! tort is awrongful act co""itted against another person or the person5s property. he pri"ary ai" of tort law is

to provide relief for da"ages. %o""on law is a syste" of law that is derived fro" judges5 decisions.

%ontract law is a way to govern a pro"ise or agree"ent that has been "ade between two parties.



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1+. ! patient leaves the hospital without receiving his "edication prescriptions and discharge

instructions* which causes the patient to sustain physical har". he hospital should be concerned about

which of the following ele"ents of "alpractice7

1. Injury

2. (uty$. @reach of duty

&. %ausation

%orrect !nswer) Injury

ationale) Injury "eans that actual har" results to the patient. !n exa"ple of this would be failing to

provide patient education and discharge planning. (uty "eans care is provided according to what aprudent nurse would have done. @reach of duty is not giving the care that should be given to a patient.

%ausation "eans the patient was har"ed because proper care was not given.

%ognitive Level) !naly3ing8ursing 9rocess) 9lanning

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18/34

1,. ! patient with an elevated blood glucose level was given 1 units of regular insulin when the

order was written for the patient to receive 1. units of regular insulin. he patient5s blood glucose

level dropped to & "gBdl* re/uiring additional "edical intervention to stabili3e. he inappropriatea"ount of insulin this patient received would be considered as which ele"ent of "alpractice7

1. %ausation2. @reach of duty

$. ?oreseeability of har"

&. (uty

%orrect !nswer) %ausation

ationale) %ausation "eans that a direct relationship exists between the failure to "eet the standard ofcare and an injury. he patient is har"ed because proper care is not given. In this situation* the patient

received 1 ti"es the prescribed a"ount of insulin* which dropped the blood glucose level down to &

"gBdl* a dangerously low level. he patient then needed additional "edical intervention to stabili3e.

(uty owed the patient is care that any prudent nurse would have done. he nature of the dutyrepresents the "ini"u" re/uire"ents that define acceptable or standard care. @reach of duty would be

not giving the care that should be given under the circu"stances. ?oreseeability of har" "eans thenurse needed to have access to infor"ation about whether the possibility of har" exists.



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19/34

1-. ! patient has proven that a hospital e"ployee was negligent when providing care. he nurse

reali3es that the outco"e of this decision would result in which of the following7

1. (a"ages

2. Injury

$. %ausation&. ?oreseeability of har"

%orrect !nswer) (a"ages

ationale) (a"ages is the final step in the ele"ents of "alpractice. he patient "ust prove that

financial har" occurred while hospitali3ed. Injury is the fifth ele"ent of "alpractice and "eans that

physical injury occurred and not psychological or transient injury. %ausation is the fourth ele"ent of"alpractice and "eans that an action or lac# of action directly caused har". ?oreseeability of har" is

the third ele"ent of "alpractice and "eans that certain events "ay reasonably be expected to cause

specific results.


8ursing 9rocess) Evaluation%lient 8eed) ;afe* Effective %are Environ"ent

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20/34

1. he parents of a stillborn baby are suing the hospital for "alpractice. 6hich of the following

standards would "ost li#ely be consulted for this case7

1. 8eonatal 8ursing) ;cope and ;tandards of 9ractice

2. Ao"e Aealth 8ursing) ;cope and ;tandards of 9ractice

$. 9ublic Aealth 8ursing) ;cope and ;tandards of 9ractice&. ;cope and ;tandards of 9ractice for 8ursing 9rofessional (evelop"ent

%orrect !nswer) 8eonatal 8ursing) ;cope and ;tandards of 9ractice

ationale) ;everal sources can be used to deter"ine the applicable standard of care. he !"erican

8urses !ssociation* as well as a cadre of specialty organi3ations* publishes standards for nursing

practice. he overall fra"ewor# of these external standards is the nursing process. !dditionalstandards have been published that describe nursing care for a variety of patient populations and in

selected nursing settings. ;ince this situation is about a baby* the standards about ho"e health* public

health* and professional nursing develop"ent would not apply.



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2. he nurse is not sure which approach to ta#e when providing one aspect of care to a patient. 6hich

of the following should the nurse do7

1. %hec# the organi3ation5s procedure "anual to find out the standard of practice for the care.

2. ;earch for a "aga3ine article that discusses the aspect of care.$. !s the health care provider what should be done about the care.

&. (ocu"ent that the patient refused the one aspect of care.

%orrect !nswer) %hec# the organi3ation5s procedure "anual to find out the standard of practice for the

care.

ationale) ;tandards of care are established by reviewing the organi3ation5s policy and procedure"anual. ;earching for a "aga3ine article about the aspect of care "ight be done but it "ay not

coincide with the organi3ation5s policy and procedure "anual. he nurse should not as# the health care

provider what should be done about the care. he nurse should not falsely docu"ent that the patient

refused one aspect of care.



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21. he nurse is considering "oving into the role of providing care to ter"inally ill patients. 6hich of

the following scope and standards of practice would the nurse review to learn the "ost infor"ation

about the care provided to these types of patients7

1. Aospice and 9alliative 8ursing

2. 9ain Manage"ent 8ursing$. adiology 8ursing

&. Ao"e Aealth 8ursing

%orrect !nswer) Aospice and 9alliative 8ursing

ationale) he !"erican 8urses !ssociation has published "any different types of scopes and

standards for nursing practice. he one that would be the "ost applicable to the care of a ter"inally illpatient would the standards to address Aospice and 9alliative 8ursing. 9ain Manage"ent "ight

provide infor"ation as well as Ao"e Aealth 8ursing. adiology 8ursing is the one that would

provide the least a"ount of infor"ation.


8ursing 9rocess) 9lanning%lient 8eed) ;afe* Effective %are Environ"ent

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23/34

22. ! patient co"es into a s"all co""unity hospital e"ergency depart"ent with a severely lacerated

hand. !fter appropriate treat"ent* the patient receives nursing care based upon docu"ented standards

of care so that the hand will function well with "ini"al scarring. his standard of practice would beconsidered aCnD)

1. 8ational nor".2. Internal standard.

$. External standard.

&. egional nor".

%orrect !nswer) 8ational nor"

ationale) 8ational standards of careare based on reasonableness and are the average degree of s#ill*care* and diligence exercised by "e"bers of the sa"e profession. ;uch national standards "ean that

nurses in all settings* urban and rural* "ust "eet the sa"e standards when caring for patients in

clinical settings. 8ational standards of care have slowly replaced the previously used regional or

locality standard of care* which allowed the standard of care to be viewed fro" the perspective of carewithin a given geographical area or =si"ilar co""unity.> he only way of #nowing if this practice is

an internal standard would be to review the co""unity hospital5s policy and procedure "anual. heonly way of #nowing if this practice is an external standard would be to review published "aterials

regarding the care of the patient with a severely lacerated hand.


8ursing 9rocess) Evaluation


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24/34

2$. ! patient as#s the nurse why bottled water is being used to flush her wound when she was told to

use tap water at ho"e. he nurse reali3es this patient is describing which of the following7

1. ! regional standard of care

2. ! national standard of care

$. !n infection control "easure&. ! cost contain"ent "easure

%orrect !nswer) ! regional standard of care

ationale) egional standards of care are those standards viewed fro" a given geographical area or

si"ilar co""unity. he patient using tap water to flush a wound was "ost li#ely a regional standard

of care. ! national standard is that which is done by nurses in all settings.


25/34

2&. he nursing staff fro" a co""unity hospital is attending a conference to learn how to use a closed

chest tube collection device instead of the previously used glass bottle with ' cc of sterile water. he

nurse reali3es this conference ensures that all nurses will practice chest tube care according to)

1. 8ational standards of care.

2. he oint %o""ission provision of care accreditation standards.$. %ost0effective "ethods.

&. 8ational 9atient ;afety goals.

%orrect !nswer) 8ational standards of care.

ational) 8ational standards of care are based on reasonableness and are the average degree of s#ill*

care* and diligence exercised by "e"bers of the sa"e profession. Educational progra"s "a#e it easierfor all individuals of a profession to learn the standards so that all patients receive the highest /uality

of care* regardless of location. he oint %o""ission5s provisions of care standards and the 8ational

9atient ;afety goals do not specifically address chest tube care. he closed chest tube collection device

"ay or "ay not be a cost0effective "ethod.

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2'. ! patient clai"s that fa"ily "e"bers had access to his "edical record and believes that he has had

a breach of confidentiality. his breach would be considered a part of)

1. Invasion of privacy

2. !ssault

$. @attery&. (efa"ation of character

%orrect !nswer) Invasion of privacy

ationale) !n exa"ple of a breach of confidentiality is the invasion of privacy that is considered a

/uasi0intentional tort. !ssault and battery are exa"ples of intentional torts. (efa"ation of character is

a /uasi0intentional tort with the intention of har"ing another person5s reputation.


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27/34

2+. he nurse who tells the patient that she is discharged but not allowed to leave the hospital yet and

ta#es the patient5s purse is at ris# for which of the following intentional torts7

1. ?alse i"prison"ent

2. (efa"ation of character

$. Invasion of privacy&. @reach of confidentiality

%orrect !nswer) ?alse i"prison"ent

ationale) ?alse i"prison"ent is the unjustified detention of a person without the legal right to confine

the person and "ay occur if the act is directed at the patient5s possessions such as a purse. (efa"ation

of character is har"ing another5s reputation by di"inishing the estee"* respect* or goodwill that othershave for that person. Invasion of privacy is a violation of a person5s right to protection against

unwarranted interference into their personal life. @reach of confidentiality is a type of invasion of

privacy that has to do with infor"ation within the patient5s "edical record.



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2,. ! patient* who is a local elected public official* is ad"itted with a che"ical dependency. he nurse

tells a visitor that the patient is a cocaine user. 6hich of the following has the nurse done7

1. Invaded the patient5s privacy

2. @reached the patient5s confidentiality

$. !ssaulted the patient&. 9rovided battery to the patient

%orrect !nswer) Invaded the patient5s privacy

ationale) Invasion of privacy is a violation of a person5s right to protection against unreasonable and

unwarranted interference with his personal life. !n exa"ple of this is disclosure of "edical facts to

persons not entitled to those facts. @reaching the patient5s confidentiality would be providinginfor"ation that is included in the patient5s "edical record. !ssault "eans the patient was touched in

an offensive* insulting* or physically injurious "anner. @attery is the actual contact with another

person or the person5s property.



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29/34

2-. ! patient consents to having a cardiac catheteri3ation and willingly per"its the nurse to draw blood

and "easure vital signs before the procedure. he patient5s per"itting the actions of the nurse would

be considered as which of the following7

1. I"plied consent

2. Infor"ed consent$. E"ergency doctrine

&. !cceptance

%orrect !nswer) I"plied consent

ationale) I"plied consentis consent that "ay be inferred by the patient5s conduct or that "ay legally

be presu"ed in e"ergency situations. Many patients hold out their ar" and roll up their sleeve whenthe nurse approaches with a stethoscope and blood pressure cuff. his is an exa"ple of i"plied

consent because a reasonable person would infer by the patient5s action that the patient is consenting

to the procedure. Infor"ed consent "eans the patient received infor"ation needed to "a#e a

#nowledgeable decision about a "edical procedure or treat"ent4 there is no infor"ation in thescenario about the patient5s receiving the infor"ation. E"ergency doctrine is when consent for

treat"ent is i"plied and delaying care would result in the loss of life or li"b. !cceptance is not aconcept of consent.



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2. ! patient is in the operating roo" holding area and tells the nurse that he changed his "ind and

does not want the procedure. 6hich of the following should the nurse do7

1. %ontact the surgeon and i"ple"ent steps to cancel the procedure.

2. Explain to the patient that he has already "ade his decision and cannot change his "ind.

$. !s# the surgeon to explain to the patient why he needs the surgery.&. (ocu"ent that the preoperative anesthesia has "ade the patient confused.

%orrect !nswer) %ontact the surgeon and i"ple"ent steps to cancel the procedure.

ationale) Infor"ed consent includes the patient having the right to refuse treat"ent even after the

procedure or therapy has started. he nurse should contact the surgeon and i"ple"ent steps to cancel

the procedure. he nurse should not tell the patient that he cannot change his "ind* nor should thesurgeon be called to persuade the patient to continue with the procedure. he nurse should not falsely

docu"ent that the preoperative anesthesia has "ade the patient confused.






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$. ! patient /uestions why his leg is being shaved if he is scheduled to have open0heart surgery.

6hich of the following should the nurse do in this situation7

1. %ontact the health care provider because the patient is not co"pletely infor"ed about the

procedure.

2. Explain that the leg veins will be used for the surgery.$. ell the patient that the doctor wrote an order to shave his leg.

&. (ocu"ent that the patient refused to have his leg prepped prior to surgery.

%orrect !nswer) %ontact the health care provider because the patient is not co"pletely infor"ed about

the procedure.

ationale) he nurse has the responsibility to contact the health care provider because it was obviousthat the patient does not understand everything about the open0heart surgery procedure. he nurse

should not supple"ent infor"ation provided* nor should the nurse state that the health care provider

wrote the order to have the leg shaved. he nurse should also not docu"ent that the patient refused to

have his leg prepped prior to surgery* but should contact the surgeon to provide additional infor"ationso the patient can provide infor"ed consent.


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$1. he nurse is providing care to a patient who has a history of suing health care providers. 6hich of

the following can the nurse do to reduce the ris# of a lawsuit7

1. Establish co""unication and trust.

2. ;pend as little a"ount of ti"e with the patient as possible.

$. (elegate care activities to an unlicensed assistant.&. ;witch the assign"ent with another nurse.

%orrect !nswer) Establish co""unication and trust.

ationale) One of the "ost funda"ental aspects of "alpractice law involves relationships. ?or a duty

to be owed the patient* one "ust first establish that a nurseFpatient relationship exists. his "ay be

acco"plished by showing that a reliance relationship exists) One person Cthe patientD is depending onanother person Cthe nurseD for co"petent* /uality nursing care. he core of any reliance relationship is

trust and co""unication. Establishing rapport with a patient* infor"ing patients honestly and openly

of all aspects of their care* and allowing patients to "a#e decisions for the"selves have always been

credited to nurses as one "eans of preventing potential liability. 8ursing is a caring profession4 part ofcaring is "aintaining co""unications and ensuring that trust is established and continues throughout

the interactions between the nurse and the patient. he nurse should not reduce the a"ount of ti"espent with the patient nor delegate activities to an unlicensed assistant. he nurse should also not

switch the assign"ent with another nurse.


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$2. ! patient tells the nurse that she does not want to ta#e a particular "edication but does not want to

tell the doctor because =he will be angry with "e.> 6hich of the following should the nurse do to help

this patient7

1. Encourage the patient to spea# to the health care provider on her own behalf.

2. ell the patient that the doctor does not need to #now.$. Offer to give the infor"ation to the doctor.

&. ell the patient that if she does not ta#e the "edication* she "ight have "ore troubles in the

future.

%orrect !nswer) Encourage the patient to spea# to the health care provider on her own behalf.

ationale) Encouraging the patient to spea# to the health care provider on her own behalf is anexa"ple of the values0based decision "odel of advocacy. he nurse should not encourage the

withholding of the infor"ation fro" the health care provider. he nurse should not offer to tell the

health care provider for the patient. he nurse should also not threaten the patient by saying if she does

not ta#e the "edication she "ight have "ore troubles in the future.



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$$. ! patient who fell when being transferred fro" the bed to a chair tells the nurse that he does notplan to contact an attorney because the nurse told hi" to do the transfer one way and he insisted on

doing it another and reali3es that it was his fault that he fell. his is an exa"ple of which of the

following7

1. rust and co""unication between the nurse and patient

2. 9reventative co""unication$. I"plied consent

&. Infor"ed consent

%orrect !nswer) rust and co""unication between the nurse and patient

ationale) he core of any reliance relationship is trust and co""unication. Establishing rapport with

a patient* infor"ing patients honestly and openly of all aspects of their care* and allowing patients to

"a#e decisions for the"selves is one way to prevent potential liability. here is no such concept aspreventative co""unication. I"plied consent "eans a patient per"its an action based upon the

patient5s conduct or behavior. Infor"ed consent "eans a patient has been provided with all necessaryinfor"ation so as to "a#e a decision about a plan of treat"ent or care.



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Osborn, et al., Test Item File for Medical-Surgical Nursing:

osborn ch04 tif step6 rev

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