Nokea
Which of the following is required in order for a healthcare provider to be legally justified in not attempting to save a client's life?
- A. A 'Do Not Resuscitate' (DNR) statement on the patient's care plan
- B. A 'No-Code' sign or symbol placed at the patient's bedside
- C. A 'No-Code' order written and signed on the physician's order sheet
- D. The next of kin's request for 'Do Not Resuscitate' orally or in writing
Correct Answer: C
Rationale: To legally justify not attempting to save a client's life, a healthcare provider must have a 'No-Code' order written and signed on the physician's order sheet. Unless there is a specific order stating that resuscitation should not be performed, failure to do so can be considered negligence. A 'Do Not Resuscitate' statement on the care plan or a symbol at the bedside is not legally valid without the proper medical order. Additionally, a request from the next of kin, whether oral or written, is not a substitute for a signed physician's order.
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How does the doctrine of respondent superior affect nurses?
- A. Liable for injury resulting from advice given to a member of a patient's family
- B. Responsible for double-checking the doses of medication ordered by a physician
- C. Responsible for the actions of the staff they supervise
- D. Obligated to obtain informed consent for any diagnostic procedure
Correct Answer: C
Rationale: The correct answer is C. The doctrine of respondent superior holds that supervisors are accountable not only for their own actions but also for the actions of the staff they oversee. This means that nurses, as supervisors, are responsible for ensuring that the actions of their staff comply with established protocols and standards of care. Choices A, B, and D are incorrect because they do not directly relate to the principle of respondent superior. Nurses may have other responsibilities related to giving advice, medication administration, and obtaining consent, but the doctrine of respondent superior specifically pertains to the accountability of supervisors for the actions of their subordinates.
How does guardianship differ from power of attorney?
- A. The court appoints a guardian; an individual grants a power of attorney to someone else to make decisions on his or her behalf.
- B. Guardianship is legally binding whether or not an individual is competent; power of attorney applies only to the incompetent.
- C. Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of 'reasonable prudence' are met.
- D. Guardianship stays in effect for one calendar year and must be renewed annually; power of attorney stays in effect until one or both parties choose to revoke it.
Correct Answer: A
Rationale: The correct answer is A. The key difference between guardianship and power of attorney is that the court appoints a guardian to make decisions on behalf of an individual who is deemed incompetent, while an individual grants a power of attorney to someone else to make decisions on their behalf when they are competent. Choice B is incorrect because both guardianship and power of attorney can apply to individuals who are competent or incompetent. Choice C is incorrect as guardians, like those with power of attorney, must act in the best interest of the individual they represent, and the level of oversight can vary. Choice D is incorrect as guardianship and power of attorney do not have fixed time limits; they remain in effect until revoked or ended by the appropriate legal process.
An investigation into reports of substandard care on the subacute geriatric unit of a hospital has been undertaken. Which of the following events is representative of malpractice on the part of the nursing staff?
- A. A client with a documented history of seizures was left with his bed raised and with bedrails not in place, resulting in a fall and head injury
- B. A client was sent for a colonoscopy, after which it was learned that the client had never given written consent for the procedure
- C. A client with a diagnosis of vascular dementia was found wandering in the hall outside the unit
- D. An immobile client was not turned over the course of a night shift and developed a pressure ulcer on her coccyx
Correct Answer: A
Rationale: Answer A is correct as it includes all the components of malpractice: duty, negligence, and injury. The nursing staff failed in their duty by leaving a client with a documented history of seizures unattended with bedrails not in place, resulting in a fall and head injury. Answer B involves an issue related to consent, which is the responsibility of the physician, not the nursing staff. Answer C does not demonstrate negligence or harm caused by the nursing staff. Answer D also shows negligence by failing to turn an immobile client, leading to a pressure ulcer, but it lacks a direct connection to the duty of the nursing staff in preventing harm.
A nurse is reviewing the client population of a local community health center and identifying the health care needs of the group. The nurse decides to develop a screening program for hypertension. Which client population would the nurse most likely be working with?
- A. A seniors' group based at a Jewish community center.
- B. A Native American reservation/Canadian aboriginal reserve.
- C. A predominantly Chinese-American neighborhood.
- D. A minimum-security prison serving young, rehabilitating offenders.
Correct Answer: B
Rationale: Hypertension is disproportionately high among Native American/First Nations clients. This condition is not noted to be a major health problem among Jewish Americans, prisoners, or Americans of Chinese ancestry. Developing a screening program for hypertension in a Native American reservation/Canadian aboriginal reserve would be most appropriate based on the prevalence of the condition in this population.
Nurse M obtains a signature on an informed consent form from Mr. Y, who is later shown to have a fluctuating level of mental competency. In this case, what is Nurse M's most likely legal position?
- A. Freedom from liability because Mr. Y signed the form
- B. Possibly liable for a violation of Mr. Y's rights
- C. Liable unless a malpractice insurance policy is in effect
- D. Not liable because no family member had a durable power of attorney
Correct Answer: B
Rationale: An informed consent may be considered invalid if the patient does not fully understand what he or she is signing. Patients with a fluctuating level of mental function are incapable of granting legally sound consent. Nurse M could be held liable for a violation of Mr. Y's rights as he did not have the capacity to provide informed consent. The presence of an insurance policy and the legal status of family members are irrelevant in this context and do not absolve Nurse M of potential liability.