Nursing Elites

1. What is a standard of care?

• A. A relationship in which a nurse has assumed responsibility for the care of a patient
• B. A policy or procedure established by a health care agency or professional association
• C. The norm for what a reasonable individual would do in a similar circumstance
• D. A public law that, if violated, can result in liability for the nurse

Correct answer: C

Rationale: A standard of care is the level of care that a reasonably prudent person with similar training and experience would provide in a similar circumstance. Choice A is incorrect because it describes the nurse-patient relationship. Choice B is incorrect as it refers to specific policies or procedures. Choice D is incorrect as it describes a law rather than the expected level of care.

2. How can the nurse best respond to this situation?

• A. The nurse should accept that the relationship plays a positive role for the man.
• B. The nurse should organize a family meeting that includes both the children and the man's partner in an effort to facilitate reconciliation.
• C. The nurse should document the children's concerns and investigate the truth of their claims.
• D. The nurse should ask the partner to demonstrate that she is not a negative influence on the resident.

Correct answer: A

Rationale: In this scenario, the nurse should respect the father's perspective and accept that the relationship with his common-law partner may indeed be positive and beneficial for him. The nurse's role is to support the patient's autonomy and decisions, especially when there are no legal concerns or signs of abuse. Organizing a family meeting (Choice B) might be premature without first acknowledging the father's viewpoint. Documenting concerns and investigating (Choice C) may create unnecessary conflict and breach the father's trust. Asking the partner to prove herself (Choice D) could strain the relationship further and is not within the nurse's role unless there are clear signs of harm or abuse.

3. A nurse is providing care for an older adult client who has been admitted to the hospital with liver cirrhosis. The client has expressed to the nurse his concerns that the details of his condition and treatment remain confidential, and that written documentation not 'get out there.' How can the nurse best respond to the client's concerns?

• A. Anything that is discussed between us is confidential and will not be shared with anyone else.
• B. The Health Insurance Portability and Accountability Act ensures that your medical records will not leave this hospital.
• C. Provided you signed a directive on admission, your records will not be made public.
• D. The law protects your right to confidentiality and protects your health information from being released into unintended hands.

Correct answer: D

Rationale: The correct answer is D. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects individuals' right to confidentiality and safeguards health information from being accessed by unauthorized individuals. Assuring the client that the law protects their right to confidentiality and prevents their health information from being released into unintended hands is the best response. Choice A is too broad and may not cover all aspects of confidentiality. Choice B only mentions medical records staying within the hospital, which does not address the client's concern about written documentation. Choice C incorrectly implies that a signed directive is needed for confidentiality, which is not true under HIPAA regulations.

4. To minimize liability, what action should nurses take when accepting telephone orders from physicians?

• A. Ask the physician to follow up with a faxed, written order
• B. Clearly communicate the most likely diagnosis to the physician
• C. Have another staff member talk with the physician and audiotape the conversation
• D. Accept only written orders or those communicated orally, in person

Correct answer: A

Rationale: The best action for nurses to take when accepting telephone orders from physicians to minimize liability is to ask the physician to follow up with a faxed, written order and ensure it is signed within 24 hours. This approach helps ensure clarity, accuracy, and documentation of the physician's orders, reducing the risk of misinterpretation or errors. Choices B, C, and D are incorrect. Communicating a diagnosis is outside the nurse's scope of practice and should be done by the physician. Involving another staff member to audiotape the conversation can introduce legal and practical issues. Accepting only written or orally communicated orders in person may not always be practical or feasible in urgent situations where telephone orders are necessary.

5. 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.

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