Which ethical principle will the nurse understand is vital to building a trusting relationship with clients quizlet?

1,2,4

Nurses need to maintain privacy and confidentiality when caring for clients. Health care workers (HCWs) need to use the minimum necessary standard (reasonable precautions) to protect a client's health information.

Confidentiality is violated when information about a client's personal health (eg, diagnosis, test results) is accessed by or given to those without permission or without a "need to know." For example, a transport technician may require pertinent client information (eg, fragility) to transport a client safely but never needs to know the client's exact diagnosis (Option 2). Other violations include when HCWs access medical records of clients not currently assigned or discuss client diagnoses with nonessential personnel (Options 1 and 4).

Certain incidental disclosures are allowed if reasonable precautions are taken. Common precautions include:

Allowing medical record access to a HCW only when necessary to perform job duties
Employing room dividers/curtains in semiprivate spaces (Option 3)
Avoiding discussions about clients and their conditions in public areas
Listing only last names on whiteboards at nurses' stations (Option 5)
Placing communication whiteboards where they are least visible to the public
Communicating with lowered voices in semiprivate spaces (eg, nurses' stations, client rooms)
Educational objective:
Only health care personnel requiring client health information to carry out their job duties should have access to or be advised of this information. Nurses, health care providers, and hospitals should take reasonable precautions at all times to safeguard client information.

1,3,5
Assault is an act that threatens the client and causes the client to fear harm, but without the client being touched (Option 1).

False imprisonment is the confinement of a client against the client's will or without legal justification (eg, client is not a threat to self or others) (Option 3).

Invasion of privacy includes disclosing medical information to others without client consent. Under the Health Insurance Portability and Accountability Act (HIPAA), a client's information regarding medical treatment is private and cannot be released without the client's permission (Option 5).

(Option 2) Battery involves making physical contact with the client without permission. This includes harmful acts or acts that the client refuses (eg, performing a procedure). When interacting with the client, it is important to practice veracity, the ethical principle of being truthful.

(Option 4) An emancipated minor is an individual under the age of legal responsibility who has been legally freed from parental control through a court order (eg, due to enlistment in the military, marriage, pregnancy). The parent in this situation would not need to be called. Clients have the right to be informed of risks and benefits of procedures prior to care and to give informed consent.

Educational objective:
Clients have the right to privacy and to give informed consent prior to medical care. Assault is an act that threatens the client, causing the client to fear harm without the client being touched. Battery is physical contact against a client's will or without legal justification. False imprisonment includes restraining a competent client without the client's permission.

3

In discussing the reporting aspect of suspected child abuse with a caregiver, the nurse needs to convey an attitude that is not judgmental, punitive, or threatening. Whether or not the parent has actually harmed or abused the child, the parent needs to know that a report will be made, why it is being filed, and an investigation will be conducted by a CPS worker and/or by the police. The nurse should emphasize that the primary concerns are for the safety and well-being of the child and that reporting is mandatory for the types of injuries sustained by the child.

It is not unusual for a parent to react to this information with denial and/or anger. The nurse needs to anticipate that such a reaction may occur and maintain a supportive, empathetic, and nonaccusatory approach.

(Option 1) This response also diverts the need for the nurse to provide a response or explanation to the parent. The child's caregiver should be told why the report is being filed.

(Option 2) This response is nontherapeutic. It diverts the need for the nurse to respond to the parent's question, and it does not provide information or education.

(Option 4) This response is confrontational and could give the parent the impression that the nurse and health care team do not believe the story of how the child sustained the injuries. The parent could react with a heightened sense of anger.

Educational objective:
When discussing suspected child abuse with a caregiver, the nurse needs to be supportive and empathetic and maintain a neutral, nonpunitive and nonaccusatory manner. The parent needs to be told that the safety and well-being of the child are the primary concerns and that certain types of injuries and/or situations must be reported to the appropriate CPS agencies.

2

Advance directives are legal documents that allow clients to make decisions about their future medical treatment in case the client later becomes medically incompetent (eg, end of life, dementia, brain injury). The most common forms are living will and medical power of attorney (POA) (ie, health care surrogate/proxy). A living will declares the client's wishes related to specific situations (eg, do not intubate). A medical POA allows the client to designate a specific decision-making individual who can advocate for the client as needed and can be flexible in changing circumstances (Option 2).

(Option 1) A client's spouse is typically the primary decision maker. However, clients have the right to declare any specific individual who they trust as their agent with medical POA, and the agent becomes the final decision maker.

(Option 3) The client should receive treatment immediately if there are no advance directives or family members present, but in this case, the agent authorized with medical POA is present and should approve the treatment plan before interventions are initiated.

(Option 4) If the client's medical POA agent is present, treatment should not be delayed by requesting a living will as the agent will advocate for the client's wishes and has final decision-making authority.

Educational objective:
Medical power of attorney (POA) is an advance directive that allows clients to designate a specific decision-making individual who advocates on their behalf if they become medically incompetent. Clients have the right to declare any individual they trust as their agent with medical POA, and that individual becomes the final decision maker.

1
Infants do not start rolling until age 4 months and normally roll front to back at 5 months. This explanation for the injury does not fit the growth capacity of the child. Because lethargy is present, head injury must be ruled out.

(Option 2) Congenital dermal melanocytosis (Mongolian spots) are an expected finding. These are seen on the lower back and/or buttock more often in African American, Asian, Hispanic, and Native American infants. Although they can be mistaken for bruising and the size and location should be documented, they are not a concerning finding and usually disappear by school age.

(Option 3) A toddler's forehead is the height of many tables. Due to toddlers' lack of coordination, this explanation is plausible in the absence of other concerning findings (eg, child is afraid of caregiver, multiple bruises of various ages over other parts of the body, malnourished).

(Option 4) Due to the child's short height, this is a credible explanation. A child can pull water down from a higher-level stove top. Burns that are suspicious for abuse include scalds without splash marks; scalds with a clear line of demarcation/immersion ("dunking"); scalds involving the perineum, genitalia, and buttocks; burns on the back (versus the front) of the child; mirror-image burn injury of the extremities; and cigarette burns.

Educational objective:
Infants begin to roll at age 4-5 months. History that does not match growth and development is a concern for abuse. Burns with splash, bruises from areas typically hit when falling, and Mongolian spots are expected findings.

1,5,6

Professional boundaries set limits to maintain a therapeutic professional relationship between the nurse and client. However, the line between professional and personal interactions is sometimes blurred in extended relationships or when care is given in the client's home. The nurse should always put the client's needs first and never seek personal gain (eg, accepting gift worth >$20, asking for financial investment/loan) (Options 1 & 5).

The nurse should follow a facility's policy on professional standards of behavior. In the absence of a formal policy, the nurse should consider if the action would be appropriate to include in the medical record. If the nurse is unsure, it may be indicative of a violation of professional boundaries (eg, flirting with client, consuming alcoholic beverages with client) (Option 6).

(Option 2) An occasional visit to a previous client in a different circumstance (hospital, nursing home) is considered appropriate and caring.

(Option 3) It is appropriate for the nurse to offer assistance in meeting a client's spiritual needs if the client desires it. The nurse should not force their own beliefs, religion, or practices on the client.

(Option 4) Sending a sympathy card to acknowledge a family's loss is a holistic and therapeutic measure.

Educational objective:
Professional boundaries involve maintaining a relationship that benefits the client, not the nurse, and to which the nurse would not be reluctant to admit. It is generally not appropriate to socialize with a current client after hours, ask for a financial investment/loan, or accept a valuable gift.

3,4
Documentation should be clear, concise, and accurate to be credible, which includes being timely, truthful, and appropriate. When charting a symptom or situation, the nurse should chart the interventions taken and the client response.

An adverse event is an unusual occurrence, accident, or injury unrelated to the client's underlying condition. Adverse events must be acknowledged and documented in the chart. It is essential for the nurse to note the actions taken in response to the event (eg, client teaching, safety precautions) and the time frame in which they were performed. Documenting the key, pertinent negatives indicating that no client harm resulted and the appropriate interventions implemented to rectify or reduce harm will minimize nursing liability. If an incident report is also required, it is separate from the medical record and should never be mentioned in the client's chart.

(Option 1) Lack of a verbalized symptom does not ensure that no injury was sustained. In addition, documentation should be objective and not contain opinions.

(Option 2) A generic notation of "continue to monitor" is meaningless; the nurse should monitor all clients regardless of the situation.

(Option 5) "Suspicious" is subjective wording; the nurse should document exactly which actions appeared suspicious (eg, rapidly hides package every time nurse enters room; will not let nurse see package).

Educational objective:
After an adverse event, the nurse should document objective, specific assessments and interventions. These include signs/symptoms indicating a lack of client harm and any corrective actions taken.

4
When a client is unable to make decisions, the health care proxy is legally able to make decisions for the client. In the event that the health care proxy is unable to fulfill this role, the responsibility goes to the alternate proxies identified on the advance directive. If the client does not have a health care proxy, the family members would make decisions for the client. Occasionally, there is no family and no proxy. If this happens, a proxy may be appointed, an ethics board may make the decision, or the HCP may be responsible for making the decision.

(Options 1, 2, and 3) The health care proxy would be the legally appointed primary decision maker.

Educational objective:
The role of the health care proxy is to make decisions for a client who is unable to do so. Ideally, the proxy will have a good understanding of the client's wishes and will be emotionally capable of fulfilling this important role.

2,3,4
To leave against medical advice (AMA), the client must be legally competent to make an educated decision to stop treatment. Disqualifications for legal competency include altered consciousness, mental illness (ie, a danger to self or others), and being under chemical influence (eg, drugs or alcohol).

The client who drank a 1 L bottle of vodka is intoxicated (Option 2). The client who hears voices has psychotic symptoms and is potentially homicidal (Option 3). The manic client who has not eaten in 5 days is a potential danger to self and cannot leave AMA (Option 4).

For a competent client to leave AMA, the health care provider must explain the risks of discontinuing treatment. The nurse must witness and document the discussion on risks of leaving AMA and the client's understanding of these risks ("informed refusal"). A client leaving AMA can, and should, receive discharge instructions and the option to return at any time.

(Options 1 and 5) Clients have the right to leave AMA, even if it is not in their best interests to leave (eg, even if potentially life-threatening). Not allowing a competent client to leave AMA is a form of false imprisonment, a legally liable action by the nurse.

Educational objective:
The client must be legally competent to leave against medical advice. Disqualifications for legal competency include impairment by drugs or alcohol, altered consciousness, and mental illness (ie, a danger to self or others).

1,2,3
An impaired nurse cannot safely give care regardless of the reason for impairment. If impairment is suspected, the nurse has a duty to take action that will both protect the client and ensure that the impaired individual receives assistance. The charge nurse/nurse supervisor should be notified (so the nurse can be replaced and sent home safely), the incident documented, and the nurse not allowed to give care while impaired (Options 1, 2, and 3).

(Option 4) The off-going nurse will not stay on the new shift to watch for impairment. The impaired nurse may not behave in an obvious manner while the off-going nurse is watching. Regardless of these factors, the nurse has alcohol on the breath and slurred speech; by definition there is evidence of impairment.

(Option 5) Confronting the impaired nurse in a hostile manner does nothing to protect the client and offers no support to the nurse. Confrontation may be necessary if the client is in immediate danger (eg, the impaired nurse draws up a medication for administration). The off-going nurse should notify the charge nurse so that facility authorities can collaborate with the governing state board of nursing to carry out appropriate investigation, discipline, and supportive interventions. Most state nurse practice acts allow rehabilitation for a cooperative professional rather than automatic loss of license.

Educational objective:
A nurse who is impaired by alcohol cannot be given client responsibility. The recognizing nurse should notify the supervisor, document the incident, and not give client responsibility to the impaired nurse.

4
To leave against medical advice (AMA), a client must have the risks explained and be able to understand them (ie, competent). Issues that can make a client ineligible to leave AMA include danger to self or others, lack of consciousness, altered consciousness, mental illness, being under chemical influence, or a court decision.

Despite it not being in the client's best health interest, the client with gastrointestinal bleeding can leave AMA (Option 4).

(Option 1) Parents may not refuse life-, limb-, or organ-saving treatment on behalf of their minor child for religious or personal reasons; they can make that decision only for themselves. If the parents deny critical treatments to the child, the hospital may seek protective custody.

(Option 2) Suicidal ideation (ie, danger to self) is a criterion that prevents a client from being allowed to leave AMA.

(Option 3) The client is not oriented x3 and is therefore not competent. There are 3 orientation categories (time, place, and person); orientation to time is lost first. To be oriented, the client must answer all questions in each category correctly.

Educational objective:
After an explanation of the risks is given, a client must be considered competent in order to leave against medical advice. A client with suicidal ideation or altered consciousness is not competent. Parents may not refuse limb-, life-, or organ-saving treatment for a minor child based on their own personal beliefs.

1,2,3,4

The nurse contacts the health care provider (HCP) for certain circumstances, regardless of the time of day. An emergent call is warranted if a client:

Falls
Deteriorates significantly or dies
Has critical laboratory results
Needs a prescription that requires clarification
Leaves against medical advice or runs away
Refuses key treatments in a relevant period
The HCP should be called after the initiation of hospital protocols (eg, stroke, code blue) and after a concerning assessment finding (eg, significant change in vital signs, unilateral drift, change in level of consciousness, signs of trauma after a fall ) (Options 1 and 2).

Administration of heparin is normally discontinued prior to surgery due to the increased risk of bleeding and should be clarified with the HCP (Option 3).

A serum sodium of 124 mEq/L (124 mmol/L) (normal: 135-145 [135-145]) represents a critical value that can lead to altered mental status and seizures (Option 4).

(Option 5) Clients have the right to refuse treatment; there is no indication that the client needs pain medication. With additional explanation, the client might reconsider if and when symptoms occur.

Educational objective:
The nurse should notify the health care provider, regardless of the time, for acute client deterioration (eg, neurological changes), critical laboratory values, falls, or death. Other reasons include prescription clarification and the client leaving against medical advice or refusing a key treatment.

3

All incidents, accidents, or occurrences that cause actual or potential harm to a client, employee, or visitor must be reported. The person who witnesses an unusual occurrence or event must file an incident report in the institution's computer documentation system using an electronic form. Alternately, a paper form may be completed and filed. The purposes of the report are to inform risk management of the occurrence, allowing them to consider changes that might prevent similar incidents, and to notify administration of a potential litigation claim.

The nurse should not document that an incident report was filed, or refer to the incident report in the medical record.

(Options 1, 2, and 4) Because the incident report is not a part of the medical record, an objective note should be placed in the client's medical record documenting the facts and events of the incident, HCP notification and findings, prescriptions, treatment, follow-up care, and monitoring.

Educational objective:
The person who witnesses an unusual occurrence or event must file an incident report in the institution's computer documentation system, using an electronic form. The nurse should not document that an incident report was filed or refer to the incident report in the medical record.

4

"Mature minors" are adolescents who are age 14-18 and are deemed able to understand treatment risks. They are legally allowed to give independent consent to receive/refuse treatment for some limited conditions. Classically, these conditions include testing and treatment for STIs, family planning, drug and alcohol abuse, blood donation, and mental health care.

A minor who is a parent, pregnant, or an emancipated minor can also give consent. An emancipated minor is a self-supporting adolescent under age 18 who is married, on active duty in the military, granted emancipation by the court, or not living at home.

(Option 1) This information could be requested if a professional relationship with assessment is established. It would be beneficial to reinforce the concept of safer sex regardless. However, that is not the essential need as STIs can be transmitted even when protection is used.

(Option 2) Minor children ordinarily need parental consent unless specific conditions are met. In this case, the nature of the request allows the care to be given.

(Option 3) STIs do not always have obvious signs/symptoms that would allow the client's needs to be determined accurately.

Educational objective:
Mature minors are adolescents between age 14-18 who can give independent consent for limited conditions such as STIs, family planning, drug and alcohol abuse, blood donation, and/or mental health care.

1,4,5
Ethical principles guide decision making and appropriate behavior. Justice is treating every client equally regardless of gender, sexual orientation, religion, ethnicity, disease, or social standing (Option 4). Accountability refers to accepting responsibility for one's actions and admitting errors (Option 1).

Nonmaleficence means doing no harm. It also relates to protecting clients who are unable to protect themselves due to their physical or mental condition. Examples include infants/children, clients under the effects of anesthesia, and clients with dementia (Option 5).

(Option 2) Autonomy is freedom for a competent client to make decisions for oneself, even if the nurse or family does not agree (eg, informed consent, advanced directive). The nurse can provide information and should respect the client's decisions.

(Option 3) Confidentiality means that information shared with the nurse is kept in confidence unless permission is given to share or it is required by law to be shared to protect the client and/or community (eg, reportable infectious diseases). If a client discusses suicidal ideation with the nurse, it must be appropriately reported to protect the client from self-harm.

Educational objective:
Accountability is accepting responsibility for one's actions. Autonomy is making an informed decision about treatment for oneself. Confidentiality is not sharing information unless permission is given or required by law. Justice is treating every client equally. Nonmaleficence is doing no harm.

1,3,4
The Patient Care Partnership (formerly known as the Patient's Bill of Rights) is a set of standards developed by the American Hospital Association. It informs patients/clients about what they should expect during their hospital stay with regard to their rights and responsibilities. Client rights originate in laws or desirable ethical principles but have limitations.

Clients have the right to know the names and positions of their health care providers (HCPs). These individuals should introduce themselves by name and discipline (Option 4).

Clients have the right to access information within their own medical record. A release form may need to be signed, or the HCP can review information (eg, biopsy results) with the client. In 2014, the Department of Health and Human Services further strengthened the rights of clients to access their test results (Option 1).

Pain management is also addressed by the Joint Commission and is considered a basic client right. Although success in pain relief is not guaranteed, the issue is to at least be addressed with the goal of successful management (Option 3).

(Option 2) Clients do not have an open-ended right to choose their nurse for every shift. If the client has a special request (eg, does not want a male nurse based on religious beliefs), the facility will usually try to accommodate these wishes.

(Option 5) There is no basic right for clients to have whatever procedures they want. Clients sometimes want things that are not essential to their health or that they do not need (eg, those with body dysmorphic syndrome who desire plastic surgery, those with Munchausen syndrome who act ill and request unnecessary treatment). A client is offered treatment that the HCP feels is needed and has the right to choose or refuse the treatment.

Educational objective:
Basic client rights include knowing the identity of their health care providers, access to the information in their medical records, and having pain assessed and addressed appropriately.

2,3,5

Incident/occurrence reports are used in a health facility to document events that pose unanticipated actual or potential risk to the health or safety of a client, visitor, or employee. Incident/occurrence reporting is a method of quality improvement and should not be considered punitive in nature or be documented in the health record. Examples of events requiring reporting include:

Assault and injury

Physical, verbal, or sexual assault occurring in a health facility (Option 2)
Client falls, with or without injury
Staff and visitor falls, regardless of acceptance or refusal of treatment (Option 5)
Treatment and intervention

Failure to obtain or intervene upon the results of diagnostic procedures (Option 3)
Inadequate or delayed diagnosis and monitoring
Delay, omission, or incorrect performance or administration of prescribed therapies and medications
Hospital equipment failure
(Option 1) Withdrawal of life support in clients deemed brain dead is an expected and clinically justified course of care, and should be documented in the health record.

(Option 4) Incident/occurrence reports are used to document clinical health and safety issues; managerial issues (eg, tardy or absent staff) should be documented in the employee's record.

Educational objective:
Incident/occurrence reports are used to document events that pose actual or potential risk to the health or safety of clients, visitors, or employees. Examples of reportable events include assault and injury; delay, omission, or incorrect provision of treatment; and equipment failure.

2

Informed consent is required before any nonemergency procedure. The 3 principles of informed consent include:

- The surgeon explains the diagnosis, planned procedure with risks and benefits, expected outcome, alternate treatments, and prognosis without surgery.
- The client indicates understanding of the information.
- The client is competent and gives voluntary consent.

The nurse is responsible for witnessing the client's signature and ensuring that the client is competent and understands information provided by the surgeon. Clients unconscious or under the influence of mind-altering drugs (eg, opioids) cannot provide consent. If the sedated client requires procedures not listed on the consent form, the client's medical power of attorney, legal guardian, or next of kin should be contacted so that the surgeon can explain the situation and obtain consent (Option 2).

(Option 1) Modifying a consent form after it has been signed is an illegal falsification of documentation.

(Option 3) Unless family members deny consent or cannot be reached, it is in the client's best interest to have the hernia repaired now rather than go through the physical and financial strain of a second surgery.

(Option 4) Procedures can be performed without prior consent only when lifesaving measures are necessary. Obtaining consent after a procedure is illegal and considered assault and battery.

Educational objective:
Informed consent is required before any nonemergency procedure. If the need for an additional procedure is discovered during surgery, the client's medical power of attorney, legal guardian, or next of kin should be contacted to provide consent.

2,4

Advance care planning is an ongoing process that should be revisited yearly and after changes in condition. Legal documentation is needed to ensure that the client's advance care plan is carried out correctly.

Advance care planning documents may include the following:

A health care proxy (durable power of attorney for health care or medical power of attorney) is a person appointed by the client to make decisions on behalf of the client. The proxy document only goes into effect when the health care team determines that the client lacks the capacity to make decisions. This should be deactivated if the client regains decision-making capacity.

A living will is an advanced directive describing the type of life-sustaining treatments (eg, cardiopulmonary resuscitation, intubation, mechanical ventilation, feeding tube) that the client wants initiated if unable to make decisions.

(Option 1) The financial power of attorney form can help clients having difficulty managing financial affairs and needing someone to help; however, it is not part of the advance care planning process.

(Option 3) The client must choose a beneficiary for life insurance policies; however, life insurance is not part of the advance care plan.

(Option 5) A safe deposit box can be a good place to ensure that legal documents are stored safely. It is not part of the advance care planning process.

Educational objective:
Advance care planning allows the client to determine desired treatments (eg, cardiopulmonary resuscitation, intubation, mechanical ventilation) and decision makers in the event the client is unable to do so. Advanced directives are legal documents outlining these wishes and include living wills and health care proxies (durable powers of attorney for health care or medical power or attorney).

1

The first step in the nursing process is assessment. In this situation, additional information is needed before the nurse can determine the next course of action (Option 1).

(Option 2) The United States' Health Insurance Portability and Accountability Act (HIPAA) and Canada's Personal Information Protection and Electronic Documents Act (PIPEDA) prevent release of private, privileged health care information to people who do not need to know it for a client's care. In this case, the nurse is not releasing any information and is obtaining further information to assess the client's condition. In addition, there is no privacy violation in obtaining information that the spouse would know.

(Option 3) Additional information is required before knowing whether the client needs to be seen in the clinic. The client may need instruction to instead call 911 and go to the emergency department.

(Option 4) The nurse can ask the client to call, but the client may be unable (eg, seizure, unconscious) or unwilling to do so. In addition, the client may not be aware of signs (eg, acute-onset confusion) that are concerning to the spouse. The situation is unclear (eg, the client may have trouble speaking [ie, stroke symptom]) but may be clarified after the nurse receives additional information from the spouse.

Educational objective:
The nurse should further assess the situation and gather more information when a spouse calls reporting troublesome symptoms in a client. It is not a violation to obtain information about a client from a knowledgeable source.

2,3,5
There are several circumstances in which the nurse is legally required to report to appropriate civil authorities:

- Suspected elder abuse must be reported to the appropriate authorities for investigation. The nurse has a legal obligation to report signs of abuse regardless of clients' ability or willingness to advocate for themselves
- The nurse should report deaths that meet medical examiner reporting guidelines (eg, suspected to be the result of a crime, trauma, or suicide) to the authorities for investigation. The local medical examiner has the legal authority and obligation to perform an autopsy independent of the family's wishes
- For the sake of client safety, nurses should immediately report impaired or intoxicated health care workers, regardless of their position
- Under the Health Insurance Portability and Accountability Act, a client's reason for an emergency department visit cannot be communicated to employers without the client's permission
- Health authorities must be notified of a reportable sexually transmitted disease regardless of client wishes. Depending on the condition, authorities may report findings to sexual contacts, but it is a violation of client privacy for the nurse to share this information with the client's family or spouse (Option 4).

Educational objective:
The nurse is required to report an impaired coworker, a suspicious death, and elder abuse to appropriate authorities. The nurse is legally prohibited from sharing health information with employers or family members without the client's permission.

3,5

Ethical principles guide the nurse in making appropriate decisions and acting accordingly. They speak to the essence but not to the specifics of the law. Fidelity is exhibiting loyalty and fulfilling commitments made to oneself and others. It includes meeting the expected responsibilities of professional nursing practice and provides the basis of accountability (taking responsibility for one's actions) (Option 3).

Nonmaleficence means to do no harm and relates to protecting clients from danger when they are unable to do so themselves due to a mental/physical condition (eg, children, client with Alzheimer disease) and from a nurse who is impaired (Option 5).

(Option 1) Autonomy is the right to make decisions for oneself (eg, informed consent). Although having an advance directive is an example of autonomy, requiring one violates this principle. The client has a right to refuse even if the nurse believes it is in the client's best interest.

(Option 2) When a diagnosis is withheld, even if due to the nurse's or family's good intentions, it violates the principle of autonomy. Beneficence means to do good (eg, implementing interventions to promote the client's well-being).

(Option 4) The principle of justice refers to treating all clients fairly (ie, without bias). Veracity is telling the truth as a fundamental part of building a trusting relationship.

Educational objective:
Nonmaleficence is doing no harm, fidelity is loyalty and commitment, justice is equal treatment for all, beneficence is doing good for the client's best interest, and autonomy is making decisions for oneself.

4
Although acetaminophen is an over-the-counter drug, the nurse should not give it without a prescription. By doing so, the nurse would be functioning outside the job description. There has not been a proper assessment (eg, allergies, liver disease), and a legal caregiving relationship will be established by administering the medication. If the employee does not want to go to the employee health provider, the nurse can suggest that the employee purchase acetaminophen in the gift shop.

(Option 1) It is advisable for the nurse to ask about liver issues prior to administering acetaminophen, but this nurse has no prescription to administer it. Taking the medication from a personal supply, rather than hospital stock, does not change the fact that the nurse is functioning outside the job description while on duty.

(Option 2) The nurse could technically perform the assessment, but it is not within the nurse's current role and job description. The employee health provider (or the emergency department) should be used for this assessment.

(Option 3) The nurse should check for allergies before administering a drug, but this nurse has no prescription to administer acetaminophen. Acetaminophen being an over-the-counter medication does not change this fact.

Educational objective:
The nurse should not give medication to an employee without a prescription even if it is an over-the-counter drug.

3
Opioids (eg, morphine, hydromorphone, fentanyl) are controlled medications, regulated in the United States by the Controlled Substances Act and in Canada by the Controlled Drugs and Substances Act. These laws contain regulations (eg, methods of disposal) for various controlled substances.

To properly dispose of leftover opioid medication in a patient-controlled analgesia pump, the nurse must have a second licensed nurse witness the waste of the medication (Option 3). Hospital policy should be followed to properly waste the medication and discard the empty cartridge. When a controlled substance is discontinued, the nurse documents the date, time, amount used, reason for the waste, and amount wasted.

(Option 1) Unlicensed assistive personnel (UAP) cannot witness the waste of medication as it is outside their scope of practice. Two licensed nurses must document this process.

(Option 2) Simply documenting that another nurse is not available does not follow government regulations for wasting controlled substances. Disposal should occur only when a second licensed nurse is available as a witness.

(Option 4) It is never appropriate to waste a controlled substance without the witness of another nurse. In addition, nurses should never document or sign off on anything that was not personally witnessed or completed as this constitutes falsified documentation.

Educational objective:
Waste of controlled substances (eg, opioids) must be witnessed by two licensed nurses to comply with facility policy and government regulations.

1,3,4,5

The National Council of State Boards of Nursing advises any individual who has knowledge of a potential violation of a nursing law or rule to file a complaint with the appropriate state board of nursing. A nurse should be knowledgeable concerning the presiding board's stance on mandatory reporting and which actions are considered reportable. In general, reportable actions may include any behavior by a licensed nurse that is unsafe, unethical, incompetent, impaired (eg, by substances or a mental or physical condition), or in violation of nursing law.

- Practicing outside of the scope of the license is reportable even if the practice meets quality standards
- Documenting an intervention that was not performed is considered falsification of records regarding client care and is a reportable action (Option 3).
- Stealing narcotics is a criminal offense (a violation punishable by the state that can result in prison or a fine) and is reportable in all states. Many states offer an alternate rehabilitation program to nurses who diverted or abused drugs (Option 4).
- Abandonment (eg, leaving without proper replacement of personnel and transfer of responsibility for client care) is reportable in all states (Option 5).
(Option 2) Work habits are handled under the facility's management policies and are often part of the criteria for discipline and/or termination. If the facility has 24-hour care, the off-going nurse cannot leave without someone assuming responsibility for the clients or waiting for the tardy nurse.

Educational objective:
Nurse offenses reportable to the state board of nursing include criminal acts (such as theft), practicing outside of the scope, falsification of records, and client abandonment. Any individual may file a complaint regarding an action that is potentially unethical, incompetent, impaired, or in violation of nursing law.

3

The electronic record is a legal document and should contain factual, descriptive, objective information that the nurse sees, feels, hears, and smells. It should be the result of direct observation and measurement. "Inspiratory wheezes heard in bilateral lung fields" best fits these criteria. The nurse should avoid vague terms such as "appears," "seems," and "normal." These words suggest that the nurse is stating an opinion and do not accurately communicate facts or provide information on behaviors exhibited by the client. The nurse should provide exact measurements, establish accuracy, and not provide opinions or assumptions.

(Option 1) The nurse should not use the word "appears" as it is too vague. "Eyes closed" is a factual observation. A more accurate entry would be, "Client lying in bed with eyes closed. Respirations even and unlabored."

(Option 2) It is a good practice to document client quotes. However, in this case, the nurse should have elicited more information from the client, such as a pain scale, and then documented the analgesic the client was given.

(Option 4) This documentation would be more descriptive if it listed how much urine, its color and clarity, and if an odor was present.

Educational objective:
Nursing documentation should be factual, descriptive, and contain objective information that the nurse sees, hears, feels, or smells. It must include direct observation and measurement.

Which ethical principle will the nurse understand is vital to building a trusting relationship with clients?

Which type of ethics focuses on the importance of relationships in the decision

What is the most important ethical principle in nursing?

What are the 4 main ethical principles in nursing?