Deck 3: Legal and Ethical Issues

Question 1

The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation.The family expresses a concern that the patient may "change her mind." The nurse best reassures the family by stating

A)"The nursing staff will watch her very closely for any indication she has changed her mind."
B)"We will discuss her wishes with her regularly."
C)"She can change her mind about any provision in the document at any time."
D)"Your mother was very clear about her wishes when she signed the document."

Answer 1

"The nursing staff will watch her very closely for any indication she has changed her mind."

Question 2

A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on which of the following?

A)Physician's medical orders
B)Stated requests of the individual patient
C)Care that a responsible gerontologic nurse would provide
D)Implementation of the nursing process

Answer 2

Care that a responsible gerontologic nurse would provide

Question 3

An older adult patient has been approached to participate in a research study.The nurse best advocates for the patient's right to self-determination by doing which of the following?

A)Evaluating the patient's cognitive ability to understand the risks of the study.
B)Determining what risks to the patient are involved.
C)Discussing the importance of the study with the patient and family.
D)Encouraging the patient to discuss the decision with trusted family or friends.

Answer 3

Evaluating the patient's cognitive ability to understand the risks of the study.

Question 4

The director of nursing at a long-term care facility is getting ready for the annual inspection.What information guides the director?

A)Visits cannot be unannounced.
B)The director must be off site during the inspection.
C)Nurses must answer questions from the inspectors.
D)Results will be shared only through the mail.

Question 5

A nurse caring for older adult patients shows an understanding of the implementation of standards of care when

A)dialing the telephone when the patient wants to call his daughter.
B)requesting the patient's favorite dessert on his birthday.
C)closing the patient's door when he is praying.
D)reminding the patient to call for assistance before getting out of bed.

Question 6

A nurse new to gerontologic nursing asks the nurse manager to clarify how to handle a patient's claim that she has been physically abused.The nurse manager responds most appropriately when stating

A)"I'll show you where you can find this state's reporting requirements."
B)"As a nurse you are considered a 'mandated reporter' of elder abuse."
C)"As long as you are reasonably sure abuse has occurred,report it."
D)"You need to report any such claims directly to me."

Question 7

The manager of a long-term care facility is evaluating patients' use of drugs.The resident on which of the following medications would be allowed to continue taking medications to control behavior?

A)On anxiolytics;now able to participate in group activities
B)Given a benzodiazepine at night;roommate now sleeps well
C)Given sedatives;eats 100% of meals if resident is fed
D)Taking an antipsychotic;no longer wanders at night

Question 8

An older adult resident of a long-term care nursing facility frequently attempts to get out of bed and is at risk of sustaining an injury.The nurse's planned intervention to minimize the patient's risk for injury is guided by which of the following?

A)The patient's right to self-determination and to be free to get out of bed.
B)An understanding that nondrug interventions must be tried before medications.
C)The knowledge that application of a vest restraint requires a physician's order.
D)The patient's cognitive ability to understand and follow directions.

Question 9

To meet current guidelines regarding incontinence in a long-term care facility,what action by the director of nursing is best?

A)Assess residents for the ability to participate in a bladder training program.
B)Take all residents to the toilet every 2 hours and after meals.
C)Ensure all residents wear incontinence briefs,which are changed routinely.
D)Ask physicians and other providers to prescribe medications for bladder control.

Question 10

A graduate nurse learns about the provisions of the Health Insurance Portability and Accountability Act (HIPAA),which include which of the following?

A)Requires employers to offer health care insurance
B)Regulates the amount employers can charge for insurance
C)Mandates that employers provide specific benefits
D)Helps maintain coverage when a person changes jobs

Question 11

An 87-year-old patient is unsure of the purpose of a living will.Which statement by the nurse is the best description?

A)"It's a legal document that Social Services can help you create."
B)"It designates a family member to make decisions if you become incompetent."
C)"It provides a written description of your wishes in the event you become terminally ill."
D)"It assures you won't be subjected to treatments you don't want."

Question 12

An alert but disoriented older patient lives with family members.The home health nurse,being aware of the role of patient advocate,recognizes the obligation to report possible patient abuse based on which of the following?

A)A family member stating,"It's hard being a caregiver."
B)Assessment showing bruises in the genital area.
C)Observation of mild changes in orientation.
D)Patient's report of always being hungry.

Question 13

During the state inspection of a skilled nursing facility,a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care.The nurse manager informs the nurse to expect

A)a review of the situation by the state board of nursing.
B)termination of employment from the facility.
C)mandatory remediation related to the suspect care issues.
D)unannounced reevaluation of performance within the next 3 months.

Question 14

What provisions for nursing service are part of the Omnibus Budget Reconciliation Act (OBRA)as it pertains to long-term care facilities? (Select all that apply. )

A)Resident assessments
B)Annual screenings
C)Minimum staffing
D)Ensuring resident rights
E)Registered nurse educational requirements

Question 15

The adult child of a long-term care facility resident receives a phone call from the director of nursing stating that resident has 30 days to move out of the home.Under what conditions can a facility require a resident to move? (Select all that apply. )

A)Nonpayment for services received
B)Needs exceeding what the facility can provide
C)Stay is no longer required based on the resident's medical condition
D)Facility is going out of business
E)Frequent disruptive behavior during the night

Question 16

To best address the patient's right to self-determination,which of the following questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply. )

A)"Do you understand what a living will and durable power of attorney are?"
B)"If you have already prepared an advance care directive,can you provide it now?"
C)"Are you prepared to discuss your end-of-life choices with the nursing staff?"
D)"Have you discussed your end-of-life choices with your family or designated surrogate?"
E)"Would you like help with preparing a living will or a durable power of attorney?"

Question 17

The nurse manager in a long-term care facility reviews resident care plans at what interval?

A)Quarterly
B)Every 60 days
C)Annually
D)When changes occur

Question 18

The director of nursing at a certified long-term care facility overhauls the nursing assistant training program to include which features? (Select all that apply. )

A)12 hours of classroom content
B)Training in infection control measures
C)Instruction on resident rights
D)6 hours of quarterly in-service education
E)Education on safety measures

Question 19

The nursing student learns about the Patient Self-Determination Act.What is a key provision of this act?

A)It establishes new rights for patients in medical facilities.
B)It requires facilities to educate patients on their rights.
C)It allows families to be approached for organ donation.
D)It spells out the procedures for creating an advance directive.

Question 20

A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients' rooms during the night.The nurse views the patient's PRN antipsychotic medication order as which of the following?

A)An appropriate intervention to help assure the resident's safety.
B)An option to be used only when all other nondrug interventions prove ineffective.
C)Inappropriate unless the physician is notified and approves its use.
D)Not an option because it should not be used to manage behaviors of this type.