Deck 3: Legal and Ethical Issues

Question 1

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.

Answer 1

reminding the patient to call for assistance before getting out of bed.

Question 2

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

Answer 2

Quarterly

Question 3

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

Answer 3

On anxiolytics;now able to participate in group activities

Question 4

The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not Resuscitate order in effect.A family member tells the nurse,"I'll sue you and every other nurse here if you don't do everything possible to keep her alive." The nurse understands that protection from legal prosecution in this situation is provided by:

A)legal immunity granted when acting according to the patient's expressed wishes.
B)the legal view that the duty to put into effect the patient's wishes falls to the physician.
C)knowledge of and compliance with facility policies and procedures regarding end-of-life care.
D)implementing interventions that preserve the patient's right to self-determination.

Question 5

A nurse new to geriatric 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 6

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 7

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

A)evaluating the patient's cognitive ability to understand the consequence of the study.
B)determining what risks to the patient are involved.
C)discussing the importance of the study with the patient and his family.
D)encouraging the patient to discuss the decision with trusted family or friends.

Question 8

An 87-year-old patient is unsure of the purpose of a living will.The nurse describes its purpose best when stating:

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 9

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 10

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 11

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 12

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 the:

A)physician's medical orders.
B)stated requests of the individual patient.
C)care that a responsible geriatric nurse would provide.
D)implementation of the nursing process.

Question 13

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:

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 14

The nurse recognizes that a nursing aide likely to abuse an older patient is one who has:

A)ineffective verbal communication skills.
B)little experience working with the older population.
C)poor stress management skills.
D)been a victim of abuse.

Question 15

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 16

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:

A)an appropriate intervention to help assure his 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.

Question 17

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."

Question 18

To best address the patient's right to self-determination,which of the follow 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 19

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:

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 20

The nurse caring for an older patient who resides in an assisted living facility is asked to obtain and witness the patient's signature on a living will document.The nurse responds most appropriately when stating:

A)"I will,because such a document is so valuable to the patient's plan of care."
B)"I'll ask the patient's family if they agree that the patient should sign the document."
C)"First I need to discuss the purpose of this document with the patient."
D)"I'm sorry but I cannot ethically do that."

Question 21

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 22

The adult child of a long-term care facility resident receives a phone call from the director of nursing stating that her parent 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 23

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