Deck 3: Ethical, Social, and Legal Issues

Question 1

The nurse is providing care to a patient who was just admitted to the labor and birth unit in active labor at term. The patient informed the nurse that she has not received any prenatal care because "I cannot afford to go to the doctor. And, this is my third baby, so I know what to expect." What is the nurse's primary concern when developing the patient's plan of care?

A) Low birth weight
B) Oligohydramnios
C) Gestational diabetes
D) Gestational hypertension

Answer 1

Low birth weight

Question 2

A nurse is admitting a client to the labor and birth unit in early labor who was sent to the facility following her checkup with her health care provider in the office. The client is a gravida 1, para 0, and is at term. No health issues are discerned from the initial assessment, and the nurse prepares to initiate physician orders based on standard procedures. Which action is warranted by the nurse manager in response to this situation?

A) No action is indicated because the nurse is acting within the scope of practice.
B) The nurse manager should intervene and ask the nurse to clarify admission orders directly with the physician.
C) The nurse manager should review standard procedures with the nurse to validate that orders are being carried out accurately.
D) The nurse manger should review the admission procedure with the nurse.

Answer 2

No action is indicated because the nurse is acting within the scope of practice.

Question 3

A charge nurse is working on a postpartum unit and discovers that one of the clients did not receive AM care during her shift assessment. The charge nurse questions the nurse assigned to provide care and finds out that the nurse thought that "the client should just do it by herself because she will have to do this at home." On further questioning of the nurse, it is determined that the rest of her assigned clients were provided AM care. The assigned nurse has violated which ethical principle?

A) Justice
B) Truth
C) Confidentiality
D) Autonomy

Answer 3

Justice

Question 4

Which client will most likely seek prenatal care?

A) Janice, 15 years old, tells her friends, "I don't believe I am pregnant."
B) Carol, 28 years old, is in her second pregnancy and abuses drugs and alcohol.
C) Margaret, 20 years old, is in her first pregnancy and has access to a free prenatal clinic.
D) Glenda, 30 years old, is in her fifth pregnancy and delivered her last infant at home with the help of her mother and sister.

Question 5

The United States ranks 27th in terms of worldwide infant mortality rates. Which factor has the greatest impact on decreasing the mortality rate of infants?

A) Providing more women's shelters
B) Ensuring early and adequate prenatal care
C) Resolving all language and cultural differences
D) Enrolling pregnant women in the Medicaid program by their eighth month of pregnancy

Question 6

A nurse working in a labor and birth unit is asked to take care of two high-risk clients in the labor and birth suite: a 34 weeks' gestation 28-year-old gravida 3, para 2 in preterm labor and a 40-year-old gravida 1, para 0 who is severely preeclamptic. The nurse refuses this assignment telling the charge nurse that based on individual client acuity, each client should have one-on-one care. Which ethical principle is the nurse advocating?

A) Accountability
B) Beneficence
C) Justice
D) Fidelity

Question 7

The nurse is planning a teaching session for staff on ethical theories. Which situation best reflects the deontologic theory?

A) Approving a physician-assisted suicide
B) Supporting the transplantation of fetal tissue and organs
C) Using experimental medications for the treatment of AIDS
D) Initiating resuscitative measures on a 90-year-old patient with terminal cancer

Question 8

With regard to an obstetric litigation case, a nurse working in labor and birth is found to be negligent. Which intervention performed by the nurse indicates that a breach of duty has occurred?

A) The nurse did not document fetal heart tones (FHR) during the second stage of labor.
B) The client was only provided ice chips during the labor period, which lasted 8 hours.
C) The nurse allowed the client to use the bathroom rather than a bedpan during the first stage of labor.
D) The nurse asked family members to leave the room when she prepared to do a pelvic exam on the client.

Question 9

A nurse is working in the area of labor and birth. Her assignment is to take care of a gravida 1 para 0 who presents in early labor at term. Vaginal exam reflects the following: 2 cm, cervix posterior, -1 station, and vertex with membranes intact. The client asks the nurse "if she can break her water so that her labor can go faster?" The nurse's response, based on the ethical principle of nonmaleficence, is which of the following?

A) Tell the client that she will have to wait until she has progressed further on the vaginal exam and then she will perform an amniotomy.
B) Have the client write down her request and then call the physician for an order to implement the amniotomy.
C) Instruct the client that only a physician or certified midwife can perform this procedure.
D) Give the client an enema to stimulate labor.

Question 10

Which statement is true regarding the quality assurance or incident report?

A) Reports are a permanent part of the patient's chart.
B) The report assures the legal department that there is no problem.
C) The nurse's notes should contain this statement: "Incident report filed and copy placed in chart."
D) This report is a form of documentation of an event that may result in legal action.

Question 11

Which step of the nursing process is being used when the nurse decides whether an ethical dilemma exists?

A) Analysis
B) Planning
C) Evaluation
D) Assessment

Question 12

Which of the following complications are associated with late preterm infants? (Select all that apply.)

A) Hyperglycemia
B) Tachycardia
C) Jaundice
D) Thermoregulation problems
E) Require mechanical ventilation
F) Feeding problems

Question 13

The nurse is teaching a homeless pregnant teenager about prenatal care. Which should the nurse emphasize in the teaching session?

A) The importance of naming the baby
B) Risk factors associated with pregnancy
C) Information about employment opportunities
D) Eating habits that will provide adequate nutrition

Question 14

The nurse is interviewing a 6-week pregnant client. The client asks the nurse, "Why is elective abortion considered an ethical issue?" Which is the best response that the nurse should make?

A) Abortion requires third-party consent.
B) The U.S. Supreme Court ruled that life begins at conception.
C) Abortion law is unclear about a woman's constitutional rights.
D) There is a conflict between the rights of the woman and the rights of the fetus.

Question 15

Which of the following statements is true regarding late preterm infants?

A) These infants are born before 32 weeks' gestation and thus are at higher risk than LBW infants.
B) These infants do better than LBW infants because their weight provides added protection against physiologic stressors.
C) Care of these infants has led to increased health care costs compared with LBW infants.
D) These infants suffer fewer respiratory problems than LBW infants.

Question 16

A nurse is working with a labor client who is in preterm labor and is designated as a high-risk client. The client is very apprehensive and asks the nurse, "Is everything going to be all right?" The nurse tells the client, "Everything will be okay." Following birth via an emergency cesarean section, the newborn undergoes resuscitation and does not survive. The client is distraught over the outcome and blames the nurse for telling her that everything would be okay. Which ethical principle did the nurse violate?

A) Autonomy
B) Fidelity
C) Beneficence
D) Accountability

Question 17

A nurse is entering information on the client's electronic health record (EHR) and is called to assist in an emergency situation with regard to another client in the labor and birth suite. The nurse rushes to the scene to assist but leaves the chart open on the computer screen. The emergent client situation is resolved satisfactorily, and the nurse comes back to the computer entry screen to complete charting. At the end of the shift, the nurse manager asks to speak with the nurse and tells her that she is concerned with what happened today on the unit because there was a breach in confidentiality. Which response by the nurse indicates that she understands the nurse manager's concerns?

A) The nurse acknowledges that she should have made sure that her client was safe before assisting with the emergency.
B) The nurse states that she should have logged out of the EHR prior to attending to the emergency.
C) The nurse indicates that the unit was understaffed.
D) The nurse indicates that the she changed her password following the clinical emergency to maintain confidentiality.

Question 18

At the present time, surrogate parenting is governed by which of the following?

A) State law
B) Federal law
C) Individual court decision
D) Protective child services

Question 19

A nurse who works in the emergency department (ED) is assigned to a client who is experiencing heavy vaginal bleeding at 12 weeks' gestation. An ultrasound has confirmed the absence of a fetal heart rate, and the client is scheduled for a dilation and evacuation of the pregnancy. The nurse refuses to provide any further care for this client based on moral principles. What is the nurse manager's initial response to the nurse?

A) "I recall you sharing that information in your interview. I will arrange for another nurse to take report on this client."
B) "Because we are shorthanded today, you have to continue to provide care. There is no one else available to provide care for this client."
C) "I understand your point of view. You were hired to work here in the ED so you had to know this situation was possible."
D) "Abandonment is a serious issue. I have to advise you to continue to provide care for this client."

Question 20

A medical surgical nurse is asked to float to a women's health unit to care for clients who are scheduled for therapeutic abortions. The nurse refuses to accept this assignment and expresses her personal beliefs as being incongruent with this medical practice. The nursing supervisor states that the unit is short-staffed and that they could really use her expertise because it just involves taking care of clients who have undergone a surgical procedure. In consideration of legal and ethical practices, can the nursing supervisor enforce this assignment?

A) The staff nurse has the responsibility of accepting any assignment that is made while working for a health care unit, so the nursing supervisor is within his or her rights to enforce this assignment.
B) Because the unit is short-staffed, the staff nurse should accept the assignment to provide care by benefit of her or his experience to clients who need care.
C) The staff nurse has expressed a legitimate concern based on his or her feelings; the nursing supervisor does not have the authority to enforce this assignment.
D) The nursing supervisor should emphasize that this assignment requires care of a surgical client for which the staff nurse is adequately trained and should therefore enforce the assignment.

Question 21

Match each term with the correct definition.

Damage

A)The nurse's breach of duty caused harm.
B)The nurse has a responsibility to give care to the client.
C)An actual injury or harm to the client occurred because of the nurse's breach of duty.

Question 22

Which actions by the nurse indicate compliance with the Health Insurance Portability and Accountability Act (HIPAA)? (Select all that apply.)

A) The nurse posts an update about a client on Facebook.
B) The nurse gives the report to the oncoming nurse in a private area.
C) The nurse gives information about the client's status over the phone to the client's friend.
D) The nurse logs off any computer screen showing client data before leaving the computer unattended.
E) The nurse puts any documentation with the client's information in the shred bin at the hospital before leaving for the day.

Question 23

Match each term with the correct definition.

Duty

A)The nurse's breach of duty caused harm.
B)The nurse has a responsibility to give care to the client.
C)An actual injury or harm to the client occurred because of the nurse's breach of duty.

Question 24

Match each term with the correct definition.

Proximate cause

A)The nurse's breach of duty caused harm.
B)The nurse has a responsibility to give care to the client.
C)An actual injury or harm to the client occurred because of the nurse's breach of duty.

Question 25

The RN is delegating tasks to the unlicensed assistive personnel (UAP). Which tasks can the nurse delegate? (Select all that apply.)

A) Teaching the client about breast care
B) Assessment of a client's lochia and perineal area
C) Assisting a client to the bathroom for the first time after birth
D) Vital signs on a postpartum client who delivered the night before
E) Assisting a postpartum client to take a shower on the second postpartum day

Question 26

The clinic nurse often cares for clients who are considering an abortion. Which responsibilities does this nurse have in regard to this issue? (Select all that apply.)

A) Informing the client about pro-life options
B) Informing the client about pro-choice support groups
C) Being informed about abortion from a legal standpoint
D) Being informed about abortion from an ethical standpoint
E) Recognizing that this issue may result in confusion for the client

Question 27

A couple asks the nurse about the procedure for surrogate parenting. Which correct responses should the nurse give to the couple? (Select all that apply.)

A) Donated embryos can be implanted into the surrogate mother.
B) The surrogate mother needs to have carried one previous birth to term.
C) You both need to be infertile to be eligible for surrogate parenting.
D) Conception can take place outside the surrogate mother's body and then implanted.
E) The surrogate mother can be inseminated artificially with sperm from the intended father.