TEST 1 - UNIT A - CH 3 - PROFESSIONAL RESPONSBILITIES (Leadership Book)

Question 1

Professional responsibilities

Answer 1

are the obligations
that nurses have to their clients.

Question 2

To meet their
professional responsibilities, nurses must be
knowledgeable in the following areas:

AACC DEIIIL

Answer 2

advance directives,
advocacy
client rights,
confidentiality
disruptive behavior
ethical practice.
information security,
information technology,
informed consent,
legal practice,

Question 3

Client rights are

Answer 3

the legal guarantees that clients have
with regard to their health care.

Question 4

◯ Clients using the services of a health care institution
retain
◯ Residents in nursing facilities that participate
in Medicare programs

Answer 4

-their rights as individuals and citizens of the
United States.
-similarly retain resident
rights under statutes that govern the operation of
these facilities.

Question 5

The American Hospital Association
(AHA) identifies client rights in health care settings

Answer 5

in
the Patient Care Partnership (www.aha.org).

Question 6

Nurses are accountable for

Situations that require particular attention
include

Answer 6

protecting the rights of
clients.

informed consent, refusal of treatment, advance
directives, confidentiality, and information security.

Question 7

Nurses must ensure that clients
Nurses also must

Answer 7

-understand their rights.
-protect clients’ rights during
nursing care.

Question 8

● Regardless of the client’s age, nursing needs, or the
setting in which care is provided, the basic tenants are
the same. Each client has the right to the following.

Answer 8

◯ Be informed about all aspects of care and take an
active role in the decision‑making process.
◯ Accept, refuse, or request modification to the
plan of care.
◯ Receive care that is delivered by competent
individuals who treat the client with respect.

Question 9

The Patient Self‑Determination Act (PSDA) stipulates that

-Competent
adults have the right to

Answer 9

on admission to a health care facility, all clients must be
informed of their right to accept or refuse care.

refuse treatment, including the
right to leave a health care facility without a prescription
for discharge from the provider.

Question 10

If the client refuses a treatment or procedure, the
client is asked to

The client should be informed of the following.

Answer 10

sign a document (AMA Against Medical Advice form) indicating that they understand the risk involved with refusing the treatment or procedure, and that they have chosen to refuse it.

Possible complications that could occur without treatment
◯ Possibility of permanent physical or mental impairment or disability
◯ Possibility of other complications that could lead to death

Question 11

● When a client decides to leave the facility without
a prescription for discharge, the nurse does what:

Answer 11

-notifies the provider and discusses with the client the potential
risks associated with leaving the facility prior to discharge.

-carefully documents the information that was provided to the client and that notification of the provider occurred.

Question 12

If the client refuses to sign the form, this is

Answer 12

also
documented by the nurse.

Question 13

Advocacy refers to

Answer 13

nurses’ role in supporting clients by
ensuring that they are properly informed,
that their rights are respected,
and that they are receiving the proper level of care.

Question 14

Advocacy is one of the most important roles of the
_______, especially when clients are unable to speak or act
for themselves.
● As an advocate, the nurse ensures that the client has_______

● Nurses must act as advocates even when ________
● The complex health care system puts clients in a
_______

Answer 14

Nurse

-the information they need to make decisions about
health care.
-they disagree with clients’ decisions.
-vulnerable position.

Question 15

Nurses are clients’ voice when the
system is

Answer 15

-not acting in their best interest.

Question 16

● The nursing profession also has a responsibility to
support and advocate for

Answer 16

legislation that promotes
public policies that protect clients as consumers and
create a safe environment for their care.

Question 17

As advocates, nurses must ensure that clients are

● Nurses must be careful to assist clients with making
health care decisions and not

Answer 17

-informed of their rights and have adequate information
on which to base health care decisions.

-direct or control their decisions.

Question 18

Nurses mediate on the client’s behalf when the actions
of others are

Answer 18

not in the client’s best interest or changes
need to be made in the plan of care.

Question 19

Situations in which nurses might need to advocate for
clients or assist them to advocate for themselves include
the following.

Answer 19

◯ End‑of‑life decisions
◯ Access to health care
◯ Protection of client privacy
◯ Informed consent
◯ Substandard practice

Question 20

Nurses are accountable for their actions even if they are

Answer 20

carrying out a provider’s prescription.

It is the nurse’s responsibility to question a prescription if it could harm a client (incorrect medication dosage, potential adverse
interaction with another prescribed medication,
contraindication due to an allergy or medical history).

Question 21

ESSENTIAL COMPONENTS OF ADVOCACY

skills

values

Answer 21

skills -
● Risk‑taking
● Vision
● Self‑confidence
● Articulate communication
● Assertiveness

values-Caring
● Autonomy
● Respect
● Empowerment

Question 22

Informed consent is a legal process by which

Answer 22

a client
has given written permission for a procedure or
treatment to be performed.

Question 23

Consent is considered to be
informed when the client has been provided with and
understands the following.

Answer 23

◯ Reason the treatment or procedure is needed
◯ How the treatment or procedure will benefit the client
◯ Risks involved if the client chooses to receive the
treatment or procedure
◯ Other options to treat the problem, including the
option of not treating the problem
◯ Risk involved if the client chooses no treatment

Question 24

The nurse’s role in the informed consent process is to

Answer 24

witness the client’s signature on the informed consent
form and to ensure that informed consent has been
appropriately obtained.

Question 25

Consent is required for

For most aspects of nursing care,

Answer 25

-all care given in a health care
facility.
-implied consent
is adequate.

Question 26

The client provides implied consent when

Answer 26

they comply with the instructions provided by the nurse.
For example, the nurse is preparing to administer a TB
skin test, and the client holds out their arm for the nurse.

Question 27

For an invasive procedure or surgery, the client is
required to provide
● __________ regulate who is able to give informed consent.
Laws vary regarding age limitations and emergencies.
Nurses are responsible for knowing the laws in the state
of practice.
● The nurse must verify that ________

Answer 27

-written consent.

-state laws

-consent is informed and
witness the client sign the consent form.

Question 28

The form for informed consent must be signed by a

WHAT ABOUT EMANCIPATED MINORS?

Answer 28

-competent adult.

◯ Emancipated minors (minors who are independent
from their parents [a married minor]) can provide
informed consent for themselves.

Question 29

The person who signs the form must be capable of

The person must be able to

Answer 29

-understanding the information provided by the health
care professional who will be providing the service.

-fully communicate in return
with the health care professional.

Question 30

When the person giving the informed consent is
unable to communicate due to a language barrier or
hearing impairment,

Answer 30

a trained medical interpreter
must be provided. Many health care agencies
contract with professional interpreters who have
additional skills in medical terminology to assist with
providing information.

Question 31

Individuals authorized to grant
consent for another person

Answer 31

Parent of a minor
● Legal guardian
● Court‑specified representative
● Client’s health care surrogate (individual who has the
client’s durable power of attorney for health care/health
care proxy)
● Spouse or closest available relative (state laws vary)

Question 32

INFORMED CONSENT RESPONSIBILITIES

PROVIDER

NURSE

CLIENT

Answer 32

ROVIDER - Obtains informed consent

NURSE - Witnesses informed consent

CLIENT - Gives informed consent

Question 33

PROVIDER: Obtains informed consent. To do so, the
provider must give the client the following.

Answer 33

Complete description of the treatment/procedure
● Description of the professionals who will be performing
and participating in the treatment
● Description of the potential harm, pain, and/or
discomfort that might occur
● Options for other treatments and the possible
consequences of taking other actions
● The right to refuse treatment
● Risk involved if the client chooses no treatment

Question 34

CLIENT: Gives informed consent. To give informed consent,
the client must do the following.

Answer 34

Give it voluntarily (no coercion involved).
● Be competent and of legal age, or be an emancipated
minor. (If the client is unable to provide consent, an
authorized person must give consent.)
● Receive sufficient information to make a decision based
on an informed understanding of what is expected.

Question 35

NURSE
● Witnesses informed consent. The nurse is responsible
for the following.

Answer 35

Ensuring that the provider gave the client the
necessary information
◯ Ensuring that the client understood the information
and is competent to give informed consent
◯ Having the client sign the informed
consent document
◯ Notifying the provider if the client has more questions
or does not understand any of the information
provided (The provider is then responsible for
giving clarification.)

Question 36

WITH REGARD TO INFORMED CONSENT, THE NURSE DOCUMENTS THE FOLLOWING:

Answer 36

Reinforcement of information originally given by
the provider
◯ That questions the client had were forwarded to
the provider
◯ Use of an interpreter

Question 37

The purpose of advance directives is to

Answer 37

communicate
a client’s wishes regarding end‑of‑life care should the
client become unable to do so.

Question 38

The PSDA (PATIENT SELF DETERMINATINO ACT) requires that all clients admitted to a health
care facility be asked if
◯ A client who does not have advance directives must be
given __
◯ A health care representative should be

Answer 38

• they have advance directives.
• written information that outlines their rights
  related to health care decisions and how to formulate
  advance directives.

-available to
help with this process.

Question 39

Two components of an advance directive are

Answer 39

the living
will and the durable power of attorney for health care.

Question 40

living will is a legal document that

Types of treatments that are
often addressed in a living will are those that have
the capacity to ___

Examples of treatments
that are addressed are

Answer 40

-expresses the client’s wishes regarding medical treatment in the
event the client becomes incapacitated and is facing
end‑of‑life issues.

-prolong life.

-cardiopulmonary resuscitation,
mechanical ventilation, and feeding by artificial means.

Question 41

Living wills are

However, state
statutes and individual health care facility policies can

Most state laws include provisions that

Answer 41

legal in all states.

vary. Nurses need to be familiar with their state statute
and facility policies.

health care providers who follow the health care directive in a living
will are protected from liability.

Question 42

A durable power of attorney for health care/health care
proxy is a l

Answer 42

egal document that designates a health care
surrogate, who is an individual authorized to make health
care decisions for a client who is unable.

Question 43

A durable power of attorney for health care/health care
proxy is a

Answer 43

Legal document that designates a health care
surrogate, who is an individual authorized to make health
care decisions for a client who is unable.

Question 44

The person who serves in the role of health care
surrogate to make decisions for the client should be
●

Answer 44

-very
familiar with the client’s wishes.

Question 45

Living wills can be difficult to interpret, especially in
the face of unexpected circumstances. A durable power
of attorney for health care, as an adjunct to a living will,
can be

Answer 45

a more effective way of ensuring that the client’s
decisions about health care are honored.

Question 46

● Unless a do not resuscitate (DNR) or allow natural death
(AND) prescription is written, the nurse should
● Additional prescriptions by the provider are based on the
client’s individual needs and decisions and provide for

Answer 46

initiate CPR when a client has no pulse or respirations.

comfort measures. The client’s decision is respected in
regard to the use of antibiotics, initiation of diagnostic
tests, and provision of nutrition by artificial means.

Question 47

The
written prescription for a DNR or AND must be placed

Answer 47

in the client’s medical record. The provider consults
the client and the family prior to administering a
DNR or AND.

Question 48

NURSING ROLE IN ADVANCE DIRECTIVES

Answer 48

Providing written information regarding advance
directives
● Documenting the client’s advance directives status
● Ensuring that advance directives are current and
reflective of the client’s current decisions
● Recognizing that the client’s choice takes priority when
there is a conflict between the client and family, or
between the client and the provider
● Informing all members of the health care team of the
client’s advance directives

Question 49

Clients have the right to

Answer 49

privacy and confidentiality in
relation to their health care information and medical
recommendations

Question 50

Nurses who disclose client information to an
unauthorized person can be

Answer 50

liable for invasion of
privacy, defamation, or slander.

Question 51

The security and privacy rules of the Health Insurance
Portability and Accountability Act (HIPAA) were enacted
to

Answer 51

protect the confidentiality of health care information
and to give the client the right to control the release of
information.

Question 52

Specific rights provided by HIPAA the legislation
include the following

Answer 52

The rights of clients to obtain a copy of their medical
record and to submit requests to amend erroneous or
incomplete information
◯ A requirement for health care and insurance providers
to provide written information about how medical
information is used and how it is shared with
other entities (permission must be obtained before
information is shared)
◯ The rights of clients to privacy and confidentiality

Question 53

NURSING ROLE IN CONFIDENTIALITY

Answer 53

It is essential for nurses to be aware of the rights of
clients in regard to privacy and confidentiality.

Question 54

Facility
policies and procedures are established in order to ensure

Answer 54

compliance with HIPAA regulations.

It is essential that
nurses know and adhere to the policies and procedures.
HIPAA regulations also provide for penalties in the event
of noncompliance with the regulations.

Question 55

The Privacy Rule of HIPAA requires that nurses

Answer 55

protect all
written and verbal communication about clients.

Question 56

COMPONENTS OF THE PRIVACY RULE

Answer 56

Only team members directly responsible
for client’s care - access to the client’s
records.
Nurses cannot share information with other
clients or staff not involved in the care of the client.
● Clients have a right to read and obtain a copy of their
medical record, - agency policy should be followed
when client requests read/copy of
the record.
● No part of client record can be copied except for
authorized exchange of documents between health care
institutions. For example:
◯ Transfer from a hospital to an extended care facility
◯ Exchange of documents between a general
practitioner and a specialist during a consult

Question 57

ADDITIONAL COMPONENTS OF THE PRIVACY RULE

Answer 57

Client medical records must be kept in a secure area to prevent inappropriate access to the information. Using public display boards to list client names and diagnoses is restricted.
● Electronic records should be password‑protected, and care must be taken to prevent public viewing of the information. Health care workers should use only their own passwords to access information.

Question 58

MORE COMPONENTS OF THE PRIVACY RULE

Answer 58

Client information cannot be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone.
◯ Many hospitals use a code system in which information is only disclosed to individuals who can provide the code.
◯ Nurses should ask any individual inquiring about a client’s status for the code and disclose information only when an individual can give the code.

Question 59

LAST COMPONENT OF PRIVACY RULE

Answer 59

Communication about a client should only take place in a private setting where it cannot be overheard by unauthorized individuals.
The practice of “walking rounds,” where other clients and visitors can hear what
is being said, is no longer sanctioned. Taped rounds also are discouraged because nurses should not receive information about clients for whom they are not
responsible.
Change‑of‑shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present.

Question 60

Health information systems (HIS) are used to

The clinical portion of the system is often referred to as the

The CIS can be used to

Answer 60

• manage
  administrative functions and clinical functions.

-clinical information systems (CIS).

-coordinate essential aspects of client care.

Question 61

● In order to comply with HIPAA regulations, each
health care facility has

Answer 61

specific policies and procedures
designed to monitor staff adherence, technical protocols,
computer privacy, and data safety.

Question 62

INFORMATION SECURITY PROTOCOLS

Answer 62

● Log off from the computer before leaving the workstation to ensure that others cannot view protected health information (PHI) on the monitor.
● Never share a user ID or password with anyone.
● Never leave a client’s chart or other printed or written PHI where others can access it.
● Shred any printed or written client information used for reporting or client care after it is no longer needed.

Question 63

The use of social media by members of the nursing
profession is common practice. The benefits to using
social media are numerous.

Answer 63

-It provides a mechanism for nurses to access current information about health care
-enhances communication among nurses, colleagues,
and clients and families.
-provides an opportunity for nurses to express concerns and seek support from others.

However, nurses must be cautious about the risk
of intentional or inadvertent breaches of confidentiality
via social media.

Question 64

The right to privacy is a

Invasion of privacy as it relates to health care is the

Confidentiality is the duty of

Answer 64

-fundamental component of client care.
-Release of client health information to others
without the client’s consent.
-the nurse to protect a client’s private information.

Question 65

The inappropriate use of social media can result
in a

Depending on
the circumstances, the consequences can include

Answer 65

breach of client confidentiality.

termination of employment by the employer,
discipline
by the board of nursing,
charges of defamation
or invasion of privacy,
federal charges for violation of HIPAA.

Question 66

Protecting yourself and others WITH REGARD TO INVASION OF PRIVACY BY:

Answer 66

Become familiar with facility policies about the use of social media, and adhere to them.
● Avoid disclosing any client health information online. Be sure no one can overhear conversations about a client when speaking on the telephone.
● Do not take or share photos or videos of a client.
● Remember to maintain professional boundaries when interacting with clients online.
● Never post a belittling or offensive remark about a client, employer, or coworker.
● Report any violations of facility social media policies to the nurse manager.

Question 67

Informatics is

The use of technology in health care is

Answer 67

• the use of computers to systematically
  resolve issues in nursing.

-increasing and most forms of
communication are in electronic format.

Question 68

Examples of how a nurse can use the electronic
format while providing client care include
● Databases on diseases and medications are available for
● The nurse can review medications, diseases, procedures,
and treatments using an
● Computers can be beneficial for use with clients who
have

Answer 68

-laptops for documentation and the use of an automated medication dispensing system to dispense medications.

-the nurse to review. These databases can also be used as
a teaching tool when nurses are educating clients.

-electronic format.

-visual impairments.

Question 69

The Internet is a valuable tool for clients to review

● Nurses should instruct clients to only review
● Clients can access their electronic health record (EHR)
which is part of

Answer 69

current medications and health questions. This is
especially true for clients who have chronic illnesses.

-valid and credible websites by verifying the author, institution,
credentials, and how current the article is. A disclaimer
will be presented if information is not medical advice.

-e‑health.

Question 70

E‑health enables the client to

The goal of e‑health is

Answer 70

make appointments online, review laboratory results,
refill an electronic prescription, and review billing
information.

improved health care outcomes due to 24 hr access by the client and provider to the client’s health care information.

Question 71

In order to be safe practitioners, nurses must understand
the
● Understanding the laws governing nursing practice
allows nurses to
● Nurses are accountable for practicing nursing in
accordance with

It is important that nurses know and comply with these laws.

Answer 71

legal aspects of the nursing profession.

-protect client rights and reduce the risk
of nursing liability.

-the various sources of law affecting
nursing practice.

Question 72

By practicing nursing within the confines of the law, nurses are able to do the following.

Answer 72

◯ Provide safe, competent care
◯ Advocate for clients’ rights
◯ Provide care that is within the nurse’s scope of practice
◯ Discern the responsibilities of nursing in relation to the responsibilities of other members of the health care team
◯ Provide care that is consistent with established standards of care
◯ Shield oneself from liability

Question 73

SOURCES OF LAW
Federal regulations
Some of the federal laws affecting nursing
practice include the following

Answer 73

HIPAA
● Americans with Disabilities Act (ADA)
● Mental Health Parity Act (MHPA)
● Patient Self‑Determination Act (PSDA)
● Uniform Anatomical Gift Act (UAGA)
● National Organ Transplant Act (NOTA)
● Emergency Medical Treatment and Active Labor
Act (EMTALA)

Question 74

Criminal law is a subsection of public law and relates to

Violations of criminal law can be categorized as either

EX: A nurse who falsifies a record to cover up a serious mistake can be found guilty of

Answer 74

-the relationship of an individual with the government.

-a felony (a serious crime [homicide]) or
misdemeanor (a less serious crime [petty theft]).

-breaking a criminal law.

Question 75

Civil laws protect the

-One type of civil law that relates to the provision of nursing
care is Torts can be classified as unintentional,
quasi‑intentional, or intentional.

Answer 75

-individual rights of people.

-tort law.

Question 76

Torts can be classified as

Answer 76

unintentional,
quasi‑intentional, or intentional.

Question 77

types of unintentional torts

Answer 77

Negligence:
● Malpractice:

Question 78

Unintentional torts
● Negligence:
● Malpractice:

Answer 78

Practice or misconduct that does not meet
expected standards of care and places the client at risk
for injury (a nurse fails to implement safety measures
for a client who has been identified as at risk for falls).

Professional negligence (a nurse
administers a large dose of medication due to a
calculation error. The client has a cardiac arrest and dies).

Question 79

types of quasi-intentional torts

Answer 79

Invasion of privacy: Intrusion into a client’s private
affairs or a breach of confidentiality (a nurse releases the
medical diagnosis of a client to a member of the press).
● Defamation: False communication or communication
with careless disregard for the truth with the intent to
injure an individual’s reputation.
◯ Libel: Defamation with the written word or
photographs (a nurse documents in a client’s health
record that a provider is incompetent).
◯ Slander: Defamation with the spoken word (a nurse
tells a coworker that she believes a client has been
unfaithful to the spouse).

Question 80

Invasion of privacy:

Defamation:

Answer 80

Intrusion into a client’s private
affairs or a breach of confidentiality (a nurse releases the
medical diagnosis of a client to a member of the press).

False communication or communication with careless disregard for the truth with the intent to injure an individual’s reputation.

Question 81

types of defamation

Answer 81

◯ Libel:
◯ Slander:

Question 82

◯ Libel:
◯ Slander:

Answer 82

-Defamation with the written word or
photographs (a nurse documents in a client’s health
record that a provider is incompetent).

Defamation with the spoken word (a nurse
tells a coworker that she believes a client has been
unfaithful to the spouse).

Question 83

types of intentional torts

Answer 83

Assault:
● Battery:
● False imprisonment

Question 84

Assault:
● Battery:
● False imprisonment:

Answer 84

-The conduct of one person makes another
person fearful and apprehensive (threatening to place a
nasogastric tube in a client who is refusing to eat).

-Intentional and wrongful physical contact with
a person that involves an injury or offensive contact
(restraining a client and administering an injection
against their wishes).

-A competent person not at risk for
injury to self or others is confined or restrained against
their will (using restraints on a competent client to
prevent their leaving the health care facility).

Question 85

The core of nursing practice is regulated by

Answer 85

state law.

Question 86

● The nurse should seek the assistance of an interpreter if

-

Answer 86

the client does not speak and understand the language
used by the provider.