Nursing Elites

1. Why might nurses not be the best choice to obtain informed consent from patients?

• A. Nurses may be tempted to influence the patient's decision in subtle ways.
• B. Nurses may not be able to answer some of the medical questions the patient asks.
• C. A signature obtained by anyone other than a physician will not stand up in court.
• D. Under the law, nurses are only allowed to act as witnesses to informed consent signatures.

Correct answer: B

Rationale: Nurses may not have the medical expertise to answer all the questions that patients may have regarding their treatment, which is a crucial aspect of obtaining informed consent. While nurses should not influence a patient's decision, it is not a major reason why they should not obtain informed consent. Signatures obtained by nurses are legally binding, and although nurses often act as witnesses, there is no legal restriction preventing them from obtaining informed consent itself.

2. What is the most important advantage of an advance directive?

• A. Such a directive indicates how medical decisions are to be made in case a patient is unable to communicate their wishes.
• B. It spares the family the burden of making significant decisions for a patient regarding terminal care.
• C. It ensures that a person's property is distributed according to their wishes after death, avoiding legal complications.
• D. It allows individuals to appoint a guardian for themselves in case of incapacity, without involving the court system.

Correct answer: B

Rationale: An advance directive, or living will, is a legal document that specifies an individual's preferences for medical treatment if they are unable to communicate their wishes. The most important advantage of an advance directive is that it spares the family from having to make challenging decisions about terminal care on behalf of the patient. Choice A is incorrect because advance directives pertain to healthcare decisions, not property matters. Choice C is incorrect as it refers to a will for property distribution, which is a different legal document. Choice D is incorrect as advance directives are not related to appointing guardians but rather focus on healthcare decision-making.

3. A newly hired nurse is being orientated in a community health center that provides care to the adjacent large Native American reservation/Canadian aboriginal reserve. Which statement by the nurse indicates a sound understanding of the Native American/First Nations population?

• A. I suppose that we will see a disproportionately high number of clients with lung and oral cancers.
• B. The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area.
• C. It is unfortunate that many of the older Native Americans/First Nations people are unlikely to have family members involved in their care.
• D. The unique skin pigmentation of Native Americans/First Nations people means that I will have to modify my assessment techniques.

Correct answer: B

Rationale: Diabetes, hypertension, and stroke are all higher than average in Native American/First Nations adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these older adults. The skin tone of Native American/First Nations people is not noted to require specific assessment techniques. The Native American population may have close family bonds.

4. How does the doctrine of respondent superior affect nurses?

• A. Liable for injury resulting from advice given to a member of a patient's family
• B. Responsible for double-checking the doses of medication ordered by a physician
• C. Responsible for the actions of the staff they supervise
• D. Obligated to obtain informed consent for any diagnostic procedure

Correct answer: C

Rationale: The correct answer is C. The doctrine of respondent superior holds that supervisors are accountable not only for their own actions but also for the actions of the staff they oversee. This means that nurses, as supervisors, are responsible for ensuring that the actions of their staff comply with established protocols and standards of care. Choices A, B, and D are incorrect because they do not directly relate to the principle of respondent superior. Nurses may have other responsibilities related to giving advice, medication administration, and obtaining consent, but the doctrine of respondent superior specifically pertains to the accountability of supervisors for the actions of their subordinates.

5. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite her lack of relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case?

• A. Larceny
• B. Assault
• C. Invasion of privacy
• D. Negligence

Correct answer: D

Rationale: In this case, the most likely relevant category of legal liability is negligence. Negligence involves the commission of an improper act, as exemplified by the nurse's actions of performing a procedure without the necessary education and experience, leading to permanent nerve damage for the client. Larceny refers to theft, assault involves a deliberate threat to harm, and invasion of privacy pertains to the violation of a person's right to privacy. Therefore, in this scenario, the nurse's actions align more closely with negligence.

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