Quiz: Ethical and Legal Issues

Correct answer: Autonomy
Explanation: Autonomy requires respect for the client’s right to decide. Supporting a choice despite personal disagreement reflects self-determination. Beneficence, fidelity, and justice do not center on decision authority. High-Yield Tip: Supporting informed choices reflects autonomy.

Correct answer: Nonmaleficence
Explanation: Nonmaleficence means avoiding harm. Withholding an intervention due to high risk reflects harm prevention. Beneficence promotes good, autonomy respects choice, and veracity concerns truthfulness. The central issue is harm avoidance. High-Yield Tip: When avoiding harm is primary, think nonmaleficence.

Correct answer: Breach of confidentiality
Explanation: This scenario describes an unauthorized disclosure of protected health information, which is a breach of confidentiality. Confidentiality requires that client information be shared only with individuals who are involved in the client’s care or who otherwise have legal authorization to receive it. A visitor who is not part of the care team does not have a need to know the client’s diagnosis or reason for admission. Even if the information is accurate, disclosing it casually violates privacy expectations and can harm the client by exposing sensitive information.

Negligence involves failing to meet a standard of care through an unintentional act or omission, typically linked to client harm from inadequate care, not from disclosure. Informed refusal relates to a client choosing to decline a treatment after receiving information; it does not address staff sharing information with outsiders. Assault involves a threat of harm that causes fear, which is not present here. The core issue is improper release of information. Confidentiality breaches can occur through speech, written records, electronic access, or casual conversation. The correct approach is to avoid sharing any identifying or sensitive details with people who are not authorized, and to use privacy safeguards when communicating about clients within the care environment. High-Yield Tip: Only share protected health information with those directly involved in care or as legally permitted; casual disclosure to visitors is a confidentiality breach.

Correct answer: Battery
Explanation: Battery is intentional, nonconsensual physical contact. Performing a procedure after a client has refused it involves contact without permission and therefore fits battery. The critical legal point is that consent is required for treatment; when consent is absent or withdrawn, proceeding converts care into an unauthorized touching, even if the nurse believes the intervention is beneficial. This is why refusal must be respected and why clinicians must stop and clarify when a client says no.

Assault would apply if the client was threatened with the procedure and placed in fear before the contact occurred, but the stem describes the procedure actually being performed. Negligence refers to unintentional failure to meet standards and does not capture the intentional nature of proceeding despite refusal. Invasion of privacy involves improper intrusion or disclosure of private matters and is not primarily about unwanted touching. The scenario centers on unauthorized contact after refusal, which makes battery the most accurate match. Proper practice includes verifying consent, addressing concerns, documenting the refusal, and notifying the provider rather than proceeding without consent. Clinically, refusal should trigger assessment of understanding and concerns, and the care team should be notified so the plan can be adjusted. Proceeding after refusal removes voluntariness and can lead to complaints, disciplinary action, and legal claims. Respecting refusal and documenting actions taken is the safer and expected standard. High-Yield Tip: If a client refuses and the procedure is still performed, it is battery because it involves unwanted contact without consent.

Correct answer: Justice
Explanation: Justice involves fair and impartial distribution of resources. Allocation based on clinical criteria reflects fairness. Autonomy concerns choice, fidelity promises, and beneficence doing good. The focus here is fairness. High-Yield Tip: Resource allocation points to justice.

Correct answer: Veracity
Explanation: Veracity requires honesty regardless of outcome. Truthful disclosure maintains trust. Nonmaleficence focuses on harm avoidance, justice on fairness, and autonomy on decision-making rights. The defining action is truth-telling. High-Yield Tip: Honesty about errors is veracity.

Correct answer: Veracity
Explanation: Veracity requires honest communication. Providing truthful information allows realistic expectations. Fidelity involves promises, beneficence comfort, and justice fairness. The key action is honesty. High-Yield Tip: Truthful explanations demonstrate veracity.

Correct answer: Withhold resuscitative measures and provide comfort-focused care while following policy for notification
Explanation: A DNR order directs that resuscitative measures such as CPR are not initiated when arrest occurs. The appropriate response is to honor the order and focus on comfort measures and supportive care that align with the plan, while following policy for notification and documentation. Beginning CPR directly violates the DNR instruction. Waiting for family does not change the validity of the order and can create confusion and delay in providing appropriate comfort care. Calling a code and proceeding “until restated” undermines the purpose of having a DNR order in place and can result in unwanted interventions. The nurse’s responsibility includes recognizing the DNR status, ensuring it is accessible and communicated, and responding in a way that respects the client’s documented wishes. Comfort-focused care can include positioning, oxygen if used for comfort, symptom relief, and supportive presence, depending on the plan. The key legal-ethical point is honoring the documented order while ensuring appropriate communication and compassionate care. The nurse should ensure the order is confirmed, clearly communicated, and followed according to policy. Comfort-focused care does not mean “do nothing”; it means providing appropriate symptom relief and supportive measures consistent with the plan. Ignoring a valid DNR can result in unwanted interventions that conflict with documented wishes. High-Yield Tip: A DNR means do not initiate resuscitative efforts during arrest; continue comfort-focused care and follow facility policy.

Correct answer: Stop further preparation and notify the provider
Explanation: Consent is valid only while the client continues to agree, and a client has the right to withdraw consent at any time. When the client states they have changed their mind, the priority is to stop any further preparation that could lead to an unwanted procedure and to notify the provider so the plan can be reassessed. This response protects the client’s rights and prevents care from proceeding on an invalid consent. It also allows time for the provider to clarify information, address questions, and explore the client’s concerns in a way that supports informed decision-making and voluntariness.

Continuing preparation because a form was signed ignores the current refusal and risks proceeding without valid consent. Asking family members to convince the client introduces pressure and can compromise voluntariness; consent must be free from coercion. Even well-meaning persuasion can make the client feel forced and can invalidate the decision process. Discharging the client immediately is not appropriate because the client may still require clinical assessment, alternative care, pain control, or stabilization; discharge decisions involve provider evaluation and safe planning, not a quick response to refusal. The best action is to stop preparation, ensure the refusal is communicated promptly, and document the client’s decision and the steps taken. High-Yield Tip: A client can withdraw consent at any time, including immediately before a procedure; stop preparation and notify the provider.

Correct answer: Verify authorization and share only what is needed in a private setting
Explanation: Confidentiality allows sharing protected information only when properly authorized and for an appropriate purpose. If a client wants information shared with a visitor, the safe action is to verify the client’s authorization using facility procedures and then disclose only the information needed to meet the request, in a private manner. This approach respects the client’s wishes while still protecting privacy. Relying on a casual verbal request without verification can lead to misunderstandings, especially if the visitor’s relationship is unclear or if the client later disputes what was shared. Refusing all disclosure is unnecessary when the client is competent and authorizes it; the requirement is to disclose appropriately, not to withhold information absolutely. Posting results publicly violates confidentiality because it exposes protected information to unauthorized individuals. The “minimum necessary” mindset helps limit accidental over-disclosure: share what is required for the purpose, not everything in the chart. Following the correct process also supports documentation and accountability, since the nurse can show that the disclosure was authorized and handled safely. Confidentiality practices also include choosing appropriate locations for conversations and avoiding sharing more information than necessary. Clear authorization reduces misunderstandings and protects the nurse if questions arise later. The goal is to respect the client’s preferences while keeping control of who receives protected information and what details are disclosed. High-Yield Tip: Even when a client wants information shared, follow authorization procedures and disclose only the minimum necessary information in a private manner.