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Difficulty: MediumLegal and Ethical Practice

A practical nurse (PN) is providing home health care to a client who requires complex wound management and intravenous (IV) therapy. During the visit, several of the client's family members are present in the home. Which actions by the PN demonstrate adherence to legal and ethical practice standards? Select all that apply.

  1. Respecting the client's decision to refuse the wound dressing change and documenting the refusal in the medical record.Answer
  2. Immediately contacting the nursing supervisor after witnessing a family member forcefully grab the client's arm.Answer
  3. Asking the client for explicit permission before exposing the wound while family members are in the room.Answer
  4. D
    Leaving the client's printed clinical documents visible on a table while stepping outside to retrieve supplies.
  5. E
    Waiting to report suspected physical abuse until the client verbally confirms that the family member caused intentional harm.
  6. F
    Administering the initial dose of a newly prescribed intravenous push (IVP) medication to the client.

Answer

The correct actions are respecting the client's treatment refusal, immediately reporting the witnessed physical altercation, and asking for permission before exposing the client's wound in front of family.
The practical nurse legally and ethically complies with standards by respecting a competent client's right to refuse treatment, honoring their privacy by asking permission before exposing their body to others, and fulfilling the legal duty to immediately report suspected physical abuse.

Step-by-Step Solution

1
Evaluate the actions related to the PN's scope of practice and clinical delegation.
Identified that administering initial IV push medications is beyond the recognized scope for a practical nurse.
Scope of practice defines the legal boundaries of nursing interventions based on licensure.
2
Analyze the actions concerning client confidentiality and physical privacy.
Determined that leaving clinical documents visible violates HIPAA, whereas obtaining permission before exposing a wound appropriately protects client privacy.
Nurses are legally obligated to protect protected health information (PHI) and maintain client dignity.
3
Assess the responses to suspected client abuse.
Recognized that reporting forceful grabbing immediately is legally required, while delaying the report until receiving a verbal confirmation violates mandated reporting laws.
Mandated reporters must act on reasonable suspicion to protect vulnerable populations from immediate harm.
4
Review the action regarding the client's refusal of care.
Concluded that respecting and documenting a competent client's refusal of wound care upholds their right to autonomy.
The Patient Self-Determination Act protects a competent adult's right to accept or refuse medical interventions.

Key Concept

The practical nurse must operate strictly within their legal scope of practice while upholding core ethical principles, including mandatory abuse reporting, client confidentiality (HIPAA), and the right to autonomy.
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Topics

Legal and Ethical Practice

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