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Difficulty: HardLegal and Ethical Practice

A practical nurse (PN) on a medical-surgical unit receives a client transferred from a skilled nursing facility. The client has a soiled dressing and multiple unexplained bruises in various stages of healing on their torso. The registered nurse (RN), who is occupied with an unstable patient, directs the PN to complete the client's initial comprehensive admission assessment, explain the risks of an ordered blood transfusion to obtain the consent signature, and wait to discuss the bruises with the family before notifying the nursing supervisor. Which action by the PN correctly adheres to the legal and ethical scope of practice?

  1. Decline the delegations to perform the comprehensive assessment and explain the transfusion, and immediately report the suspected abuse to the appropriate facility authority.Answer
  2. B
    Complete the initial comprehensive admission assessment to assist the RN, but refuse to obtain the consent signature for the blood transfusion.
  3. C
    Explain the risks and benefits of the blood transfusion to obtain the client's signature, but independently report the bruises to the nursing supervisor.
  4. D
    Decline the delegated admission assessment, but wait to gather concrete proof from the family regarding the bruises before filing an official report.

Answer

The practical nurse must decline both out-of-scope delegations (the comprehensive assessment and the explanation of the transfusion) and fulfill the mandated duty to immediately report the suspected abuse without waiting for further proof.
The legally and ethically sound action addresses all three components of the scenario correctly. The PN must decline the comprehensive admission assessment as it is exclusively within the RN's scope of practice. The PN must also refuse to explain the risks of the blood transfusion, as obtaining informed consent is the responsibility of the healthcare provider, while the PN may only act as a witness to the signature. Finally, as a mandated reporter, the PN is legally required to immediately report the unexplained bruises (suspected abuse) to the appropriate authority without delaying to gather concrete proof.

Step-by-Step Solution

1
Evaluate the RN's delegation of the initial comprehensive admission assessment.
The PN identifies that comprehensive admission assessments fall outside their scope of practice.
The Nurse Practice Act restricts initial comprehensive assessments and care planning to RNs; PNs may only contribute to data collection.
2
Evaluate the directive to explain the blood transfusion risks and obtain the consent signature.
The PN recognizes this as an inappropriate delegation and a misunderstanding of the informed consent process.
The healthcare provider is legally responsible for explaining the risks, benefits, and alternatives of a procedure. The PN's role is strictly limited to witnessing the client's voluntary signature after the provider's explanation.
3
Evaluate the RN's instruction to delay reporting the unexplained bruises until speaking with the family.
The PN identifies this as a direct violation of mandatory reporting laws.
Nurses are mandated reporters. Suspicion of abuse alone triggers the legal obligation to report immediately to the designated authority; requiring concrete proof or investigating further is not the nurse's role and places the client at risk.

Key Concept

Scope of Practice, Informed Consent, and Mandatory Reporting
Estimated Time:1m 30s
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Topics

Legal and Ethical Practice

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