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Difficulty: HardLegal and Ethical Practice

During a home health visit, a practical nurse (PN) is caring for an older adult client who is recovering from a recent stroke. The client has designated an out-of-state relative as their durable power of attorney for healthcare. What actions should the PN take to maintain legal and ethical practice standards? Select all that apply.

  1. Verifying the identity of the out-of-state healthcare proxy before discussing the client's current care plan over the telephone.Answer
  2. B
    Providing a detailed explanation of the risks and benefits of a newly prescribed treatment before obtaining the client's signature on the consent form.
  3. Declining to answer a visiting neighbor's questions regarding the client's expected recovery timeline and newly prescribed medications.Answer
  4. D
    Postponing the report of newly discovered, suspicious bruising on the client's torso until the supervising registered nurse (RN) arrives for a visit the following week.
  5. E
    Accepting a telephone order directly from the physical therapist to administer a new intravenous (IV) pain medication.
  6. Honoring the client's decision to refuse their morning oral medications, documenting the refusal, and promptly notifying the healthcare provider.Answer

Answer

The correct actions include verifying the identity of the healthcare proxy before sharing information, declining to share medical details with the neighbor, and honoring the client's right to refuse medication.
The correct actions demonstrate strict adherence to legal and ethical standards. Verifying the healthcare proxy's identity and refusing to answer the neighbor's questions both protect the client's privacy in compliance with HIPAA. Honoring the client's refusal of medication respects the ethical principle of autonomy and the client's legal right to refuse care. Documenting this and notifying the provider completes the professional obligation.

Step-by-Step Solution

1
Analyze the scenario to identify the distinct legal and ethical domains being tested, including HIPAA, informed consent, scope of practice, and client rights.
Recognize that the PN must protect client information, act strictly within the LPN/LVN scope, and advocate for client autonomy.
Home health care frequently presents overlapping legal and ethical challenges that require the PN to apply professional boundaries independently.
2
Evaluate the options related to confidentiality and client rights.
Verifying the proxy's identity, declining to inform the neighbor, and honoring the refusal of medication all correctly uphold HIPAA laws and the ethical principle of autonomy.
Protected health information (PHI) can only be shared with authorized individuals, and competent clients retain the right to refuse care.
3
Evaluate the options related to the PN scope of practice and mandated reporting.
Explaining treatment risks, delaying the reporting of suspected abuse, and accepting a medication order from a physical therapist all violate legal statutes and professional scope.
PNs witness consent but do not obtain it, must report suspected abuse immediately, and can only accept medication orders from authorized prescribing providers.

Key Concept

Maintaining professional boundaries, confidentiality (HIPAA), mandatory reporting, and adhering to the LPN/LVN scope of practice in community settings.
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Topics

Legal and Ethical Practice

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