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Difficulty: Very hardLegal and Ethical Practice

A practical nurse (PN) in a community health clinic is caring for an alert and oriented older adult client who has a fading, hand-shaped bruise on the upper arm. The client is accompanied by an adult child who continuously interrupts and answers questions on the client's behalf. The client's spouse, who is the legally appointed healthcare proxy, calls the clinic from another state requesting the client's recent diagnostic test results. Meanwhile, the healthcare provider has just discussed an upcoming elective minor procedure with the client and delegates the PN to obtain the client's signature on the informed consent form. When the PN presents the form, the client asks, 'What exactly are the risks of this procedure again?'

Which actions by the practical nurse are legally and ethically appropriate? (Select all that apply.)

  1. Request that the adult child step out of the room to interview the client privately regarding the bruise.Answer
  2. B
    Disclose the diagnostic test results to the spouse over the phone based on the healthcare proxy designation.
  3. Withhold the consent form and notify the provider to return and address the client's questions about procedural risks.Answer
  4. D
    Explain the potential complications of the procedure to the client before witnessing the signature.
  5. E
    Delay reporting the suspected abuse to state authorities until there is definitive evidence that the adult child caused the bruise.
  6. Obtain explicit permission from the client before sharing any medical information with the spouse.Answer

Answer

The legally and ethically appropriate actions are to request the adult child leave the room for a private interview, withhold the consent form to have the provider answer the client's questions, and obtain the client's explicit permission before sharing information with the spouse.
The correct actions reflect the practical nurse's legal scope of practice and ethical obligations in a multi-layered scenario. When elder abuse is suspected, especially with a domineering family member present, the nurse must separate the client to conduct a private assessment. Because the client is alert and oriented, the healthcare proxy is not active; therefore, the nurse must obtain the client's explicit permission before sharing any protected health information, even with a spouse. Finally, informed consent requires the provider to explain the risks and benefits. If a client expresses confusion, the nurse must not explain the medical risks, but instead act as a client advocate by withholding the form and notifying the provider to return and clarify.

Step-by-Step Solution

1
Evaluate the client's cognitive status regarding the healthcare proxy.
The client is alert and oriented, meaning the proxy is dormant and the client retains full privacy rights.
To determine who has legal access to the client's medical information under HIPAA.
2
Assess the situation regarding the suspicious bruise and the domineering adult child.
The nurse must separate the client from the child to ask about the injury privately and must report the suspicion to authorities immediately.
To ensure client safety and fulfill mandated reporting laws without requiring definitive proof.
3
Determine the appropriate response to the client's question about surgical risks during the consent process.
The nurse must stop the consent process and contact the provider.
Explaining medical risks is outside the PN scope of practice; the PN acts only as a witness to a fully informed signature.

Key Concept

Integration of Confidentiality, Mandated Reporting, and Informed Consent
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Topics

Legal and Ethical Practice

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