Examkin

Question

Difficulty: Very hardLegal Rights and Responsibilities

A home-dwelling older adult with advanced Alzheimer's disease is admitted to the medical-surgical unit for sepsis. During the initial physical assessment, the nurse observes distinct, patterned thermal burns on the client's posterior thorax. The client's adult child, who is the legally designated healthcare proxy, becomes highly agitated, demanding that the nurse immediately apply bilateral wrist restraints "to stop them from ripping out the IV." The adult child then insists the nurse send the unlicensed assistive personnel (UAP) to feed the client their arrival meal immediately. Which response by the nurse represents the legally and professionally sound course of action?

  1. A
    Apply the wrist restraints based on the healthcare proxy's directive to prevent disruption of life-sustaining treatment, as the proxy assumes legal decision-making authority.
  2. B
    Delegate the initial feeding to the UAP to de-escalate the adult child's hostility while the nurse leaves the room to notify adult protective services.
  3. C
    Document the thermal injuries objectively in the electronic health record and await the attending physician's clinical evaluation before filing a state abuse report.
  4. Implement alternative safety measures instead of restraints, perform the initial feeding assessment personally, and immediately initiate an external report regarding the thermal injuries.Answer

Answer

Implement alternative safety measures instead of restraints, perform the initial feeding assessment personally, and immediately initiate an external report regarding the thermal injuries.
The correct response demonstrates a comprehensive understanding of multiple competing legal and ethical priorities. The nurse correctly identifies that a healthcare proxy cannot legally mandate restraints without clinical justification and a provider order. The nurse also protects their license and the client's safety by refusing to delegate an initial swallowing assessment in a client with altered mental status. Finally, the nurse fulfills the absolute legal mandate to report suspected elder abuse immediately upon discovery, without waiting for physician validation.

Step-by-Step Solution

1
Evaluate the legal validity of the healthcare proxy's demand for physical restraints.
Determine that restraints cannot be applied solely based on family demand.
Restraint application requires an independent clinical assessment demonstrating danger to self/others, failure of less restrictive alternatives, and a specific provider order.
2
Determine the legality of delegating the initial feeding task in this specific clinical scenario.
Identify that the feeding cannot be delegated to a UAP.
The client is a new admission with altered mental status, requiring an RN to perform the initial assessment of swallowing function and aspiration risk.
3
Establish the priority legal response to the discovery of patterned thermal burns.
Initiate an immediate mandatory report to Adult Protective Services or the designated state authority.
Nurses possess an independent, legal mandate to report suspected elder abuse immediately; this duty cannot be deferred to a physician or delayed for further internal investigation.

Key Concept

Synthesis of complex legal responsibilities including mandatory abuse reporting, scope of practice in delegation, and the legal parameters of restraint application.
Rate this question

Topics

Legal Rights and Responsibilities

More questions from this topic