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Difficulty: MediumLegal Rights and Responsibilities

A nursing supervisor is conducting a chart audit focused on client rights and ethical practice within a medical-surgical unit. Which of the following documented actions by the nursing staff indicate correct adherence to legal responsibilities? Select all that apply.

  1. Providing a competent client with the facility's release form after the client states an intent to leave before medical dischargeAnswer
  2. B
    Waiting to notify protective services about suspected elder abuse until the client's family confirms the allegations
  3. Verifying that a client has voluntarily signed the surgical consent document before administering a prescribed preoperative sedativeAnswer
  4. D
    Delegating the task of explaining the risks of a routine blood transfusion to the unlicensed assistive personnel (UAP)
  5. E
    Applying bilateral soft wrist restraints to a restless client pulling at a urinary catheter before attempting verbal reorientation
  6. Documenting a cognitively intact adult client's explicit refusal to undergo a scheduled diagnostic imaging procedureAnswer

Answer

The correct actions are providing the AMA release form to a client wanting to leave, verifying the surgical consent is voluntarily signed before giving sedatives, and documenting a competent client's refusal of a diagnostic procedure.
These actions correctly uphold the principles of client autonomy, self-determination, and informed consent. Competent clients have the legal right to refuse treatment or leave a facility against medical advice, and the nurse must facilitate this safely. Furthermore, obtaining informed consent requires the nurse to verify that the client signed voluntarily before any mind-altering medications are given.

Step-by-Step Solution

1
Identify the core legal principles being assessed in the scenario.
The scenario tests informed consent, the right to refuse treatment, mandatory reporting, appropriate delegation, and restraint guidelines.
Recognizing the underlying legal standard is required to evaluate whether each documented nursing action is a violation or appropriate.
2
Evaluate the actions regarding client autonomy and self-determination.
Providing an AMA form and documenting a refusal of testing are both legally correct actions supporting client autonomy.
Competent adults have the absolute legal right to refuse care or leave the facility against medical advice.
3
Evaluate the action regarding informed consent.
Verifying a voluntary signature before administering preoperative sedatives is correct.
Consent must be given by a competent individual. Administering sedatives alters cognition, making any subsequent consent legally invalid.
4
Evaluate the remaining actions for violations of safety or reporting mandates.
Waiting to report abuse, delegating education to a UAP, and skipping restraint alternatives are all violations.
Nurses are mandatory reporters (no proof needed), teaching cannot be delegated, and restraints legally require the prior failure of less restrictive measures.

Key Concept

Client autonomy, mandatory reporting, and safe practice boundaries
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Topics

Legal Rights and Responsibilities

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