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Difficulty: MediumLegal Rights and Responsibilities

A nurse preceptor on a medical-surgical unit is evaluating the clinical decision-making of a newly licensed registered nurse (RN). Which actions by the newly licensed RN demonstrate appropriate adherence to legal rights and responsibilities? Select all that apply.

  1. Advocating for the use of an objective medical interpreter instead of allowing a client's adolescent child to translate surgical consent informationAnswer
  2. B
    Instructing the unlicensed assistive personnel (UAP) to assess whether a client fully comprehends the risks of an upcoming cardiac catheterization
  3. C
    Delaying a report to protective services regarding a pediatric client with suspicious spiral fractures until the healthcare provider can provide definitive proof of abuse
  4. Documenting the refusal of prescribed intravenous antibiotics by an oriented, legally competent adult client who expresses a desire to go homeAnswer
  5. Intervening immediately when two healthcare team members begin discussing a client's positive hepatitis C test results in a public hospital elevatorAnswer
  6. F
    Applying soft wrist restraints to a confused older adult client who is pulling at a urinary catheter before attempting to use a bed alarm or a bedside sitter

Answer

The correct actions that demonstrate adherence to legal rights and responsibilities are: advocating for an objective medical interpreter, documenting a competent client's right to refuse treatment, and intervening when client privacy is breached in a public space.
The newly licensed RN acts appropriately by advocating for a qualified medical interpreter to ensure true informed consent, respecting the legal right of a competent adult client to refuse prescribed therapies, and actively protecting client confidentiality by stopping a public discussion of private health data.

Step-by-Step Solution

1
Evaluate the action regarding informed consent and translation.
Using an objective medical interpreter rather than a minor family member is the legally and ethically correct action to ensure true informed consent.
Family members may lack medical vocabulary or introduce bias, compromising the client's right to make an informed decision.
2
Evaluate the action regarding delegation of assessment.
Delegating the assessment of a client's procedural comprehension to a UAP is a violation of the nursing scope of practice.
Assessment and evaluation are strictly RN responsibilities.
3
Evaluate the action regarding mandatory reporting of abuse.
Delaying a report of suspected child abuse to wait for definitive proof is a violation of mandatory reporting laws.
Nurses must report any reasonable suspicion immediately; they are not investigators.
4
Evaluate the action regarding a client's right to refuse treatment.
Documenting the refusal of antibiotics by a competent adult is legally appropriate.
Competent adults have a fundamental legal right to refuse any medical treatment, even if it is contrary to medical advice.
5
Evaluate the action regarding client confidentiality.
Intervening during a public discussion of a client's diagnosis upholds privacy laws.
Nurses are obligated to protect client health information from unauthorized disclosure under privacy laws such as HIPAA.
6
Evaluate the action regarding the use of physical restraints.
Applying physical restraints before trying less restrictive measures is a violation of the client's legal rights.
The law strictly mandates that restraints be used only as a last resort after exhausting and documenting alternative safety measures.

Key Concept

Nurses are legally accountable for protecting client rights, which includes ensuring true informed consent, maintaining confidentiality, reporting suspected abuse, honoring treatment refusal by competent adults, adhering to the legal scope of delegation, and using restraints only as a last resort.
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Topics

Legal Rights and Responsibilities

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