ANM Ethical and Legal Standards 4 — Questions and Answers
Question 1: A nurse manager is approached by a pharmaceutical sales representative offering gift cards to nurses who prescribe a specific medication. The ANM's response should be:
- Accept the gifts if the medication is clinically appropriate
- Decline and report the offer to compliance, as it represents a conflict of interest (Correct answer)
- Allow nurses to accept gifts under $25 as permitted by hospital policy
- Defer the decision to nursing staff since it is their individual choice
Correct answer: Decline and report the offer to compliance, as it represents a conflict of interest
Accepting gifts from pharmaceutical representatives creates conflicts of interest that compromise clinical objectivity and violates most hospital compliance policies and ANA ethics guidelines.
Question 2: Which of the following scenarios constitutes patient abandonment by a nurse?
- A nurse transfers care to an equally qualified nurse at the end of a shift
- A nurse refuses a dangerous patient assignment and reports safety concerns
- A nurse leaves the unit mid-shift without notifying supervisors or arranging coverage (Correct answer)
- A nurse takes a scheduled break while another nurse covers their patients
Correct answer: A nurse leaves the unit mid-shift without notifying supervisors or arranging coverage
Patient abandonment occurs when a nurse unilaterally terminates the nurse-patient relationship without ensuring continuity of care, such as leaving mid-shift without notice.
Question 3: The ANM is responsible for ensuring staff understand mandatory reporting requirements. Which of the following MUST be reported regardless of patient consent?
- A patient's positive HIV status to their sexual partners
- Suspected child abuse observed during patient assessment (Correct answer)
- A competent adult's history of prior domestic violence
- A patient's illegal drug use disclosed during nursing assessment
Correct answer: Suspected child abuse observed during patient assessment
Suspected child abuse is a mandatory reporting requirement in all U.S. states, superseding confidentiality obligations and not requiring patient or guardian consent.
Question 4: A night shift nurse calls in sick and no replacement is available. The ANM decides to mandate overtime for a nurse who has already worked 12 hours. Which ethical consideration is most relevant?
- Justice — the nurse must equally share the unit's staffing burden
- Nonmaleficence — fatigued nurses pose increased risk of errors and patient harm (Correct answer)
- Beneficence — requiring the nurse to stay benefits all patients on the unit
- Autonomy — the ANM has authority to mandate overtime as a management right
Correct answer: Nonmaleficence — fatigued nurses pose increased risk of errors and patient harm
Nonmaleficence requires considering that fatigue significantly increases medication error rates, placing both patients and the mandated nurse at increased risk.
Question 5: A nurse from a staffing agency makes a clinical error. From a legal liability standpoint, which party is most likely responsible?
- The staffing agency exclusively, as the nurse's direct employer
- The nurse personally, as an independent contractor without employer coverage
- Both the hospital and potentially the staffing agency, depending on contract terms and supervision (Correct answer)
- The physician who ordered the treatment the nurse implemented incorrectly
Correct answer: Both the hospital and potentially the staffing agency, depending on contract terms and supervision
Liability for agency nurse errors is typically shared between the hospital (which directs daily work) and the staffing agency, depending on contractual agreements and the degree of supervision.
Question 6: Which document legally designates another person to make healthcare decisions for a patient who loses decision-making capacity?
- A living will
- A durable power of attorney for healthcare (Correct answer)
- A physician's order for DNR
- A POLST (Physician Orders for Life-Sustaining Treatment) form
Correct answer: A durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) legally designates a surrogate decision-maker who acts on the patient's behalf when capacity is lost.
Question 7: An ANM learns that a nurse has been accessing the electronic health records of patients who are not under their care. This represents a violation of:
- The Joint Commission accreditation standards only
- HIPAA minimum necessary standard and patient privacy rights (Correct answer)
- Nursing scope of practice guidelines but not federal law
- Hospital policy only, with no legal consequences
Correct answer: HIPAA minimum necessary standard and patient privacy rights
Accessing records of patients not under one's care violates HIPAA's minimum necessary standard and constitutes unauthorized access to protected health information with potential civil and criminal penalties.
ANM Ethical and Legal Standards 4
A nurse manager is approached by a pharmaceutical sales representative offering gift cards to nurses who prescribe a specific medication.
The ANM's response should be: