Pediatric Nurse Professional and Legal Issues Questions and Answers — Questions and Answers
Question 1: A 10-year-old child with a new diagnosis of osteosarcoma is being considered for a clinical trial. The parents have provided informed consent. When the nurse explains the trial to the child in age-appropriate terms, the child states, 'I don't want to do it. I'm too scared.' What is the nurse's primary legal and ethical responsibility in this situation?
- Proceed with enrollment since the parents have already given legal consent.
- Inform the parents that their consent is invalid without the child's agreement.
- Document the child's refusal and notify the healthcare provider and research team immediately. (Correct answer)
- Ask the parents to convince the child to agree to participate in the trial.
Correct answer: Document the child's refusal and notify the healthcare provider and research team immediately.
Even with parental consent, a school-aged child who is developmentally capable should provide assent, which is their affirmative agreement to participate. A child's dissent (refusal) must be respected and communicated to the healthcare team. The parents' consent gives legal permission, but the child's lack of assent is ethically and often legally binding, preventing their enrollment in the research. Forcing participation would violate the ethical principle of autonomy and the child's rights.
Question 2: A pediatric nurse in the emergency department is caring for a 5-year-old child with a spiral femur fracture and multiple bruises in various stages of healing. The parent states the child fell off a slide. The nurse has a strong suspicion of child abuse. Which of the following is the nurse's priority action?
- Confront the parent with the suspicions to get a confession.
- Report the suspected abuse to the appropriate child protective services agency. (Correct answer)
- Wait for the physician to confirm the diagnosis of abuse before taking any action.
- Document the injuries and parental explanation in the chart only.
Correct answer: Report the suspected abuse to the appropriate child protective services agency.
Nurses are mandated reporters in all states and are legally required to report any reasonable suspicion of child abuse or neglect to the designated state agency, such as Child Protective Services. The nurse's report is based on suspicion, not confirmation, and it is the agency's responsibility to investigate. Delaying the report or waiting for others to act can endanger the child and may be a violation of the law.
Question 3: A 15-year-old female patient asks a clinic nurse for information about obtaining contraception. She explicitly asks that her parents not be informed. Which statement best guides the nurse's response?
- The nurse is legally required to inform the parents of any medical services provided.
- The nurse can provide the information but must obtain parental consent before a prescription is written.
- The nurse must first determine the specific laws regarding minor consent and confidentiality in their state. (Correct answer)
- The nurse should refuse to discuss contraception without a parent present to avoid legal issues.
Correct answer: The nurse must first determine the specific laws regarding minor consent and confidentiality in their state.
Laws regarding a minor's right to consent to healthcare and confidentiality, particularly for sensitive services like contraception, vary significantly from state to state. Some states allow minors to consent to contraceptive services without parental notification, while others have specific age or circumstantial requirements. Therefore, the nurse's first and most critical step is to be knowledgeable about and act in accordance with the laws of the state in which they practice.
Question 4: A family who are Jehovah's Witnesses refuses a medically necessary blood transfusion for their 8-year-old child who has life-threatening anemia following a trauma. This situation creates a conflict primarily between which two ethical principles?
- Justice and Fidelity
- Beneficence and Veracity
- Confidentiality and Justice
- Parental Autonomy and Beneficence (Correct answer)
Correct answer: Parental Autonomy and Beneficence
This scenario highlights a classic ethical conflict. Parental Autonomy is the right of the parents to make decisions for their child based on their values and beliefs. Beneficence is the duty of the healthcare provider to act in the best interest of the child and promote their well-being. In this case, the parents' autonomous decision conflicts with the provider's duty to provide life-saving treatment. While parents have the right to make decisions, this right is not absolute and the state can intervene to protect the child's life.
Question 5: Which of the following tasks falls outside the generally accepted scope of practice for a registered nurse (RN) on a pediatric floor and is typically reserved for an Advanced Practice Registered Nurse (APRN)?
- Administering a prescribed PRN dose of intravenous morphine for post-operative pain.
- Performing a comprehensive developmental screening using a standardized tool.
- Formulating a medical diagnosis of asthma and prescribing an initial treatment plan. (Correct answer)
- Providing education to a family about a new medication's side effects.
Correct answer: Formulating a medical diagnosis of asthma and prescribing an initial treatment plan.
Formulating a medical diagnosis and prescribing medications are advanced practice functions that fall within the scope of an APRN (such as a Pediatric Nurse Practitioner) or a physician. While a registered nurse is skilled in assessment, data collection, administering prescribed treatments, and patient education, they do not independently diagnose medical conditions or prescribe therapies.
Question 6: When documenting in a pediatric patient's electronic health record (EHR), which principle is most critical for legal protection?
- Charting only at the end of the shift to ensure a complete summary.
- Using common abbreviations to save time and space.
- Documenting assessments, interventions, and patient responses factually and contemporaneously. (Correct answer)
- Copying and pasting a previous note for a patient with a stable chronic condition.
Correct answer: Documenting assessments, interventions, and patient responses factually and contemporaneously.
For legal purposes, documentation must be accurate, objective, and timely (contemporaneous). Factual charting of what was assessed, what was done, and the patient's response provides the clearest and most defensible legal record. Delaying charting, using unapproved abbreviations, and copying previous notes can lead to inaccuracies, omissions, and legal vulnerabilities.
