Ethical Practice Within Scope
Help Questions
NCLEX-PN › Ethical Practice Within Scope
A 64-year-old client in a long-term care facility has early dementia but is able to answer simple questions and has not designated a healthcare proxy. The client's neighbor arrives at the nurses' station and asks whether the client "is getting worse" and what medications the client is taking. Facility policy prohibits sharing health information without the client's permission. Which action should the nurse take to maintain client confidentiality?
Explain the medication list to the neighbor because the neighbor visits often and helps with errands
Ask the client if they want the nurse to share information with the neighbor and follow the client's decision
Provide a general statement that the client is stable but do not discuss medications
Give the neighbor the social worker's extension and share the client's diagnosis so the neighbor understands the situation
Explanation
This question tests ethical practice within the scope of the LPN/VN, addressing confidentiality for clients with cognitive changes. The ethical principle is confidentiality, guided by facility policy requiring client permission before sharing health details, even with frequent visitors. Option B is the most ethical as it seeks the client's decision, respecting autonomy despite dementia, and follows policy. Option A shares unauthorized information; C assumes helpfulness overrides privacy; D discloses diagnosis without consent. The framework involves assessing client capacity for simple decisions, obtaining permission, and documenting to prevent breaches. Escalate if the client cannot decide, involving proxies only if designated. A transferable strategy is to always confirm client wishes before sharing and use it as a teaching moment for ethical boundaries in care.
A 70-year-old client in a long-term care facility has an advance directive stating no feeding tube. The client now has difficulty swallowing after a stroke and the family asks the nurse to "go ahead and arrange a feeding tube" because they do not want the client to lose weight. Facility policy requires honoring documented directives and notifying the provider of changes in condition. Which action aligns with respecting the client's advance directives?
Tell the family the nurse will schedule the feeding tube because the family is acting in the client's best interest
Ask the family to sign a form overriding the advance directive so the procedure can proceed
Start tube feeding through a nasogastric tube immediately to prevent further weight loss
Explain that the advance directive must be followed, notify the provider of the swallowing change, and request a speech therapy evaluation per policy
Explanation
This question tests ethical practice within the scope of the LPN/VN, focusing on honoring advance directives amid family requests. The legal standard requires following documented directives and notifying providers of changes, not overriding without process. Option A is the most ethical as it explains the directive, notifies the provider, and requests evaluation, respecting autonomy. Option B assumes family override; C facilitates override; D starts without orders. The framework reviews directives, communicates respectfully, and escalates conflicts. Involve ethics if needed. A transferable strategy is to educate on directives and advocate for clients, promoting ethical resolution in care disputes.
A 66-year-old client on a medical unit has an advance directive requesting comfort-focused care only if the condition worsens. The client is now alert and tells the nurse, "I changed my mind; I want all treatments," but the written document has not been updated. Facility policy requires the nurse to report changes in wishes to the provider and document the client's statements. Which action aligns with respecting the client's advance directives?
Have the client sign a new advance directive form without involving the provider or following facility procedure
Tell the client the written directive cannot be changed and continue comfort measures only
Ask the family to decide whether the client is allowed to change the directive
Notify the provider of the client's updated wishes and document the discussion so the plan of care and orders can be reviewed
Explanation
This question tests ethical practice within the scope of the LPN/VN, concerning changes in advance directives. The legal standard allows alert clients to update wishes, requiring notification and documentation for review. Option B is the most ethical as it notifies the provider of changes and documents, facilitating plan updates. Option A dismisses verbal changes; C involves family; D bypasses procedure. The framework assesses capacity, reports changes, and follows policy. Ensure interdisciplinary involvement. A transferable strategy is to document verbal updates and escalate, supporting ethical flexibility in client decisions.
A 24-year-old client is admitted for dehydration due to gastroenteritis. The nurse is working with a UAP in a hospital setting and must follow delegation principles: stable clients and routine tasks may be delegated; assessment and evaluation remain with the nurse. What task can the nurse delegate to the UAP?
Initiate the peripheral intravenous line and start the ordered fluids
Collect a clean-catch urine specimen after providing instructions and label it per policy
Teach the client how to advance the diet and recognize signs of dehydration
Evaluate the client's response to intravenous fluids by assessing mucous membranes
Explanation
This question tests ethical practice within the scope of the LPN/VN, focusing on delegation in dehydration management. The legal standard reserves assessment, evaluation, and teaching for nurses, allowing UAP specimen collection. Option B is the most ethical as collecting urine is routine after instructions, per policy. Option A is evaluation; C involves IV initiation; D is teaching. The framework assesses task invasiveness, client stability, and delegation rights. Supervise to prevent errors. A transferable strategy is to delegate specimen tasks ethically, ensuring accurate diagnostics and team support.
A 40-year-old client is scheduled for a lumbar puncture on a hospital unit and says, "I heard people can be paralyzed from that. Is that true?" The provider is on the way but not yet present. Policy states the provider must answer questions about risks and alternatives; the nurse may clarify what has been taught and advocate for the client. How should the nurse proceed with client teaching on informed consent?
Tell the client paralysis is extremely rare and the client should not worry so the procedure is not delayed
Explain all potential complications and obtain the client's signature again to confirm understanding
Tell the client the nurse cannot discuss the procedure and leave the room until the provider arrives
Reinforce that the provider will explain risks and benefits, hold the procedure preparation, and notify the provider that the client has specific risk concerns
Explanation
This question tests ethical practice within the scope of the LPN/VN, addressing informed consent for invasive tests. The legal standard assigns risk discussions to providers, with nurses clarifying taught information and advocating for clients. Option B is the most ethical as it reinforces provider responsibility, holds preparation, and notifies of concerns, promoting informed choices. Option A minimizes risks; C exceeds scope; D avoids engagement. The framework identifies specific fears, advocates by notifying, and documents. Prioritize client safety in decisions. A transferable strategy is to bridge client-provider communication on risks, upholding ethical standards in procedural care.
A 58-year-old client is scheduled for a cardiac catheterization and tells the nurse, "I signed the form, but I don't really understand what they will do." The provider is not currently available on the unit. The nurse must stay within LPN/VN scope and facility policy, which states the provider obtains informed consent while nurses reinforce teaching and notify the provider of questions. How should the nurse proceed with client teaching on informed consent?
Ask the family to explain the procedure to the client since they were present for the consent discussion
Tell the client that signing the form means they already consented and the procedure will proceed as planned
Reinforce the basic purpose of the procedure using approved educational materials and notify the provider that the client has questions before proceeding
Explain the full risks, benefits, and alternatives in detail and have the client sign a new consent form
Explanation
This question tests ethical practice within the scope of the LPN/VN, concerning informed consent for procedures. The ethical principle is informed consent, requiring understanding of risks, benefits, and alternatives, with the provider responsible for obtaining it while the nurse reinforces teaching. Option B is the most ethical as it provides reinforcement using approved materials and notifies the provider of questions, staying within LPN/VN scope. Option A exceeds scope by explaining details and signing; C dismisses concerns; D inappropriately delegates to family. The framework involves assessing client understanding, reinforcing education, and escalating unanswered questions to the provider. Ensure documentation of teaching and client responses for legal protection. A transferable strategy is to advocate for client comprehension by facilitating provider discussions, promoting ethical consent processes in nursing.
A 27-year-old client is being treated in a community health clinic for a sexually transmitted infection and asks that no information be shared with their partner. Later, a person identifying as the partner calls and asks whether the client "tested positive." Clinic policy requires written authorization before disclosing protected health information. Which action should the nurse take to maintain client confidentiality?
Ask the partner to come to the clinic with identification so the nurse can discuss results privately
Explain that the clinic cannot confirm or discuss any patient information and offer general education about testing resources
Tell the partner to contact the local health department and provide the client's name and appointment date
Confirm the diagnosis but advise the partner to seek testing and treatment
Explanation
This question tests ethical practice within the scope of the LPN/VN, addressing confidentiality in sensitive diagnoses. The ethical principle is confidentiality, requiring written authorization for disclosure, even to partners, per clinic policy. Option B is the most ethical as it neither confirms nor discusses, offering general education, maintaining privacy. Option A discloses; C requires identification but risks breach; D directs to health department inappropriately. The framework assesses authorization, provides resources without specifics, and documents. Involve public health if mandated. A transferable strategy is to offer education neutrally, upholding ethical confidentiality in infections.
A 76-year-old client in a hospital is scheduled for a blood transfusion and asks, "What could go wrong with this?" The provider obtained consent earlier, but the client now appears unsure. Policy states the nurse may reinforce prior teaching and must notify the provider if the client has new questions or uncertainty. How should the nurse proceed with client teaching on informed consent?
Reinforce the reason for the transfusion and review common signs to report, then notify the provider that the client is expressing uncertainty before starting
Explain all risks, benefits, and alternatives and witness the client signing a new consent
Provide reassurance, start the transfusion, and explain possible reactions while the blood is infusing
Tell the client that transfusions are routine and there is nothing to worry about
Explanation
This question tests ethical practice within the scope of the LPN/VN, focusing on informed consent for transfusions. The legal standard requires provider involvement for new questions on risks, with nurses reinforcing prior teaching and notifying of uncertainty. Option C is the most ethical as it reinforces information, identifies uncertainty, and notifies the provider before proceeding, preventing uninformed consent. Option A minimizes concerns; B starts without addressing; D exceeds scope by explaining fully. The framework assesses client knowledge, provides reinforcement, and escalates to ensure informed decisions. Always document to support continuity. A transferable strategy is to monitor for consent doubts and advocate promptly, fostering ethical safety in procedures.
A 62-year-old client is scheduled for a central venous catheter insertion and says, "The doctor talked fast; I don't know what questions to ask." The provider is not in the room. Policy states the provider obtains informed consent; the nurse reinforces teaching and ensures the client has the opportunity to ask questions before the procedure. How should the nurse proceed with client teaching on informed consent?
Explain the procedure and all possible complications, then witness the consent signature as the client's understanding is now confirmed
Ask the client to sign the consent now so the procedure is not delayed and the provider can answer questions afterward
Tell the client to trust the provider's judgment and that questions are unnecessary
Review the client education handout, encourage the client to state concerns, and notify the provider that the client needs further discussion before proceeding
Explanation
This question tests ethical practice within the scope of the LPN/VN, concerning informed consent for invasive procedures. The ethical principle is informed consent, with nurses reinforcing teaching and ensuring provider addresses concerns before proceeding. Option B is the most ethical as it reviews materials, elicits concerns, and notifies the provider, promoting understanding. Option A pressures signing; C exceeds scope; D dismisses questions. The framework evaluates comprehension, facilitates discussion, and documents. Advocate for delays if needed. A transferable strategy is to encourage question-asking, enhancing ethical consent in procedural settings.
A 36-year-old client is admitted to a surgical unit and is scheduled for an appendectomy. The client says, "I do not want surgery; I want antibiotics only," and appears anxious. Policy states the client has the right to refuse and the provider must address treatment options; the nurse should not coerce the client. How should the nurse proceed with client teaching on informed consent?
Ask the family to convince the client to consent and have them sign as witnesses
Acknowledge the client's right to refuse, reinforce the purpose of the surgery as previously explained, and notify the provider immediately to discuss options
Document the refusal and cancel the surgery without informing the provider
Tell the client the surgeon will proceed because appendicitis is an emergency
Explanation
This question tests ethical practice within the scope of the LPN/VN, addressing informed consent in emergencies. The ethical principle is autonomy, allowing refusal with provider discussion of options, without coercion. Option B is the most ethical as it acknowledges refusal, reinforces purpose, and notifies promptly, upholding rights. Option A assumes proceeding; C involves family to coerce; D cancels without notification. The framework recognizes anxiety, supports decisions, and involves providers. Ensure documentation. A transferable strategy is to balance urgency with rights, promoting ethical advocacy in surgical consent.