Professional Practice and Legal-Ethical Standards
The Professional Practice and Legal-Ethical Standards domain tests whether you can apply the Nurse Practice Act, scope-of-practice rules, informed consent, confidentiality, and ethical frameworks to realistic bedside decisions. Questions often hinge on who may perform an action, what must be documented, and when to escalate rather than comply.
Core rules and concepts
- The state Nurse Practice Act and its board rules define legal scope. Institutional policy may be stricter but cannot expand scope. Know your state's delegation and LPN/UAP rules.
- Informed consent is the provider's responsibility to obtain. The nurse witnesses the signature, confirms the patient understands risks, benefits, and alternatives, advocates for unanswered questions, and documents.
- A competent adult may refuse any treatment. Respect autonomy, document the refusal and teaching, notify the provider, and continue monitoring. Do not conceal medication or coerce.
- HIPAA permits treatment, payment, and operations disclosures under the minimum-necessary standard. Legally required reporting duties, such as suspected abuse or impaired colleagues, are permitted exceptions.
- Restraints require a provider order, the least restrictive option, and monitoring. Violent/self-destructive restraints require a face-to-face evaluation within one hour and time-limited orders; never use restraints for convenience or as a fall substitute.
- Ethical principles include autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. Malpractice requires duty, breach, causation, and damages.
Worked example
A competent 68-year-old with COPD refuses a scheduled nebulizer, saying it makes him jittery. The nurse should not persuade him by withholding information or medicate covertly. She explores the concern, offers to notify the provider about an alternative delivery method, documents the refusal and teaching, and continues to assess respiratory status. If distress develops, she escalates. The legal and ethical priority is the competent patient's autonomy, paired with ongoing assessment and documentation.
Traps that cost marks
- Choosing 'obtain informed consent' for the nurse; the provider obtains it.
- Letting an adult child override a competent patient's refusal.
- Applying restraints for fall prevention or staffing convenience.
- Following an order that violates scope or policy; question and use the chain of command.