JURISPRUDENCE EXAM

JURISPRUDENCE EXAM CNO MISSION - ANS regulating nursing in the public interest 2 documents that provide the legislative framework for regulating nursing in Ontario: - ANS 1. Regulated Health Professions Act, 1991 2. Nursing Act, 1991 4 regulatory functions: - ANS 1. practice standards. 2. entry to practice. 3. quality Assurance Program. 4. enforcing standards 5 statutory committeess - ANS 1. Discipline 2. Fitness to Practice 3. Inquiries, Complaints, and Reports 4. Quality Assurance 5. Registration The Outreach Program provides ways for nurses to engage in _____________ ___________ by offering consultation and resources to help members practise according to the practice standards. - ANS nursing regulation COMPETENCY ASSUMPTIONS Entry-level RPNs possess the ________________ required to demonstrate the wide range of competencies in this document. - ANS knowledge COMPETENCY ASSUMPTIONS Entry-level RPNs are beginning practitioners whose level of autonomy and proficiency will grow through ______________ and ______________ from the interprofessional health care team. - ANS collaboration support COMPETENCY ASSUMPTIONS Entry-level RPNs are _____________ to practise safely, competently and ethically in situations of health and illness with individuals across the lifespan. - ANS prepared COMPETENCY ASSUMPTIONS Entry-level RPNs' practice decisions are _________-___________ and must take into account the environment, the client's circumstances and whether the client's needs can be met by the entry-level RPN. - ANS client-specific COMPETENCY ASSUMPTIONS Entry-level RPNs enter into practice with competencies that are _______________ across diverse practice settings. - ANS transferable COMPETENCY ASSUMPTIONS Entry-level RPNs have a _______________ ___________ in nursing, health and social sciences, ethics, leadership and research. - ANS knowledge base COMPETENCY ASSUMPTIONS Entry-level RPNs are committed to engaging in quality assurance practices, including ____________ _____________. - ANS Reflective Practice COMPETENCY ASSUMPTIONS Entry-level RPNs use ____________ _______________ skills to support clinical decision-making and reflect upon practice experiences. - ANS critical thinking The entry-level RPN is accountable for: All client __________ she or he provides. - ANS care The entry-level RPN is accountable for: All decisions about _____________ _________ to other care providers - ANS assigning care The entry-level RPN is accountable for: Knowing and recognizing her or his _______________ __________ (knowledge, skill and judgment) when making decisions and providing care to clients. - ANS competence level The entry-level RPN is accountable for: Actively identifying and asking ________________ of self, colleagues (including members of the Interprofessional health care team) and clients. - ANS questions The entry-level RPN is accountable for: The application of _____________ to ______________ via the use of critical thinking and problem-solving skills consistent with the RPN's educational preparation. - ANS theory to practice WHICH COMPETENCY STATEMENT? Demonstrates professional conduct; practises in accordance with legislation and the standards as determined by the regulatory body and the practice setting; and demonstrates that the primary duty is to the client to ensure consistently safe, competent and ethical care - ANS Professional Responsibility and Accountability WHICH COMPETENCY STATEMENT? Demonstrates competence in professional judgments and practice decisions by applying principles implied in the ethical framework, and by using knowledge from many sources. Engages in critical thinking to inform clinical decision- making, which includes both systematic and analytical processes, along with reflective and critical processes. Establishes therapeutic caring and culturally safe relationships with clients and health care team members based on appropriate relational boundaries and respect - ANS Ethical Practice WHICH COMPETENCY STATEMENT? Demonstrates an understanding of the concept of public protection and the duty to practise nursing in collaboration with clients and other members of the health care team to provide and improve health care services in the best interests of the public. - ANS Service to the Public WHICH COMPETENCY STATEMENT? Demonstrates an understanding of professional self-regulation by developing and enhancing one's competence, ensuring consistently safe practice, and ensuring and maintaining one's fitness to practise. - ANS Self-Regulation DEFINITION The obligation to answer for the professional, ethical and legal responsibilities of one's activities and duties. - ANS ACCOUNTABILITY DEFINITION Actively supporting a right and good cause; supporting others for speaking for themselves or speaking on behalf of those who cannot speak for themselves. - ANS ADVOCATE DEFINITION defining lines that separate the therapeutic behaviour of an RPN from any behaviour that, well-intentioned or not, could reduce the benefit of nursing care to clients, families or communities. - ANS BOUNDARY DEFINITION Individuals, families, groups or entire communities across the lifespan who require nursing expertise. - ANS CLIENT DEFINITION To work together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her or his scope of practice. - ANS COLLABORATE DEFINITION An organized group of people bound together by ties of social, ethnic, cultural or occupational origin; or by geographic location. - ANS COMMUNITY DEFINITION The ability of a nurse to integrate the professional attributes required to perform in a given role, situation or practice setting. Professional attributes include, but are not limited to, knowledge, skill, judgment, values and beliefs. - ANS COMPETENCE DEFINITION Descriptions of the expected performance behaviour that reflects the professional attributes required in a given nursing role, situation or practice setting. - ANS COMPETENCY STATEMENTS DEFINITION Activities that are considered potentially harmful if performed by unqualified people. - ANS CONTROLLED ACTS DEFINITION Reasoning in which one analyzes the use of language, formulates problems, clarifies and explains assumptions, weighs evidences, evaluate conclusions, discriminates between pros and cons, and seeks to justify those facts and values that result in credible beliefs and actions. - ANS CRITICAL THINKING DEFINITION Includes, but is not restricted to age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief and disability. - ANS CULTURE DEFINITION The formal process that transfers authority to perform a controlled act. - ANS DELEGATE DEFINITION At every stage of life, health is determined by complex interactions among social and economic factors, the physical environment and individual behaviour. They do not exist in isolation from each other. These determinants, in combination, influence health status. - ANS DETERMINANTS OF HEALTH DEFINITION Practice that is based on successful strategies that improve client outcomes and are derived from a combination of various sources of evidence, including client perspective, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data. - ANS EVIDENCE-INFORMED PRACTICE DEFINITION All people sharing a common health issue, problem or characteristic. These people may or may not come together as a group. - ANS POPULATIONS DEFINITION A relationship that is professional and ensures the client's needs are first and foremost. The relationship is based on trust, respect and intimacy and requires the appropriate use of the power inherent in the health care provider's role. The professional relationship between RPNs and their clients is based on a recognition that clients (or their alternative decision-makers) are in the best position to make decisions about their lives when they are active and informed participants in the decision-making process. - ANS THERAPEUTIC RELATIONSHIP DEFINITION Expectations that contribute to public protection that inform nurses of their accountabilities and the public of what to expect of nurses. These apply to all nurses regardless of their role, job description or area of practice. - ANS NURSING STANDARDS What legislation governs health care information privacy in Ontario? - ANS Personal Health Information Protection Act, 2004 (PHIPA) TRUE OR FALSE? PHIPA permits the sharing of personal health information among health care team members to facilitate efficient and effective care. - ANS TRUE Which legislation provides a broad protection to quality of care information produced by a health care facility or a health care entity, or for a governing or regulatory body. - ANS Quality of Care Information Protection Act (QOCIPA) What is the purpose of the Quality of Care Information Protection Act (QOCIPA)? - ANS To promote open discussion of adverse events, peer review activities and quality of care information, while protecting this information from being used in litigation or accessed by clients. What is personal health information? - ANS Personal health information is any identifying information about clients that is in verbal, written or electronic form. TRUE OR FALSE? Clients have to be named for information to be considered personal health information. - ANS FALSE. Information is "identifying" if a person can be recognized, or when it can be combined with other information to identify a person. Personal health information can also be found in a "mixed record," which includes personal information other than that noted above. TRUE OR FALSE? When a nurse learns information that, if not revealed, could result in harm to the client or others, she/he must keep this information confidential within the therapeutic relationship. - ANS FALSE. He/she must consult with the health care team and, if appropriate, report the information to the person or group affected. TRUE OR FALSE? Nurses must explain to clients that information will be shared with the health care team and identify the general composition of the health care team. - ANS TRUE. TRUE OR FALSE. Nurses must report suspected child abuse. - ANS TRUE Child and Family Services Act, 1990 requires all health care professionals to report suspected child abuse to the Children's Aid Society; the Health Protection and Promotion Act permits reporting of certain conditions to the Medical Officer of Health. Your client with an acquired brain injury has been stabilized and is being transferred to another hospital for continuing care. The client is unconscious. Her husband is aware of the transfer, but does not know it is happening today. You tried to reach him by telephone, without success. Before the client is transferred, you want to share information about the care she received and the current plan of care with the nurse who will receive her. The client's cost for this transfer is being covered by private insurance, so you also need to share personal health information with the insurance company. How much information can you share, and with whom, under these circumstances? - ANS 1. the receiving hospital nursing staff. These nurses are members of the health care team; therefore, there is implied consent for the sharing of information with them to provide health care. You can, therefore, share her personal health information. 2. the insurance company. Express consent is required because this disclosure is not to a custodian and is not required to treat the client. Because the client is incapable of providing this consent, her husband (the substitute decision- maker) must provide express consent either in writing or verbally, before you share information. Since you cannot reach him, you may arrange her transfer. Once you obtain express consent from the husband, you may provide the information to an insurance company staff member. A man who received severe facial injuries in a motor vehicle crash arrives in your emergency room (ER). He is unable to communicate. No next of kin has come with him. A woman calls in distress and asks if her husband is a patient in your ER. She provides you with details that match the information on the man's identification. You believe she is the wife of the man with the facial injuries. Can you tell this woman that he is in the ER? - ANS Normally, a client would have an opportunity to request that the hospital not disclose that he is a client in the facility or his location within the facility. This information may be given out in this case, however, because it is reasonably necessary to provide care. Because the law permits disclosure that a person is a client in a facility, and his/her location and general health status, you may provide this information to the woman. PHIPA allows you to contact a friend or relative of an injured client for consent. You may provide more information if the woman indicates she is the person who can act as a substitute decision-maker for consent to treatment. Your client has reviewed his health record. You answered his questions to ensure he understood the record, but he wants corrections made to a consulting physician's note. What do you do? - ANS The issue is correcting a health record made by another health care professional. If the client requested a correction to your note, and you agreed with the correction the client requested, you could have the client write a correction and include it with the record or make the changes yourself. If you did not agree with the correction the client requested, then you can have the client make a note and append it to the record. You can then make a separate note regarding the client's request in the health record. A client does not have the right to correct an opinion or professional judgment by a health care professional. Because this is a note by another health care professional (the consulting physician), you cannot be certain about the accuracy of the information that the client wants corrected. You have two options in this case: you can either contact the health care professional who wrote the note and have this physician speak with the client about the corrections; or you can speak with the person responsible for ensuring compliance with PHIPA in your practice setting. You are an OHN. The manager of an employee who is your client has asked questions about the client's health condition. The manager has also asked if the client has medical notes to substantiate absences on particular dates. Can you provide this information to the manager? - ANS There are two issues here. The first is what is included in the definition of personal health information; the second is if a manager has access to personal health information. Medical notes to substantiate the employee's absences may be held in an employee's health file. If the medical note does not contain other personal health information (e.g., symptoms, treatment, diagnosis), then this information can be provided to the manager. Information concerning accommodation for the employee's needs may be given so the employer can make provisions to meet these needs. Accommodation information does not include the nature of the illness or the diagnosis. If there is personal health information included in the note, then the OHN can only provide the information that there were notes to substantiate the absences on the applicable dates. The manager is not entitled to any personal health information. This includes information about the nature of the illness, the diagnosis, the plan of treatment or any care provided; therefore, you cannot respond to any questions about the nature of the illness(es) or health condition(s). In this example, the nurse is the custodian and is responsible for maintaining the confidentiality of the client's personal health information. Providing information to the employer without the client's express consent is a breach of PHIPA. However, if a client would like personal health information to be given to the employer, then the client must give express consent to the nurse. In obtaining express consent, the nurse needs to clarify exactly which information the client is requesting be disclosed, and obtain written express consent that includes the employee's specific request. DEFINITION means by which the authority to perform a procedure is obtained or the decision is made to perform a procedure - ANS AUTHORIZING MECHANISM DEFINITION formal process that transfers the authority to perform a controlled act - ANS DELEGATION DEFINITION A client-specific order can be an order for a procedure, treatment, drug or intervention for an individual client - ANS DIRECT CLIENT ORDER DEFINITION an order for a procedure, treatment, drug or intervention that may be implemented for a number of clients when specific conditions are met and specific circumstances exist - ANS DIRECTIVE DEFINITION a prescription for a procedure, treatment, drug or intervention - ANS ORDER Which legislation contains a scope of practice statement that describes in a general way what the profession does and the methods that it uses? - ANS NURSING ACT WHAT IS "The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function." - ANS SCOPE OF PRACTICE STATEMENT HOW MANY CONTROLLED ACTS ARE SPECIFIED BY THE Regulated Health Professions Act, 1991? - ANS 13 HOW MANY CONTROLLED ACTS CAN A NURSE PERFORM? - ANS 3 WHAT ARE THE 3 CONTROLLED ACTS THAT NURSES CAN PERFORM? - ANS 1. Performing a prescribed procedure below the dermis or a mucous membrane. 2. Administering a substance by injection or inhalation. 3. Putting an instrument, hand or finger beyond the external ear canal, the point in the nasal passages where they normally narrow, the larynx, the opening of the urethra, the labia majora, the anal verge, or into an artificial opening into the body. WHAT ARE THE TWO CONDITIONS BY WHICH AN RPN CAN PERFORM A CONTROLLED ACT? - ANS 1. if initiated (see Appendix D) in accordance with conditions identified in the regulation; 2. if the procedure is ordered by a physician, dentist, chiropodist, midwife or NP. WHAT ARE THE EXCEPTIONS to the Need for Authorization UNDER WHICH AN RPN CAN PERFORM OTHER CONTROLLED ACTS? - ANS 1. EMERGENCY 2. STUDENT PRACTICING UNDER AN AUTHORIZE PERSON 3. when treating a member of a person's household and the procedure is within the second or third controlled act authorized to nursing; 4. when assisting a person with his/her routine activities of living and the procedure is within the second or third controlled act authorized to nursing; or 5. when treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment. There are four standards, each with accompanying indicators, that describe a nurse's accountabilities when performing any procedure, whether or not it requires delegation, what are they? - ANS 1. Appropriate health care provider 2. Authority 3. Competence 4. Managing Outcomes STANDARD STATEMENTS Nurses must consider each situation to determine if the performance of the procedure promotes safe client care, and if it is ______________ for a nurse to perform the procedure. - ANS appropriate STANDARD STATEMENTS Nurses ensure that they have the appropriate _______________ before performing procedures. - ANS authority STANDARD STATEMENTS Nurses ensure that they are ________________ in both the cognitive and technical aspects of a procedure prior to performing it. - ANS competent STANDARD STATEMENTS Prior to performing procedures, nurses ensure that they are able to identify the potential outcomes of procedures, have the authority and competence to ____________ the ________________ , or have the resources available to manage those outcomes. - ANS manage the outcomes 3 requirements of nursing documentation - ANS 1. documentation presents an accurate, clear and comprehensive picture of the client's needs, the nurse's interventions and the client's outcomes. 2. documentation of client care is accurate, timely and complete. 3. safeguard client health information by maintaining confidentiality and acting in accordance with information retention and destruction policies and procedures that are consistent with the standard(s) and legislation. DEFINITION therapeutic relationship that enables the client to attain, maintain or regain optimal function by promoting the client's health through assessing, providing care for and treating the client's health conditions. - ANS NURSING CNO'S 7 ETHICAL VALUES - ANS 1. client well-being; 2. client choice; 3. privacy and confidentiality; 4. respect for life; 5. maintaining commitments; 6. truthfulness; 7. fairness. TRUE OR FALSE? All nurses must respond to situations in the same way. - ANS FALSE. Not all nurses experience the same situation in the same way, and a situation that causes conflict, uncertainty or distress for some nurses may be straightforward for others. TRUE OR FALSE? Ethical disagreements between nurses are acceptable. - ANS TRUE. There is room for disagreement among nurses on how they weigh the different ethical values. But above all, nurses need to choose ethical interventions that meet the needs of clients. TRUE OR FALSE? It is always possible to find a conflict resolution that meets everyone's satisfaction. - ANS FALSE. It is not always possible to find a resolution to a conflict that satisfies everyone. At these times, the best possible outcome is identified in consultation with the client, and the health care team works to achieve that outcome. Nurses may still not be individually satisfied with the resolution; in this case, they need to examine why they're unsatisfied, and consider the possibility of taking follow-up action. TRUE OR FALSE. Clients are always the best people to make decisions about their own health. - ANS TRUE. If a client is competent, then they are the best person to make choices about their health, but... if a client is deemed incompetent, they a nurse must consult a substitute decision-maker WHAT SHOULD A NURSE DO IF THEY DISCOVER THAT A CLIENT'S WISHES CONFLICT WITH THEIR OWN PERSONAL VALUES? - ANS When a client's wish conflicts with a nurse's personal values, and the nurse believes that she/he cannot provide care, the nurse needs to arrange for another caregiver and withdraw from the situation. If no other caregiver can be arranged, the nurse must provide the immediate care required. If no other solution can be found, the nurse may have to leave a particular place of employment to adhere to her/his personal values. WHICH ETHICAL VALUE? facilitating the client's health and welfare, and preventing or removing harm. - ANS CLIENT WELL-BEING WHICH ETHICAL VALUE? self-determination and includes the right to the information necessary to make choices and to consent to or refuse care - ANS CLIENT CHOICE WHICH ETHICAL VALUE? limited access to a person, the person's body, conversations, bodily functions or objects immediately associated with the person - ANS PRIVACY AND CONFIDENTIALITY WHICH ETHICAL VALUE? means that human life is precious and needs to be respected, protected and treated with consideration - ANS RESPECT FOR LIFE WHICH ETHICAL VALUE? keeping promises, being honest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings. - ANS MAINTAINING COMMITMENTS WHICH ETHICAL VALUE? speaking or acting without intending to deceive. - ANS TRUTHFULLNESS TRUE OR FALSE. Omissions are as untruthful as false information. - ANS TRUE. WHICH ETHICAL VALUE? allocating health care resources on the basis of objective health-related factors - ANS FAIRNESS TRUE OR FALSE. In regards to ethical concerns, sometimes the best possible outcome may be the one that is least bad. - ANS TRUE. Sometimes a completely good outcome is impossible One of Joanne's clients in the psychiatric unit, John, confides to her that he is fascinated by young children, boys and girls. He tells Joanne he is afraid that he will hurt a child some day. Joanne brings that information to the team. A short time later, John is discharged. Some weeks following his discharge, Joanne notices that John is the ice-cream vendor in her neighbourhood. She is concerned for the children in the neighbourhood, her own as well as the others, and wonders what she should do. - ANS A. ASSESS There is no absolute duty to respect confidentiality. Confidential information can be disclosed when a person(s) is at serious risk. However, it is preferable if the client discloses the information. Joanne decides that she needs to know more about John's clinical situation and sees John's psychiatrist the next time she is working. The psychiatrist shares Joanne's concerns. With the information she has, Joanne thinks the dilemma is whether she should break client confidentiality to protect children from the threat of serious harm. Joanne is also concerned about John's well-being, now that he is living in the community and has found employment. As well, by disclosing confidential information, she will not have maintained a commitment to a client. Try to meet both her obligation to protect the public and to protect her client's confidentiality and well-being. Working with the mental health care team, Joanne would arrange for John to be assessed by the team to determine whether he poses a danger to children at this time. If the team determines that John poses a serious danger to children, it must then decide how to respond to this situation. John could be an involuntary client unless he agreed to be admitted to a psychiatric facility. If it were found that John does not pose a danger, then there is no justification to disclose confidential information. With this option, Joanne can begin to meet her obligations to the client and to the public. What is the simplest and most important practice a nurse can do to reduce contamination and spread of infection? - ANS Proper hand hygiene is the single most- important infection prevention and control practice. The spread of infection requires an _____________ ____________ - ANS infectious agent The infectious agent needs a ______________ where it can live, grow and reproduce - ANS reservoir The transmission of infection also requires a _______________ _________ - ANS susceptible host Factors that influence a person's ________________ include age; general physical, mental and emotional health; the amount and duration of exposure to the agent; and the immune status and inherent susceptibility of the individual. - ANS susceptibility How the infectious agent is transmitted from the reservoir to the susceptible host is called the ___________ of ___________________ - ANS mode of transmission Transfer requires a route for the infectious agent to exit the _____________ (a portal of exit), a mode of travel to the ________________ _______ (a mode of transmission) and a ___________ to enter the susceptible host (a portal of entry) - ANS reservoir susceptible host route WHICH MODE OF TRANSMISSION? Direct contact transmission involves contact between the infectious agent and the susceptible host. - ANS CONTACT TRANSMISSION WHICH MODE OF TRANSMISSION? involves contact of the conjunctivae or mucous membranes of the nose or mouth of a susceptible host with large particle droplets (larger than five microns) that contain an infectious agent - ANS DROPLET TRANSMISSION WHICH MODE OF TRANSMISSION? Food, water or medication contaminated with an infectious agent can act as a ________________ for transmission when consumed - ANS VEHICLE WHICH MODE OF TRANSMISSION? Small particle residue (five microns or smaller) of evaporated droplets may remain suspended in the _________ for long periods of time, or dust particles may contain an infectious agent. - ANS AIR WHICH MODE OF TRANSMISSION? insects may harbour an infectious agent and transfer it to humans through bites (for example, West Nile virus). - ANS VECTORBORNE The four major elements to preventive practice are: - ANS 1. HANDWASHING 2. PROTECTIVE BARRIERS 3. CARE OF EQUIPMENT 4. HEALTH PRACTICES OF THE NURSE DEFINITION a waterless antiseptic designed for application to the hands to reduce the number of viable micro-organisms. In Canada, such preparations usually contain 70 percent ethyl alcohol. - ANS ALCOHOL-BASED HAND RINSE DEFINITION a substance that destroys or stops the growth of micro-organisms on living tissue (for example, skin). - ANS ANTISEPTIC DEFINITION viruses found in blood which produce infection, such as hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). - ANS BLOOD-BORNE PATHOGENS DEFINITION an individual who is found to be colonized (culture-positive) for a particular organism, at one or more body sites, but has no signs or symptoms of infection. - ANS CARRIER DEFINITION a chemical agent with a drug identification number (DIN) used on inanimate (non-living) objects to kill micro-organisms. - ANS DISINFECTANT DEFINITION a process that destroys or kills some, but not all, disease-producing micro-organisms on an object or surface. - ANS DISINFECTION DEFINITION a circumstance of being in contact with an infected person or item in a manner that may allow for the transfer of micro-organisms, either directly or indirectly, to another person. - ANS EXPOSED DEFINITION an agent that destroys micro-organisms, especially pathogenic organisms. A product with the suffix "-cide" indicates that it is an agent that destroys the micro-organism identified by the prefix (for example, virucide, fungicide, bactericide). - ANS GERMICIDE DEFINITION the physical separation of infected individuals from uninfected individuals for the period of communicability of a particular disease. - ANS ISOLATION DEFINITION microscopic organisms such as bacteria, virus or fungus, commonly known as germs, that can cause an infection in humans. - ANS MICRO-ORGANISM DEFINITION thin sheets of tissue that line various openings of the body, such as the mouth, nose, eyes and genitals. - ANS MUCUS MEMBRANES DEFINITION infection acquired in a health care setting. - ANS NOSOCOMIAL INFECTION DEFINITION specialized clothing or equipment (for example, gloves, masks, protective eyewear, gowns) worn by an employee for protection against an infectious hazard. - ANS PERSONAL PROTECTIVE EQUIPMENT DEFINITION interventions implemented to reduce the risk of transmitting micro-organisms from client to client, client to health care worker, and health care worker to client. - ANS PRECAUTIONS CNO'S 8 RIGHTS - ANS 1. right client, 2. right medication 3. right reason, 4. right dose, 5. right frequency, 6. right route, 7. right site, 8. right time; DEFINITION any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer. - ANS MEDICATION ERROR DEFINITION giving the wrong medication - ANS ERROR OF COMMISSION DEFINITION not administering an ordered medication - ANS ERROR OF OMISSION error does not reach the client, but had it, the client could have been harmed - ANS NEAR MISS DEFINITION Undesirable physical reactions to health products, including drugs, medical devices and natural health products. - ANS ADVERSE REACTION DEFINITION Drugs that bear a heightened risk of causing significant client harm when they are used in error. - ANS HIGH ALERT MEDICATIONS DEFINITION A process that ensures that a second practitioner conducts a verification, either in the presence or absence of the first practitioner. - ANS Independent double-check. DEFINITION An order communicated via telephone by an authorizer who is not physically present to write the order. - ANS TELEPHONE ORDER WHAT MUST A NURSE POSSESS BEFORE ACCEPTING A TELEPHONE ORDER - ANS The person accepting the order must have knowledge of the client, including his or her health history and treatment plan. DEFINITION An interactive process of transferring client-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity of care and the safety of the client - ANS TRANSFER OF ACCOUNTABILITY DEFINITION An order that is communicated by an authorizer who is present in the practice environment but is unable to document the order. - ANS VERBAL ORDER MEDICATION TERMS The administration of an allergen by oral, inhaled or other route in which a positive test is a significant allergic response (for example, anaphylactic shock). - ANS Allergy challenge testing MEDICATION TERMS a prick/puncture procedure to determine allergies, if any. - ANS ALLERGY TESTING MEDICATION TERMS an intracutaneous injection to desensitize to an allergen - ANS DESENSITIZING INJECTION Because allergy testing and desensitizing injections carry a risk of adverse reactions, nurses must be able to do what? - ANS recognize side effects, intervene in the event of complications (for example, difficulty breathing, rash or anaphylactic shock) and manage outcomes. MEDICATION TERMS Any type of drug that the federal government has categorized as having a higher-than-average potential for abuse or addiction. Such drugs are divided into categories based on their potential for abuse or addiction. - ANS CONTROLLED SUBSTANCE MEDICATION TERMS A vaccine. - ANS IMMUNIZING AGENT MEDICATION TERMS Medications and preparations that do not require a prescription; for example, herbal therapies and acetaminophen. - ANS OVER THE COUNTER (OTC) DEFINITIONS A pharmacologically inert substance that has no physiological effect. - ANS PLACEBO DEFINITION Medications that are prescribed and administered as needed. - ANS PRN MEDICATION DEFINITION Dosages, frequencies or routes that are prescribed in ranges (for example, Gravol 50-100 mg for nausea). - ANS RANGE DOSES Most medications are not prescribed in range doses; however, range doses are used in situations in which the need for the amount of a drug varies from day to day or within the same day. Range doses give nurses the flexibility to administer the dose that best suits the assessment of the client. DEFINITION Administrating one's own medication. - ANS SELF-ADMINISTRATION TRUE OR FALSE? A nurse cannot teach a PSW how to administer medication. - ANS FALSE Nurses may teach UCPs medication administration, including the process of administration and documentation, as required. TRUE OR FALSE? If a nurse delegates medication administration to a PSW, they assume all the responsibilities related to med admin. - ANS FALSE The nurse remains responsible for the: - ongoing assessment of the client's needs; - plan of care in conjunction with the health care team; - evaluation of the client's health status; and - effectiveness of the medication(s). Reasons for using _____________ include protecting clients from injury, maintaining treatment and controlling disruptive behaviour. - ANS restraints Many facilities in Ontario use a __________ ____________ philosophy that the quality of life for each client, with the preservation of dignity, is the value guiding the practice of health care practitioners, including nurses. CNO supports this in all settings where nurses practise. - ANS least restraint DEFINITION physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body. - ANS RESTRAINT ___________ restraints limit a client's movement. These restraints include a table fixed to a chair or a bed rail that cannot be opened by the client. - ANS Physical ____________ restraints control a client's mobility. Examples include a secure unit or garden, seclusion or a time-out room. - ANS Environmental _____________ restraints are any form of psychoactive medication used not to treat illness, but to intentionally inhibit a particular behaviour or movement. - ANS Chemical ___________ _____________ means all possible alternative interventions are exhausted before deciding to use a restraint. - ANS Least restraint Jody, a three-year-old, is intubated post-operatively on a ventilator following brain surgery. To prevent her from pulling out the endotracheal tube, her hands are restrained with mittens. Prior to the surgery, the need to use the mittens was explained to her parents and consent was obtained. - ANS This is an appropriate use of restraints that will be discontinued as soon as possible. To avoid frightening the child, the nurse arranged for the family to reassure Jody during the post-operative period. As well, using language Jody could understand, the nurse explained to her why she had to wear mittens. There are circumstances in which a nurse may need to restrain clients when they are not capable of understanding the necessity for the intervention. The nurse needs to consider these situations carefully and use the least restraint possible. ___________ is critical in the nurse-client relationship because the client is in a vulnerable position. - ANS Trust ___________ is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem - ANS Respect ________ ____________ is inherent in the type of care and services that nurses provide. It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that create closeness. - ANS Professional intimacy ____________ is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client. - ANS Empathy The nurse-client relationship is one of unequal ___________. Although the nurse may not immediately perceive it, the nurse has more _____________ than the client. - ANS power power DEFINITION the misuse of the power imbalance intrinsic in the nurse-client relationship. It can also mean the nurse betraying the client's trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have known, the action could cause, or could be reasonably expected to cause, physical, emotional or spiritual harm to the client - ANS ABUSE DEFINITION the nurse-client relationship is the point at which the relationship changes from professional and therapeutic to unprofessional and personal. Crossing a _____________ means that the care provider is misusing the power in the relationship to meet her/his personal needs, rather than the needs of the client, or behaving in an unprofessional manner with the client. - ANS BOUNDARY DEFINITION In this approach, a client is viewed as a whole person. - ANS CLIENT-CENTRED CARE DEFINITION relationship involves planned and structured psychological, psychosocial and/or interpersonal interventions aimed at influencing a behaviour, mood and/or the emotional reactions to different stimuli - ANS PSYCHOTHERAPEUTIC RELATIONSHIP DEFINITION may include, but is not limited to, the person who a client identifies as the most important in his/her life. - ANS SIGNIFICANT OTHER Nurses use a wide range of effective _____________ _____________ and _____________ __________ to appropriately establish, maintain, re-establish and terminate the nurse-client relationship. - ANS communication strategies interpersonal skills Nurses work with the client to ensure that all professional behaviours and actions meet the _______________ needs of the client. - ANS therapeutic Nurses are responsible for effectively establishing and maintaining the limits or ______________ in the therapeutic nurse-client relationship. - ANS boundaries Nurses ______________ the client from harm by ensuring that abuse is prevented, or stopped and reported. - ANS protect TRUE OR FALSE. It is acceptable for a nurse to spend extra time with one client beyond his/ her therapeutic needs. - ANS FALSE. TRUE OR FALSE. Feeling other members of the team do not understand a specific client as well as you do is a warning sign that a nurse should be mindful of - ANS TRUE TRUE OR FALSE. Disclosing personal information to a specific client is a good way of getting a patient to open up to you. - ANS FALSE. TRUE OR FALSE. Finding yourself frequently thinking about a client when away from work is a sign of being overly attached to a client. - ANS TRUE TRUE OR FALSE. It is acceptable to spend time outside of work hours with a client. - ANS FALSE TRUE OR FALSE. Keeping secrets with the client and apart from the health care team (for example, not documenting relevant discussions with the client in the health record) is an example of crossing an ethical boundary. - ANS TRUE TRUE OR FALSE. Your client never has any visitors and discloses extreme loneliness, giving them your phone number so that they can call you when they're feeling down is a good way to boost their spirits. - ANS FALSE. When an unregulated care provider abuses a client, the nurse must ______________ to protect the client and notify the employer. - ANS intervene _____________ can take many forms, including verbal and emotional, physical, neglect, sexual and financial. - ANS Abuse WHAT KIND OF ABUSIVE BEHAVIOUR? ■ sarcasm; ■ retaliation or revenge; ■ intimidation, including threatening gestures/ actions; ■ teasing or taunting; ■ insensitivity to the client's preferences; ■ swearing; ■ cultural/racial slurs; and ■ an inappropriate tone of voice, such as one expressing impatience. - ANS VERBAL AND EMOTIONAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ hitting; ■ pushing; ■ slapping; ■ shaking; ■ using force; and ■ handling a client in a rough manner. - ANS PHYSICAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ non-therapeutic confining or isolation; ■ denying care; ■ non-therapeutic denying of privileges; ■ ignoring; ■ withholding clothing, food, fluid, needed aids or equipment, medication, and/or communication. - ANS NEGLECT WHAT KIND OF ABUSIVE BEHAVIOUR? ■ sexually demeaning, seductive, suggestive, exploitative, derogatory or humiliating behaviour, comments or language toward a client; ■ touching of a sexual nature or touching that may be perceived by the client or others to be sexual; College of Nurses of Ontario Practice Standard: Therapeutic Nurse-Client Relationship, Revised 2006 ■ sexual intercourse or other forms of sexual contact with a client; ■ sexual relationships with a client's significant other; and ■ non-physical sexual activity such as viewing pornographic websites with a client. - ANS SEXUAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ borrowing money or property from a client; ■ soliciting gifts from a client; ■ withholding finances through trickery or theft; ■ using influence, pressure or coercion to obtain the client's money or property; ■ having financial trusteeship, power of attorney or guardianship; ■ abusing a client's bank accounts and credit cards; and ■ assisting with the financial affairs of a client without the health care team's knowledge. - ANS FINANCIAL TRUE OR FALSE. UNDER NO CIRCUMSTANCES SHOULD A NURSE PROVIDE CARE FOR A SEXUAL PARTNER. - ANS FALSE. If a nurse's sexual partner is admitted to an agency where the nurse is providing care or services, the nurse must make every effort to ensure that alternative care arrangements are made. Until alternative arrangements are made, however, the nurse may provide care. TRUE OR FALSE. If a nurse does not have time to complete an act ordered to her, it is acceptable for her to delegate it to a PSW. - ANS FALSE. They cannot delegate an act that has been delegated to them - sub-delegation TRUE OR FALSE. It is acceptable for a nurse to delegate a patient's standard dose insulin injection to a family member. - ANS TRUE The RHPA includes an exception allowing UCPs to perform some controlled acts as long as they are considered to be routine activities of living. Procedures are considered to be routine activities of living when the need for, response to, and outcome of the procedure have been established over time and are predictable. For instance, administering the same dosage of insulin to a person with well-controlled diabetes over an extended period of time is a routine activity of living. It is not a routine activity if the dosage or type of insulin requires frequent adjustment. How many requirements must be met before a nurse can delegate to an UCP. - ANS 10 How many requirements must be met before a nurse can accept delegation? - ANS 7 DEFINITION They include a wide range of treatment modalities, such as herbal therapies and manual healing, such as reflexology and acupuncture. The therapies are not discipline-specific, and the knowledge required to provide them is not specific to nursing. - ANS COMPLEMENTARY THERAPIES TRUE OR FALSE? Consent from the client is required regardless if the therapy is requested by the client or proposed by a health practitioner - ANS TRUE. A client asks a nurse to perform an act that has an unknown risk, what two things should the nurse do? - ANS 1. refuse to follow the client's wishes if she/he believes it may cause harm. 2. share her/his reasons for this decision with the client. _________________ is demonstrated through one's decision-making processes, competency and integrity. It is reflected in accurate documentation and in the nurse's actions. - ANS Accountability 3 questions a nurse must ask herself when providing complementary therapy: - ANS 1. Is it appropriate to provide the complementary therapy? 2. Do I have the required knowledge, skill and judgment to provide this therapy safely and effectively? 3. Do I understand, and can I deal with, the possible outcomes of this therapy? You are a visiting nurse providing palliative care. Your client has been told by the health care team that there are no more "curative" treatment options available to him, and the plan of treatment is to provide comfort and support. The client is having great difficulty accepting this. He has heard about an unconventional treatment involving IV infusion of ozone and is asking you to provide this treatment. What should you do? - ANS The client is asking you to participate in an unconventional treatment. You have an obligation to explore with the client his understanding of the treatment and his reason for choosing it. It is important to seek guidance from your agency and colleagues, and as much information about the treatment as possible. If you are unable to obtain adequate information about this treatment to assess the risk and recognize that there may be a significant risk, you would determine that it is not appropriate to get involved in this treatment. You would then explain your decision to the client. You have completed Levels 1 and 2 of a therapeutic touch program. In the acute care setting where you work, you have identified some clients you think could really benefit from this intervention. Is it acceptable for you to suggest it to them? - ANS You may propose to a client the use of therapeutic touch if you have the knowledge to believe that the treatment would benefit the client, and therapeutic touch has been recognized by the acute care agency as an appropriate intervention. If the agency has not determined the appropriateness of this intervention, then you may advocate to have it recognized. In the long-term care setting where you work, some of the residents are prescribed herbal remedies by a physician who practises Chinese medicine. What are you accountable for in administering these substances? - ANS You must balance client choice with professional responsibility. At a minimum, you would need information about the purpose, action and anticipated effects of the substance to fulfil your professional responsibility to assess the risks and benefits of providing this treatment in relation to the health status of the client. You would also be responsible for evaluating the effects of the treatment. If you had access to sufficient information to meet this expectation, then you may agree to provide this treatment. One way to achieve this would be to arrange for a team conference with the physician to develop a plan of care related to the administration of the prescribed herbal substances. TRUE OR FALSE? All conflict is negative. - ANS FALSE. The experience of dealing with conflict can lead to positive outcomes for nurses, their colleagues and clients. Conflict between a nurse and a client can escalate if a client is: - ANS a) intoxicated or withdrawing from a substance- induced state; b) being constrained (for example, not being permitted to smoke) or restrained (for example, with a physical or chemical restraint); c) fatigued or overstimulated; and/or d) tense, anxious, worried, confused, disoriented or afraid. Conflict between a nurse and a client can escalate if a client has: - ANS a) a history of aggressive or violent behaviour, or is acting aggressively or violently (for example, using profane language or assuming an intimidating physical stance); b) a medical or psychiatric condition that causes impaired judgment or an altered cognitive status; c) an active drug or alcohol dependency or addiction; d) difficulty communicating (for example, has aphasia or a language barrier exists); and/or e) ineffective coping skills or an inadequate support network. Conflict between a nurse and a client can escalate if a nurse: - ANS a) judges, labels or misunderstands a client; b) uses a threatening tone of voice or body language (for example, speaks loudly or stands too close); c) has expectations based on incorrect perceptions of cultural or other differences; d) does not listen to, understand or respect a client's values, opinions, needs and ethnocultural beliefs;12 e) does not listen to the concerns of the family and significant others, and/or act on those concerns when it is appropriate and consistent with the client's wishes; f) does not provide sufficient health information to satisfy the client or the client's family; and/or g) does not reflect on the impact of her/his behaviour and values on the client. Nurses can employ client-centred care strategies to _______________ behaviours that contribute to the escalation of conflict. - ANS prevent Nurses can prevent the escalation of conflict by: continually seek to ________________ the client's health care needs and perspectives; - ANS understand Nurses can prevent the escalation of conflict by: __________________ the feelings behind the client's behaviour; - ANS acknowledge Nurses can prevent the escalation of conflict by: ask __________-_____________ questions to establish the underlying meaning of the client's behaviour; - ANS open-ended Nurses can prevent the escalation of conflict by: engage in ____________ _____________ (for example, use verbal and nonverbal cues to acknowledge what is being said); - ANS active listening Nurses can prevent the escalation of conflict by: use open ___________ ______________ to display a calm, respectful and attentive attitude; - ANS body language Nurses can prevent the escalation of conflict by: acknowledge the client's _______________ about the health care system and his/her experiences as a client; - ANS concerns Nurses can prevent the escalation of conflict by: _____________ and address the client's wishes, concerns, values, priorities and point of view; - ANS respect Nurses can prevent the escalation of conflict by: anticipate _______________ in situations in which it has previously existed and create a plan of care to prevent its escalation - ANS conflict Nurses can prevent the escalation of conflict by: _____________ to understand how her/his behaviour and values may negatively affect the client. - ANS reflect Conflict-management strategies should be individually ______________ to each client situation. Nurses need to use their _________________ ____________ to determine which strategy is most appropriate for each client. - ANS tailored professional judgment To manage conflict, a nurse can: implement a ____________ ______________ management plan; - ANS critical incident To manage conflict, a nurse can: remain calm and ______________ the client to express his/her concerns; - ANS encourage To manage conflict, a nurse can: __________ arguing, criticizing, defending or judging; - ANS avoid To manage conflict, a nurse can: focus on the client's _________________ rather than the client personally; - ANS behaviour To manage conflict, a nurse can: ____________ the client, the client's family and the health care team members in assisting with the behaviour and developing ______________ to prevent or manage it; - ANS involve solutions To manage conflict, a nurse can: state that abusive language and behaviours are ______________, if the nurse believes this will not ______________ the client's behaviour; - ANS unacceptable escalate To manage conflict, a nurse can: _________ ___________ from the client, if necessary (for example, to regain composure or to set personal space boundaries); - ANS step away To manage conflict, a nurse can: leave the situation to develop a ________ ___ ________ with the assistance of a colleague if the client intends to harm the nurse - ANS plan of care To manage conflict, a nurse can: protect themselves and other clients in abusive situations by ______________ services, if necessary - ANS withdrawing Poor relationships among members of the health care team negatively affect the ___________ ____ ___________. - ANS delivery of care DEFINITION Involving the client in making decisions based on the client's values, beliefs and wishes. - ANS ANTICIPATORY PLANNING DEFINITION Any act or verbal comment that could isolate or have negative psychological effects on a person. Bullying usually involves repeated incidents or a pattern of behaviour that is intended to intimidate, offend, degrade or humiliate a particular person or group of people. - ANS BULLYING DEFINITION Any sudden unexpected event that has an emotional impact that can overwhelm the usually effective coping skills of an individual or a group - ANS CRITICAL INCIDENT DEFINITION Interpersonal conflict among colleagues that includes antagonistic behaviour such as gossiping, criticism, innuendo, scapegoating, undermining, intimidation, passive aggression, withholding information, insubordination, bullying, and verbal and physical aggression. - ANS HORIZONTAL VIOLENCE The Health Care Consent Act (HCCA) The goals of the HCCA include promoting individual authority and ______________, facilitating __________________ between health care practitioners and their clients, and ensuring a significant ___________ for family members when the client is _______________ of ________________. - ANS autonomy communication role incapable of consenting The Health Care Consent Act (HCCA) The HCCA deals separately with consent to treatment, consent to a care facility and consent to a personal assistance service. In all cases, consent must be given by a _______________ person - ANS capable The Health Care Consent Act (HCCA) Consent to treatment, and assessing the capacity to consent to treatment, must relate to a specific treatment or plan of treatment. A person could be _____________ of giving consent to one treatment, but ________________ with respect to another. - ANS capable incapable The Health Care Consent Act (HCCA) Consent to treatment involves an ongoing process that can ________________ at any time. - ANS change The Health Care Consent Act (HCCA) Health care practitioners have no ___________________ to make treatment decisions on behalf of clients, except in an ________________ when no authorized person is available to make the decisions. Similarly, they have no __________________ to make a decision to consent to the admission of a client to a care facility, except in a ________________. - ANS authority emergency authority crisis The Health Care Consent Act (HCCA) _________________ the client's capacity to make a treatment decision is the responsibility of the health care practitioner proposing the treatment. - ANS Assessing The Health Care Consent Act (HCCA) An ___________________ determines client capacity to make a decision about admission to a care facility or a personal assistance service. Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) may be _________________. - ANS evaluator evaluators The Health Care Consent Act (HCCA) The client has the ______________ to ask the Consent and Capacity Board (CCB) to review the finding of _________________. - ANS right incapacity The Health Care Consent Act (HCCA) ______________ adjustments to a treatment plan for an incapable client can be made without having to seek repeated consent from a substitute decision- maker. - ANS Minor The Health Care Consent Act (HCCA) One health care practitioner can propose a plan of treatment and obtain consent to the plan on _____________ of all the health care practitioners involved in the plan. - ANS behalf The Health Care Consent Act (HCCA) When a health care practitioner finds a client is _________________ of making a treatment decision, the legislation requires the practitioner to provide the client with ___________________ about the consequences of the finding. This provision of information must be performed in accordance with __________________ established by the practitioner's governing body. - ANS incapable information guidelines The Health Care Consent Act (HCCA) A _______________ ________________ acting as a substitute decision- maker is not required to make a formal statement verifying his/her status. The legislation does contain a __________________ of substitute decision-makers. - ANS family member hierarchy The Health Care Consent Act (HCCA) A person's ________________ about treatment, admissions or personal assistance services may be expressed _____________, in ______________, in any other form, or they may be _______________. - ANS wishes orally writing implied The Substitute Decisions Act (SDA) An individual may _______________ a specific person to make decisions about his/her personal care or treatment in the event that he/she becomes _______________. The person may also express his/her wishes about the kinds of decisions to be made or factors to ______________ decisions. - ANS designate incapable guide The Substitute Decisions Act (SDA) The Office of the PGT is the government department that deals with ____________ ____________ and _________________ _____________. - ANS personal care property matters The Substitute Decisions Act (SDA) Only trained _____________ _______________ may determine capacity for the purpose of the SDA (i.e., the capacity to make decisions on an ongoing basis). The HCCA requires assessment of capacity to make decisions about a specific treatment. - ANS capacity assessors The Substitute Decisions Act (SDA) A ____________ _____ _______________ for personal care comes into _______________ when the person who granted it becomes mentally incapable, unless it states otherwise. - ANS power of attorney effect DEFINITION A person identified by the HCCA who may make a treatment decision for someone who is incapable of making his/her own decision. Usually a spouse, partner or relative. - ANS SUBSTITUTE DECISION-MAKER DEFINITION A board established by and accountable to the government. Its members are appointed by the government. The Board considers applications for review of findings of incapacity, applications relating to the appointment of a representative, and applications for direction regarding the best interests and wishes of an incapable person. - ANS Consent and Capacity Board (CCB) DEFINITION Two persons who are married to each other, or who are living in a conjugal relationship and have cohabited for at least a year, or who are the parents of a child or who have a cohabitation agreement under the Family Law Act. - ANS SPOUSE DEFINITION Two persons who have lived together for at least one year and have a close personal relationship that is of primary importance in both persons' lives. - ANS PARTNERS DEFINITION Two persons related by blood, marriage or adoption. - ANS RELATIVES DEFINITION The PGT is the substitute decision-maker of last resort for a mentally incapable person. The court will not appoint the PGT as guardian of property or guardian of the person unless there is no other suitable person available and willing to be appointed. - ANS Public Guardian and Trustee (PGT) DEFINITION Anything done for a therapeutic, cosmetic or other health-related purpose. - ANS TREATMENT DEFINITION A plan that is developed by one or more health care practitioners, dealing with one or more of the health problems that a person has and is likely to have. It provides for the administration of various treatments or courses of treatment. It may include the withholding or withdrawal of treatment in light of the person's health condition. - ANS PLAN OF TREATMENT DEFINITION A series or sequence of similar treatments administered to a person over a period of time for a particular health problem. - ANS COURSE OF TREATMENT DEFINITION Assistance with, or supervision of, hygiene, washing, dressing, grooming, eating, drinking, elimination, ambulating, positioning or any other routine activity of living. It may also include a group or plan of personal assistance services. - ANS PERSONAL ASSISTIVE DEVICE DEFINITION A legal document in which a capable person gives someone else the authority to make decisions about his/her personal care in the event that he/she becomes incapable. The document could also contain specific instructions about particular treatment decisions. - ANS Power of attorney for personal care DEFINITION The same as the power of attorney for personal care, except relating to decisions about property. - ANS Continuing power of attorney for property According to College of Nurses of Ontario (CNO) standards, nurses are accountable for __________ ______________ whether the intervention or service relates to a treatment (as defined in the HCCA or as required in common law), admission to a facility, or the provision of a personal assistance service. - ANS obtaining consent Consent is required for any treatment except treatment provided in certain ______________ _____________. - ANS emergency situations The consent must: ◗ __________ to the treatment being proposed; ◗ be ____________; ◗ be ____________; and ◗ not have been ______________ through misrepresentation or fraud. - ANS relate informed voluntary obtained The health care practitioner who proposes the treatment is responsible for taking ______________ __________ to ensure that treatment is not administered without ______________. - ANS reasonable steps consent If consent to admission to a care facility is required by la