Ch. 7 Nursing and The Law What Are the rules

26. An example of statutory law is a. informed consent. b. the Nurse Practice Act. c. a patient's right to refuse treatment. d. a hospital's written policies and procedures.

ANS: B The Nurse Practice Act, which governs the practice of nursing, is an example of statutory law. Informed consent and a patient's right to refuse treatment are examples of common law. Statutory law is developed by the legislative branch of the state and the U.S. Congress of the federal government. Written policies and procedures are created by the agency for which a nurse works.

3. In the following list, identify the instances of possible malpractice. (Select all that apply.) a. The nurse accidentally administers an excessively large dose of a prescribed medication, and the patient becomes comatose. b. The nurse runs a red light en route to work and causes an auto accident in which three people are seriously injured and one dies. c. The nurse notes the patient's poor capillary return distal to a cast, becomes busy and does not report it, and the patient later loses limb function. d. The nurse discusses a patient's condition in a disparaging way in a hospital elevator and is overheard by the patient's husband.

ANS: A, C Medication errors and failure to communicate important information, resulting in harm to the patient, are common sources of malpractice. Running a red light en route to work and causing a

24. A nursing student is assigned to care for a patient who requires several technical procedures. The student was busy and did not prepare in advance for the assignment. In preconference, the student is unable to describe the care to be given. The instructor would be justified in a. telling the student to be very careful during caregiving. b. sending the student off duty and turning the patient's care over to staff. c. suspending the student. d. dismissing the student from the program.

ANS: B The instructor is ultimately responsible for ensuring that the patient receives safe, effective care at the hands of the student. If the instructor has doubts created by the student's lack of preparation, the student should not be allowed to continue with the assignment.

6. A nurse is found liable for battery. What does this mean? a. The nurse threatened the patient, causing fear of bodily harm. b. The nurse, without consent, touched the patient in a way that caused harm. c. The nurse detained the patient against his will. d. The nurse incorrectly performed a procedure that is within her scope of practice.

ANS: B Battery is touch that causes actual physical harm to someone. Threatening a patient, causing fear of bodily harm, is assault. Detaining a patient against his will is false imprisonment. Incorrectly performing a procedure that is within the nurse's scope of practice is malpractice.

13. How should an LPN/LVN explain the term accountability to a student nurse? a. "Accountability is the transfer of responsibility for wrong actions." b. "Accountability is shared responsibility with the physician for wrongdoing." c. "Accountability is assuming personal responsibility for one's nursing actions." d. "Accountability is giving up responsibility when the situation dictates."

ANS: C Accountability means that one is answerable for one's actions. The other options do not correctly reflect the meaning of accountability.

2. An example of a criminal action committed by a nurse is a. restraining a patient without a physician's order. b. releasing information without the patient's consent. c. discontinuing a ventilator without a physician's order. d. making a medication error.

ANS: C Commission of a felony, such as murder, is clearly a criminal act. The other options represent examples of torts, or matters of civil concern.

18. The patient tells the nurse, "I want to make sure that my daughter can make health care decisions for me in the event I'm unable to make decisions for myself. What do I need to do?" The nurse should advise the patient that he or she needs to execute a/an a. living will. b. civil action. c. informed consent. d. durable medical power of attorney.

ANS: D A durable medical power of attorney names a health care proxy, an individual whom the patient wishes to make health care decisions for him or her when the patient is not able to make decisions. A living will sets forth the care the patient is willing and unwilling to receive but does not name a health care proxy. The remaining options have no relevance to the scenario.

9. The student nurse caring for a patient with a large decubitus ulcer photographs the ulcer without obtaining permission from the patient. The patient developed the ulcer while being cared for at home by her physician husband. The student plans to give the patient's history and use the photograph in a paper she is writing. The instructor explains to the student that this action is unacceptable and could result in a court action for a. battery. b. malpractice. c. negligence. d. libel.

ANS: D An intentional tort, libel is defined as defamation through written communication or pictures. Giving the history and showing the photograph could damage the reputation of the physician husband. Battery refers to doing bodily harm to the patient. Malpractice and negligence are unintentional torts.

11. Which of the following is an example of breach of duty? a. The LPN/LVN walks off the unit during the shift. b. The LPN/LVN resigns from the position. c. The LPN/LVN delegates duties to unlicensed assistive personnel. d. The LPN/LVN does not perform duties according to the standard of care.

ANS: D Breach of duty means the nurse did not adhere to the nursing standard of care. Walking off the unit during the shift refers to abandonment. Resigning from the position is a right of the nurse. Delegating duties according to the standard of care is not a breach of duty if it is permitted by the state Nurse Practice Act and is correctly performed.

1. To function within the scope of the law, the nurse must know that the legal duties and functions of the nurse in a given state are determined by the a. U.S. Constitution. b. Bill of Rights. c. bylaws of the professional organization. d. Nurse Practice Act of the state.

ANS: D The Nurse Practice Act of each state determines the scope of practice of RNs and LPN/LVNs in that state. The U.S. Constitution and the Bill of Rights are incorrect answers, because matters dealing with the health and welfare of its citizens are states' rights. Professional organizations may issue position papers, but these do not have the force of law.

8. Patient A, who has Alzheimer's disease, wanders and is often noisy and intrusive. The patient has a prn order for haloperidol (Haldol) IM for assaultive behavior. At report, the LPN/LVN charge nurse explains that staffing is poor and she is unable to provide the supervision the patient needs. She directs the medication nurse to administer the patient's prn haloperidol q4h during the shift. This action constitutes a. negligence. b. libel. c. assault. d. false imprisonment.

ANS: D This is false imprisonment, an intentional tort. Chemical restraint is a means of detaining a person against his or her will. Negligence is an unintentional tort. Libel is a type of defamation.Assault refers to threatening behavior.

28. A nurse damages a physician's reputation through false written communication without the physician's permission. This is an example of a. libel. b. assault. c. battery. d. slander.

ANS: A Libel is defamation through written communication or pictures. Assault is an unjustified attempt or threat to touch someone. Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge. Slander is defamation by verbalizing untrue or private information (gossip) to a third party.

27. An example of battery is a. a patient who refuses to be suctioned and is suctioned anyway after refusal. b. a patient who uses the call light and yells out repeatedly is threatened with bodily harm. c. a patient who threatens to leave the hospital against medical advice is told she will be restrained. d. a patient who refuses to take his medications is threatened with being forcibly given the medications.

ANS: A Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge. Assault is an unjustified attempt or threat to touch someone.

2. Individual A has worked as an LPN/LVN for a year. The agency where she works discovers that the registration document she presented at the time she was hired was altered to remove the name of the rightful registrant and show her name instead. What are the possible outcomes of this situation? (Select all that apply.) a. The state board of nursing, when notified, will charge the nurse with fraud and deceit. b. The agency will terminate the employment of the individual. c. The agency will notify all patients for whom the individual cared to determine injury. d. The individual will be arrested for misrepresentation. e. The individual's license to practice will be revoked.

ANS: A, B Obtaining the registration of license document and changing the name on the document so that one may represent herself as a nurse when she is not is fraudulent behavior. The agency will terminate the individual's employment, because she cannot continue to work as an LPN/LVN. The agency would not notify all patients for whom the individual cared to determine injury. Arrest would occur only if criminal charges are filed. The individual does not hold licensure, so revocation cannot occur.

4. Nurse A is assigned to care for a patient with diabetes who is being regulated on new types of insulin. The patient performs most of her own care and rarely uses the call bell to summon the nurse. The nurse knows this and leaves the patient unobserved most of the shift. Just before change of shift report, the aide reports that she cannot rouse the patient. The patient enters a vegetative state as the result of brain damage related to severe hypoglycemia. Which, if any, of the four elements needed to prove malpractice are present? (Select all that apply.) a. Duty b. Breach of duty c. Damages d. Proximate cause e. No elements are present

ANS: A, B, C, D The assignment for the nurse to care for the patient constitutes duty. Breach of duty is seen when the nurse fails to observe the patient as a prudent nurse would do. The vegetative state is the injury caused by the nurse's failure to act according to the standard of care. Proximate cause can be shown based on the nurse's failure to periodically observe the patient. It can be argued that early intervention to reverse the hypoglycemia would have prevented injury to the patient.

14. The instructor tells an SP/VN, "You have functioned at a substandard level of clinical performance recently. Now you have a chance to redeem yourself. I'm assigning you to a complex nursing situation. I expect you to function without asking for assistance." What is the most accurate assessment of the instructor's action? a. The action will enable the instructor to determine whether the student should pass or fail the course. b. The instructor is accountable for making an unsafe patient care assignment. c. It is an acceptable teaching practice to challenge students to higher levels of performance. d. The instructor should be investigated for fraud by the state board of nursing.

ANS: B Assigning an SP/VN to a complex nursing situation shows poor judgment. A complex nursing situation involves a patient whose clinical condition is unpredictable. Nursing care expectations are beyond what the LPN/LVN has learned during the educational program. An instructor is expected to make patient assignments based on student knowledge and ability to give safe nursing care and is expected to provide necessary supervision.

17. With regard to HIPAA implementation, the LPN/LVN who is newly employed at a health care agency should a. realize that enough was learned about the provisions of the act in school to function effectively at work. b. be aware that each agency may interpret HIPAA provisions somewhat differently. c. operate on the assumption that all agency privacy practices are similar. d. depend on the HIPAA website to provide all necessary job-related information.

ANS: B Because each agency may interpret HIPAA provisions somewhat differently, it is important for the nurse to become familiar with the facility's notice of privacy practices and function within its parameters. The remaining options are inadequate, because they do not address facility specifics.

25. Which statement is true regarding durable medical power of attorney and living wills? a. They set standards for care of terminally ill patients by nurses. b. They allow patients a voice about medical interventions after they are incapable of acting. c. They prevent occurrences of intentional torts. d. They complicate ethical decision making for nurses.

ANS: B Durable medical power of attorney and living wills are advance directives. Advance directives allow the individual to appoint a health care proxy and to make the individual's wishes about health care known. Advance directives do not set standards. Advance directives do not prevent intentional torts. Advance directives usually simplify ethical decision making for nurses.

21. What is the nurse's responsibility regarding an improper medical order that, if carried out, may harm a patient? a. The nurse must carry out the orders as written without questioning. b. The nurse must go directly to the physician and, if necessary, refuse to carry out the order. c. The nurse must go directly to the patient and ask the patient to make a decision about the order. d. The nurse should carry out the order and then immediately resign so as not to be held responsible.

ANS: B The nurse should deal directly with the physician who wrote the order. If this is unsuccessful, the nurse should use the nursing chain of command. Carrying out the orders as written without questioning is unsafe and may cause harm to the patient. Going directly to the patient and asking the individual to make a decision abut the order is unrealistic and inappropriate. Carrying out the order and then immediately resigning so as not to be held responsible is unsafe.

16. A patient tells the LPN/LVN, "I want you to bring my medical record so I can read it. I know HIPAA gives me the right to see it." The LPN/LVN should a. bring the record from the nurses' station to the patient within the hour. b. explain that the request will be made to the RN, who will follow agency policy. c. try to talk the patient out of seeing the record by offering to answer questions. d. tell the patient to make the request in writing to the physician.

ANS: B The patient's request must be honored, but agency protocol must be followed in doing so. Usually a physician or RN reviews the record with the patient to translate medical terminology and answer questions. Student nurses and LPN/LVNs do not provide the patient with the record.

4. A resident asks an LPN/LVN, "What is meant by the practical/vocational nurse's standard of care in a long-term care agency?" The LPN/LVN should respond, "The practical/vocational nurse who provides care for residents in a long-term care agency must implement care that is consistent with a. shortcuts acceptable to the agency that allow nurses to assume larger and more complex patient assignments." b. care that an ordinary, prudent LPN/LVN with the same education and experience would perform in similar circumstances." c. the minimum competency necessary to function as a health care giver in the state in which the nurse resides." d. customs of the agency in which the nurse is employed."

ANS: B This is the standard used by the courts, and it is the same regardless of the type of agency in which the nurse is employed. The other options do not define the nurse's standard of care.

20. The nurse discusses the patient's condition on the phone with the patient's brother. On learning this, the patient is upset, saying he has not spoken with his brother for years and does not want his brother to know anything about his condition. The nurse has a. slandered the patient. b. committed a felony. c. breached confidentiality. d. assaulted the patient.

ANS: C Confidentiality and privacy are the issues. HIPAA provides for only limited disclosure of patient health care information. Patient consent is required to disclose. Disclosure of information is not necessarily slander unless the nurse speaks of the patient in a derogatory way. A felony is a major crime. Assault involves threatening the patient.

19. The term used to describe a competent patient's agreement to have a surgical procedure after the physician explains the procedure, the desired outcome, possible complications, and possible alternative treatment is a. statute. b. competency. c. informed consent. d. standard of care.

ANS: C Informed consent requires that the individual receive all relevant information and be able to make a decision based on consideration of the information. Statute is a synonym for law. Competencyrefers to having the mental capacity to be able to make informed decisions. Standard of carerefers to that which a prudent nurse would do in a given situation.

7. A nurse who angrily tells a patient, "If you don't go to sleep, I'm going to give you an injection," can be accused of a. defamation. b. breach of confidentiality. c. assault. d. respondeat superior.

ANS: C The nurse has threatened the patient. Assault is an unjustified attempt or threat to touch someone.Defamation means damaging someone's reputation. Breach of confidentiality refers to revealing personal data to individuals not entitled to know without the patient's permission. Respondeat superior is a legal term meaning "let the master respond."

12. When documenting patient behavior, the LPN/LVN should a. record subjective interpretations of patient behavior. b. avoid mentioning communicating with supervisors to report changes in condition. c. record all interventions performed and patient instruction given. d. use Wite-Out to erase errors in documentation.

ANS: C The nurse should record all interventions and instructions given to the patient. Legally, if it is not documented, it cannot be proved that the care was given. Documentation should be objective. All patient-related communication with supervisors or physicians should be documented. Flow sheets must be marked appropriately.

10. Legally, student practical/vocational nurses are held to the level of performance a. described in the job description for nursing assistants. b. described in the outline/syllabus of the course in which the student is enrolled. c. of the LPN/LVN. d. of the LPN/LVN instructor.

ANS: C The standard of practice for the SP/VN is that of the LPN/LVN. Beginning practitioners are not held to a lesser standard. SP/VNs are not held to the same level of performance as nursing assistants. Holding the student practical/vocational nurse to the level of performance described in the outline/syllabus of he course in which the student is enrolled may not correspond to the Nurse Practice Act (although it should!). The instructor would be held to the standard for RNs.

3. A new LPN/LVN passes the NCLEX-PN examination and obtains licensure in state X. The LPN/LVN wishes to work in a state other than state X but is unsure of how to proceed. Which statement provides sound advice in this situation? a. The effect of current national licensure allows a nurse licensed in one state to work in any other state for a maximum of 2 years without applying for endorsement. b. The nurse can work legally in any state that borders state X without applying for endorsement. c. The nurse should contact the state board of nursing of the state in which she wishes to work to determine whether they have multistate licensure with state X. d. The nurse should apply to take the NCLEX-PN examination in the state in which she wishes to work.

ANS: C The state board of nursing of the state in which the LPN/LVN wishes to work can provide the essential information. Eighteen states have mutual recognition compacts, and Minnesota has a border recognition agreement. National licensure does not exist. A nurse working legally in any state that borders state X without applying for endorsement describes a border recognition agreement, such as the one in existence in Minnesota. It is unnecessary for a nurse to apply to take the NCLEX-PN examination; nurses can obtain endorsement without retaking the NCLEX-PN examination.

15. The instructor tells a student nurse, "You have functioned at a substandard level of clinical performance recently. Now you have a chance to redeem yourself. I'm assigning you to a complex nursing situation. I expect you to function without asking for assistance." The most appropriate response from the student nurse would be a. "I'll try my best, but I will need someone on staff to answer my questions." b. "Is this your way of asking for my resignation from the program?" c. "I cannot accept the assignment. Complex nursing situations are beyond my abilities." d. "You'd better remember that if anything goes wrong, the hospital will hold you responsible."

ANS: C The student nurse is obligated to refuse an assignment that is clearly beyond the scope of his or her abilities rather than jeopardize patient safety. Placing a student in a complex nursing situation without access to supervision is totally inappropriate.

5. Civil law is concerned with a. acts that threaten society. b. decision making based on the nursing process. c. intentional and unintentional torts. d. guilt associated with criminal behavior.

ANS: C Torts are civil wrongs and may be intentional (intended to cause harm) or unintentional (did not mean to do harm to the patient). Acts that threaten society are considered criminal acts. Civil law is not directly concerned with the nursing process. Civil law is concerned with liability rather than guilt.

1. Which statements are accurate with regard to a living will? (Select all that apply.) a. An attorney is required to draft a living will. b. Living wills are recognized as legal documents in Canada. c. A living will does not let the person select someone to make decisions for them. d. Living wills are recognized as legal documents in 47 states in the United States, the District of Columbia, and Guam. e. The living will is filled out by the individual and witnessed by a person who will benefit by the death of that individual. f. A living will is a legal document that describes the kind of medical or life-sustaining treatments the person would want if seriously or terminally ill.

ANS: C, D, F An attorney is not required to draft a living will. Living wills are not recognized as legal documents in Canada. A living will does not let the person select someone to make decisions for them. Living wills are recognized as legal documents in 47 states in the United States, the District of Columbia, and Guam. The living will is filled out by the individual and witnessed by a person who will not benefit by the death of that individual. A living will is a legal document that describes the kind of medical treatments or life-sustaining treatments the person would want if seriously or terminally ill.

30. Which of the following is true regarding informed consent? a. Informed consent must be obtained for surgical procedures only. b. Parents can give informed consent for the treatment of their children. c. Informed consent means the patient is informed in medical language. d. A patient is informed that he or she has the right to revoke consent at any time.

ANS: D Informed consent must be obtained for invasive procedures ordered for therapeutic or diagnostic purposes. Parents cannot give informed consent for the treatment of their children, but they can authorize their treatment up to a certain age (authorized consent). Informed consent means that the patient is informed in nonmedical language. The patient is told in nonmedical language that he or she has the right to revoke written permission at any time.

22. A risk management strategy a nurse can use to prevent being named in malpractice lawsuits is a. carrying malpractice insurance. b. requesting supervision for all care. c. not signing her or his name to patient medical records. d. maintaining good relationships with patients and families.

ANS: D One of the best defenses for prevention of legal liability is developing rapport with patients. A patient who was treated with respect and consideration is less likely to sue. Carrying liability insurance does not prevent lawsuits. Requesting supervision for all care is an impractical action. Not signing a name to patient's medical records is an impossibility.

29. A nurse damages a patient's reputation by verbalizing private information about the patient to a third party. This is an example of a. libel. b. assault. c. battery. d. slander.

ANS: D Slander is defamation by verbalizing untrue or private information (gossip) to a third party. Libelis defamation through written communication or pictures. Assault is an unjustified attempt or threat to touch someone.Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge.

23. The Nurse Practice Act of state X expressly states that blood products may be administered only by physicians, registered nurses, and physician assistants. Under what conditions can an LPN/LVN administer a unit of packed red cells? a. When a physician orders it b. If the registered nurse delegates it c. If the agency policy allows it d. Never; LPN/LVNs cannot administer packed cells

ANS: D The LPN/LVN cannot under any condition administer blood products, because this action is expressly prohibited in the state Nurse Practice Act.

1. A legal document that describes the kind of medical or life-sustaining treatments the person would want if seriously or terminally ill is known as a(n) ____________________.

living will The living will is a legal document that describes the kind of medical or life-sustaining treatments the person would want if seriously or terminally ill.