Chapter 6
Analysis of cases of reported negligence from 1995 to 2001 demonstrated that the majority of cases occurred in which patient care setting? a. Acute care b. Psychiatric c. Nursing homes and long-term care facilities d. Home health
ANS: A Feedback A The majority of negligence cases (60%) occurred in acute care settings. B Psychiatric settings accounted for only 8% of the cases of negligence. C Nursing homes accounted for 18% of the cases of negligence. D Home health settings accounted for only 2% of the cases of negligence.
Which of the following falls under the jurisdiction of the state board of nursing? a. Approving or reject applications for new nursing education programs b. Expanding the provisions of the nurse practice act c. Reducing the provisions of the nurse practice act d. Right to suspend the need for licensure of registered nurses (RNs) in times of extreme shortage
ANS: A Feedback A Schools of nursing must have state approval from the state board of nursing to operate. B The state board of nursing can enforce the nurse practice act but cannot expand it. C The state board of nursing can enforce the nurse practice act but cannot reduce it. D The state board of nursing does not have the authority to suspend the licensure requirement for any reason.
Which of the following nursing responsibilities can never be delegated? a. Complex tasks b. Evaluation c. Medication administration d. Accountability
ANS: D Feedback A Complex tasks can be delegated if the person has been trained to perform the task. B While an unlicensed assistive personnel (UAP) is not qualified to evaluate results, if the nurse delegates something to another RN, the second RN is responsible for evaluating the results and acting appropriately. C Medication administration in some states can delegated (to a limited degree) to UAPs. D Professional accountability cannot be delegated.
Which of the following is a legitimate defense to a charge of assault and battery? a. Presence of a medical order b. Knowledge of what is best for the patient c. Informed consent d. Living will
ANS: C Feedback A The presence of a medical order does not negate the need for informed consent. B Even if the treatment is in the patient's best interest, without informed consent it cannot be done. C Informed consent is a viable defense against an accusation of assault and battery. D Having a living will does not replace the need for informed consent.
A competent resident in a long-term care facility refuses an ordered antidepressant medication. The nurse believes the patient needs the medication because he is clearly showing signs of depression and dissolves the medication in juice without telling the patient. This illustrates negligence by failure to a. follow the standard of care. b. assess and monitor a patient. c. communicate with a patient. d. document.
ANS: C Feedback A The standard of care was followed as related to the giving of an ordered medication. B The nurse assessed the patient and determined he still needed the medication because he was showing signs of depression. C The nurse did not communicate with the patient to determine why he did not want to take the medication. Based on the information she gathered, further actions could have been taken. D There is no evidence that the nurse did not document the administration of the medication.
Which of the following actions by the nurse constitutes professional malpractice? a. Administering a preoperative sedative in the patient holding area instead of in the patient's room b. Failing to notify the physician of a potassium level of 4 mEq/L c. Placing the head of the bed flat when a patient is receiving a tube feeding, causing the patient to aspirate the mixture d. Administering a routine medication 10 minutes late because of a unit emergency
ANS: C Feedback A Administering a preoperative sedative in the patient holding area instead of in the patient's room does no harm to the patient. B Failing to notify the physician of a potassium level of 4 mEq/L does not necessarily do harm to the patient. C The reasonable nurse would know that the head of the bed must be elevated when the patient is receiving a tube feeding. D No harm resulted from administering a routine medication 10 minutes late because of a unit emergency.
Which of the following is an example of civil law? a. Possession of marijuana b. Assault and battery c. Giving alcohol to a minor d. Child custody case
ANS: D Feedback A Possession of marijuana is an example of a violation of criminal law: possession of an illegal substance. B Assault and battery comes under the purview of criminal law. C Giving alcohol to a minor is an example of a violation of criminal law. D Civil law recognizes and enforces the rights of individuals, such as disputes over legal rights or duties of individuals in relation to one another. A child custody case is an example of civil law.
The nurse forgets to give the patient a dose of antibiotic. Later in the shift, the patient goes into cardiac arrest and dies. What element is lacking to support malpractice? a. Duty of care b. Breach of duty c. Specific injury d. Proximate cause
ANS: D Feedback A There is nothing to support that the nurse did not assume the duty of care of the patient. B Although the nurse breached her duty by not administering the antibiotic, there also has to be support that this action caused the injury. C Although one might claim injury (cardiac arrest and death), the link to the nurse's action is not supported. D There is no support that failing to administer the antibiotic caused the cardiac arrest and death.
What is the primary function of the National Council of State Boards of Nursing (NCSBN)? a. Overseeing decisions made by state boards of nursing b. Developing the NCLEX-RN® and NCLEX-PN® licensing examinations c. Administering the NCLEX examination at testing centers d. Overseeing granting licensure by endorsement
ANS: B Feedback A The NCSBN does not have the authority to oversee state boards of nursing. B The NCSBN develops the test plan and items for the NCLEX examination. C States, not the NCSBN, administer the NCLEX examination. D State boards of nursing, not the NCSBN, grant licensure through endorsement.
For a nursing malpractice action, essential characteristics of negligence must be present. Which of the following constitute these essential characteristics? (Select all that apply.) a. The nurse assumed the responsibility for the patient's care. b. The nurse is found to have failed to meet the standard of care. c. The harm to the patient must be shown to have been caused by the failure to meet the standard of care. d. Harm to an individual has occurred. e. The nurse's action involves acts of commission.
ANS: A, B, C, D Feedback Correct - The nurse assuming the responsibility for the patients' care, the nurse failing to meet the standard of care, harm occurring to an individual, and the harm being shown to have been caused by the failure to meet the standard of care are the four elements that need to be present to support the charge of malpractice. Incorrect - Malpractice can involve acts of either commission or omission.
Which of the following is an important step in preventing legal action against the nurse? a. Never make a mistake. b. Deflect blame from yourself as much as possible. c. Develop caring, therapeutic relationships with patients. d. Avoid explaining care procedures to patients.
ANS: C Feedback A It is not reasonable to expect that nurses will never make a mistake. B Nurses must have accountability for errors. C Establishing and maintaining good communication and rapport with patients not only is an aspect of best practice but also protects the nurse from lawsuits. D Nurses should explain all procedures to patients.
The quality of nursing care is judged by whether nursing actions meet the standard of care. Which of the following is an example of meeting the standard of care? a. Demonstrating the use of the nursing process when charting b. Following actions consistent with local practice c. Monitoring a patient more closely if the equipment has occasionally malfunctioned d. Bypassing medication checks to save time once the nurse is experienced
ANS: A Feedback A Charting that includes assessment, planning, intervention, and evaluation must be present in the patient's record. B National, not local, standards of practice should be used. C Nurses must use equipment properly and replace it when it is malfunctioning. D Proper medication safety checks are the standard of practice for all nurses, including those with experience.
The most common reason that nurses are disciplined by the state board of nursing is a. making medication errors. b. following unsafe nursing practice. c. practicing while impaired. d. abandoning patients.
ANS: C Feedback A Medication errors are not the most common cause of nurses having their licenses suspended. B Unsafe nursing practice is a reason to have a license suspended but not the most common reason. C The most common reason that the state board suspends a nurse's license is for practicing while impaired. D Abandoning patients is not the most common reason for suspending nursing licenses.
Which of the following chart entries represents a pitfall in documentation? a. Restless and combative; SaO2 87% b. Patient demanding and difficult to please c. Discovered in bathroom; instructed to ask for assistance before ambulating d. Three-centimeter area of serosanguineous drainage noted on the dressing to the left hip
ANS: B Feedback A "Restless and combative; SaO2 87%" is an acceptable chart entry. B The chart entry is subjective and nonspecific. It also contains judgments about the patient which could be interpreted as bias. C "Discovered in bathroom; instructed to ask for assistance before ambulating" is an acceptable chart entry; it is accurate and concise. D "Three-centimeter area of serosanguineous drainage noted on the dressing to the left hip" is complete, accurate, and concise.
Which of the following puts the nurse at increased risk for legal action? a. Delegating a Foley catheter insertion to a LPN/LVN b. Documenting the exact words a patient uses when complaining c. Not assessing a patient who is complaining of pain d. Caring for a postoperative patient who has a pulmonary embolus while being transferred to the chair
ANS: C Feedback A Proper delegation does not increase risk for legal action. B Documenting in detail, including using direct quotations when appropriate, will protect the nurse from legal liability. C Failing to assess a patient constitutes an area of risk. D The embolus may have been unavoidable, and encouraging postoperative mobility meets the standard of care.
Which patient rights are guaranteed by HIPAA? a. Patients are asked to sign a release of responsibility if their health care records inadvertently become a matter of public record. b. Patients sign a release protecting the health care provider and insurance company against computer file theft. c. Patients are protected against medical records being indiscriminately shared. d. Patients may receive a complete copy of their medical records at no cost.
ANS: C Feedback A Patients' health records are never to become a matter of public record. B Health care providers and insurance companies are not protected against computer theft. C HIPAA protects medical records: written, oral, and electronic. D Patients have access to their medical records through HIPAA, but they may be assessed a fee.
Which of the following actions is acceptable as an exception to a nurse's obligation regarding confidentiality? a. Reporting certain diseases to public health authority b. Discussing a patient's care with someone who does not know the patient c. Leaving printouts of lab reports on the desk in the physicians' lounge as a convenience d. Discussing a patient's condition in a public place as long as the patient's name is not mentioned
ANS: A Feedback A Exceptions to confidentiality include reporting certain diseases to the appropriate public health authority. B It is inappropriate to discuss a patient with anyone outside of the treatment team. C Patient records must be kept private at all times. D Even if the patient's name is not mentioned, discussing a patient in public is a violation of privacy because someone listening may be able to determine the patient's identity from the discussion.
The nurse practice act of a state defines the scope and responsibilities of nursing practice in that state. Which of the following is true regarding nurse practice acts? a. They determine the educational requirements for licensure. b. They describe the process for gaining membership to a professional organization. c. They regulate how many professional nursing organizations may be formed. d. They define the practice of medicine in relation to nursing.
ANS: A Feedback A Nurse practice acts define the minimum educational qualifications and other requirements for licensure. B Nurse practice acts do not describe the process for admission to the state board of nursing. C Nurse practice acts do not regulate nursing organizations. D Nurse practice acts have no authority over medical practice issues.
A child is tested for genetic abnormalities. After the test results are delivered from the laboratory, a representative of the parents' medical insurance company calls the nurse's station and asks for the results of the tests. The nurse's best response to this request is to a. refuse to give the information. b. tell the representative the status of the tests is unknown. c. give the results as reported because the insurance company is paying for the tests. d. tell the representative that the test results will need to be obtained from the physician who ordered them.
ANS: A Feedback A On the basis of HIPAA guidelines, this information is for the patient and health care providers. B Nurses should not provide false information. C Giving the test results to the insurance company would violate the HIPAA guidelines. D Nurses should not provide false information.
The nurse receives reports on the following patients at the beginning of the shift. Which of the following care activities could be delegated to a nursing assistant? (Select all that apply.) a. Ambulating a patient who had an emergency appendectomy 8 hours ago, has stable vital signs, and needs to ambulate for the second time b. Assisting a patient who was in an automobile accident and whose right arm and leg are in traction with bathing c. Feeding a patient recovering from a stroke resulting in difficulty holding a spoon d. Taking vital signs, including blood pressure, for a patient with newly diagnosed diabetes and a history of hypertension e. Measuring a bed-bound patient's pressure ulcer and assessing the patient's risk for skin breakdown when turning the patient
ANS: A, B, C, D Feedback Correct - Nursing assistants can assist with hygiene and activities of daily living, especially for patients in stable conditions. Incorrect - UAP cannot interpret data or assess patients, because assessment is part of the nursing process.
The American Nurses Association (ANA) published a guide for state nurses associations seeking to revise their nurse practice acts. According the ANA, which of the following should be included in these revisions? (Select all that apply.) a. Differentiation between advanced and generalist nursing practice b. Authority for boards of nursing to oversee UAP c. Specified frequency of revisions to the nurse practice acts d. Authority for boards of nursing to regulate prescription writing by advanced practice nurses e. Nurses' responsibility for delegating to LPN/LVNs
ANS: A, B, D, E Feedback Correct - "Differentiation between advanced and generalist nursing practice," "authority for boards of nursing to oversee UAP," "specified frequency of revisions to the nurse practice acts," "authority for boards of nursing to regulate prescription writing by advanced practice nurses" and "nurses' responsibility for delegating to LPN/LVNs" are identified in the ANA's Model Practice Act published in 1996. Incorrect - The frequency of revision for the nurse practice acts is not addressed.
The central question in any charge of malpractice is whether the prevailing standard of care was met. Which of the following are considered part of the standard of nursing care? (Select all that apply.) a. Basic prudent nursing care is a standard. b. Health care providers determine standards of care in health care settings. c. Standards of care are never changing. d. Standards are based on the ethical principle of nonmaleficence. e. National standards of nursing practice are standards for all nurses.
ANS: A, D, E Feedback Correct - The standard of care reflects a basic minimum level of prudent care for the nurse based on the ethical principle of nonmaleficence or "to do no harm," and the national standards of nursing relevant to the situation at that time. Incorrect - Nurses, not other health care providers, are responsible for determining whether the standard of nursing care was met. As nursing practice develops, the standards of care change accordingly.
The RN delegates changing a sterile dressing over a central line to a licensed practical/vocational nurse (LPN/LVN). The LPN/LVN contaminated the site during the dressing change, and an infection developed in the patient. Which of the following statements is true? a. The LPN/LVN is guilty of malpractice. b. The RN is ultimately responsible for acts he or she delegates. c. The hospital cannot be held responsible for the acts of its employees. d. A malpractice suit cannot be brought as no harm came to the patient.
ANS: B Feedback A Guilt has to be determined in a court of law. The LPN/LVN can be held responsible for actions in relation to the LPN/LVN scope of practice in the state. B The RN is responsible for tasks delegated to both licensed and unlicensed personnel. C The hospital can be held responsible for employees not correctly following policies related to the standards of quality care. D The patient was harmed.
The Patient Self-Determination Act of 1991, as implemented today, is known as providing a. informed consent. b. advance directives. c. patient bill of rights. d. HIPAA protections.
ANS: B Feedback A Informed consent assures patient autonomy. B Advance directives describe an individual's preferences in regard to medical intervention should the individual become incapacitated, which was the primary intent of the Patient Self-Determination Act of 1991. C The patient bill of rights assures patients certain basic rights unrelated to becoming incapacitated. D HIPAA protects medical records from disclosure.
In which of the following situations should the legality of an informed consent be questioned? a. Patient with dementia; consent given by spouse b. Patient who received a preoperative dose of Demerol before giving consent c. Patient who is anxious and asks many questions of the physician d. Patient who expresses concern about the cost of the procedure
ANS: B Feedback A When the patient is incompetent, a spouse may give informed consent. B Patients cannot be sedated or impaired and legally give informed consent. C Patients have a right to ask questions of the health care team. D Questioning the cost does not negate the legality of the informed consent.
A nursing student got a thank-you card from a patient's family and had another student take a photo of the student with the family. The student asks the nursing instructor if it would be alright to post the photo on Facebook. Which response by the instructor is best? a. "Yes, as long as you ask the family if that would be OK." b. "I think that would be OK, but you should check hospital policy." c. "No, posting pictures of patients and families on social media sites is not acceptable." d. "No, that could lead to a malpractice suit by the patient or family."
ANS: C Feedback A Confidentiality and Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations place severe restrictions on nurses' use of social media sites. The student should not post the photo. B The hospital probably has a policy regarding the use of social media sites, but the student should also be instructed to check the nursing school's policies as well. Most such policies prohibit or severely restrict what nurses and students can post. Even if there are no policies in place, the student should not post the photo due to ethical and HIPAA considerations. C The student would be wise to not post the photo on any social media site. Posts are neither "private" or inaccessible once deleted. D In order to prove a claim of malpractice, four elements are needed; duty, breach of duty, harm, and causation. This would most likely not be a case of malpractice.
Which of the following is a nursing responsibility regarding informed consent? a. Canceling the procedure if the patient has questions b. Explaining the procedure, risks, and treatment alternatives c. Serving as a witness, ensuring that the patient does not feel coerced into a decision d. Ensuring that the physician has completely explained the costs of the procedure
ANS: C Feedback A The nurse does not have the responsibility to schedule or cancel medical procedures. B The physician has the responsibility of explaining the procedure, risks, and benefits. C The nurse can serve as a witness in informed consent. D The costs of the procedure are not required to be included in the physician's explanation.
The RN asked a nursing assistant to monitor several postoperative patients. Which of the following instructions to the nursing assistant demonstrate appropriate delegation? a. "Take vital signs every 2 hours, and report to me anything outside of the norms." b. "Assess pain using a 10-point scale, and record the score on the chart." c. "Record the urine output, and report to me if they have not voided within 4 hours." d. "Record the amount of drainage on the dressing on the bedside record."
ANS: C Feedback A The nursing assistant is told to report "anything outside of the norms." An RN should not assume that the nursing assistant knows the specific norms the RN is referring to. B The nursing assistant should know if there are specific scores that the RN wishes to know about. C This is the most appropriate instruction because the nursing assistant not only knows what to do but also what specific information to report. D The RN needs to know the amount of drainage to determine whether any further actions are needed.
The nurse giving medications to a pediatric patient notes that an order for a medication is considerably larger than the usual dose. The nurse looks up the medication in a pharmacology book and finds the prescribed dose is too large. Which action should the nurse take? a. Documenting the findings in the chart after giving the medication b. Calling the nursing supervisor and ask what to do next c. Calling the pharmacist to obtain the usual dosage d. Notifying the physician of these findings before giving the medication
ANS: D Feedback A Documentation is important, but the order needs to be clarified before the medication is administered. B Although seeking advice from the supervisor is helpful, the nurse still needs to clarify the order with the physician who wrote it. C Although the pharmacist can check the dosage calculation and provide supportive information to the nurse, he or she is unable to change the order; only the physician can do that. D The nurse notifying the physician of her findings before giving the medication allows the physician to clarify the order if written incorrectly or to clarify his rationale for the increased amount.