Leadership Roles and Management functions in Nursing theory and application 10th edition Chapter 5

A state Nurse Practice Act is an example of which source of law? a. Statutes b. Constitution c. Administrative d. Judicial

ANS: A Feedback: Statutes are the only laws made by official enactment by the legislative body. A Nurse Practice Act is an example of a "law that governs." As a statute, a Nurse Practice Act is not a form of constitutional, administrative, or judicial law.

The nurse at a long-term care facility became frustrated with a client who has dementia and is unable to be redirected from wandering. The nurse applied restraints to keep the client in bed during a night shift despite there being no order to do so. How should this nurse's actions be best interpreted? a. The nurse is guilty of malpractice. b. The nurse's action is permissible if it was in the client's best interest. c. The nurse could face charges of false imprisonment. d. The nurse's action may be grounds for an assault charge

ANS: C Feedback: Inappropriate use of restraints constitutes false imprisonment. Assault, however, is characterized by a verbal threat of harm. Malpractice is an unintentional tort, but this nurse's action is an intentional tort. Even if the nurse's felt that he or she was acting in the client's best interests, there are still grounds for false imprisonment charges

The nurse-manager is working with colleagues to update the policies and procedures at a health-care facility. To ensure that the policies align with the provisions of Title VII, the team should focus on what aspect of care? a. Falls prevention b. Timely and accurate documentation c. Relationships between practical and registered nurses d. Avoiding discrimination against clients

ANS: D Feedback: Title VII is the Civil Rights Act which covers many different manifestations of diversity. The major focus of Title VII is civil rights and the avoidance of discrimination. Topics such as injury prevention, documentation, and interprofessional relationships are not normally within the scope of civil rights.

In which situations does the nurse-manager have a legal responsibility for reporting? Select all that apply. a. A nurse had to work 2 hours of overtime because another nurse failed to report for a shift. b. A nursing assistant has reported a suspected incident of elder abuse. c. A nurse is suspected of providing substandard medical care. d. A pediatric client reports physical abuse in the home. e. There is a confirmed case of a reportable infectious disease

ANS: B, C, D, E Feedback: The manager, like all professional nurses, is responsible for reporting improper or substandard medical care, child and elder abuse, and communicable diseases, as specified by the Centers for Disease Control and Prevention. Staffing issues are not mandated reportable situations

A nurse is facing a malpractice suit after a client was injured in a fall. When establishing whether the nurse committed a breach of duty, the court will consult with: A. Medical experts from the same area of specialty B. Members of public who have been treated in similar care setting C. The administrators of health facility where the fall occurred D. Other nurses who practice in similar settings and specialties

D. Other nurses who practice in similar settings and specialties Feedback: The testimony of other nurses in the same specialty as the defendant may be used to prove breach of duty. These people are considered a reliable and valid source of information by the court, more so than members of the public, administrators, or medical experts

Two registered nurses have disagreed about their scope of practice regarding medication administration. What resource should the nurse consult? A. The Nurse Practice Act B. The nursing standards of practice C. The attorney general's office D. The code of ethics

A. The Nurse Practice Act Feedback: Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. An attorney general's office cannot supersede the provisions of a Nurse Practice Act. Ethical guidelines do not establish a nurse's scope of practice. Standards of practice describe the quality of a nurse's care but not the legal scope.

A registered nurse has admitted to the manager that she obtained her license on false pretenses and that she never actually graduated from a nursing education program. What is most likely to take place next? a. An investigation by the board of nursing b. A civil lawsuit by the health-care facility c. Criminal charges d. A fine levied by the jurisdiction where the event took place

ANS: A Feedback: Following a complaint, the board of nursing completes an investigation. The facility may or may not pursue a lawsuit and is more likely to focus solely on dismissal. This would be more likely to be handled administratively by the board of nursing than criminally, by the court system. A ban from the profession would be more likely than a fine.

The preoperative admitting nurse witnessed a client sign an operative consent form. The nurse then cosigned the same document as a witness. The client suffered an injury during surgery and names the nurse in the suit because the nurse witnessed the consent form. What is the most likely outcome? a. The nurse is not likely liable because the signature only specifies that the nurse witnessed the client signing the consent form. b. The nurse is likely not liable because surgery is beyond the nurse's scope of practice. c. The nurse may be liable because cosigning the consent form makes the nurse an equal member of the surgical team. d. The nurse is liable because cosigning the consent form confirms that the client fully understood the risks of surgery.

ANS: A Feedback: Informed consent is obtained by a physician; therefore, in most cases, a nurse is not legally responsible for informed consent but is confirming that the client signed the consent form. If the nurse acts solely in the role of a witness, there are not likely to be legal consequences for the nurse. The nurse would not be considered to be a full member of the surgical team if his or her role was limited to admitting the client. Surgery is beyond the nurse's scope of practice, but this does not form the basis for the nurse's likely exemption from liability.

What initiative is most likely to promote open communication between clients and practitioners? a. Involving health-care consumers as active members of the health-care team b. Promoting the creation of cultures of client safety in health-care organizations c. Establishing a federal leadership locus for advocacy of client safety and health-care quality d. Building an evidence-based information and technology system that impacts client safety

ANS: A Feedback: One way to promote open communication between clients and practitioners is involving health-care consumers as active members of the health-care team. Pursuing client safety initiatives prevent medical injury by promoting the creation of cultures of client safety in health-care organizations, establishing a federal leadership locus for advocacy of client safety and health-care quality, and building an evidence-based information and technology system impacts client safety.

Which statement is true regarding criminal law cases in the context of nursing? Select all that apply. a. Incarceration is a likely consequence of being found guilty of a criminal offense. b. Intentionally giving an overdose of a potent narcotic is a criminal offense. c. A guilty verdict requires evidence beyond a reasonable doubt. d. Most malpractice cases are tried in criminal court. e. A serious, inadvertent drug error is likely to bring criminal charges.

ANS: A, B, C Feedback: In criminal cases, the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to clients would be charged in a criminal court. Most malpractice cases are tried in civil court. In most cases, unintentional errors do not result in criminal charges

A nurse is facing a malpractice suit after an incident where a client received the wrong dose of medication. Which elements must be present to prove malpractice? Select all that apply. a. Breach of duty b. Presence of injury c. Ability to foresee harm d. Causal relationship between inadequate care and injury e. Intent to cause harm

ANS: A, B, C, D Feedback: A lawsuit pertaining to malpractice must include a standard of care, breach of duty, injury, a causal relationship between breach of duty and injury, and a foreseeability of harm. Malicious intent does not need to be present or proven. The presence of malice would be more suggestive of a criminal act than professional malpractice.

Which nurse could face discipline for committing an intentional tort? Select all that apply. a. A nurse who slapped a client when the client became verbally abusive b. A nurse who applied restraints to a client as a punitive measure c. A nurse who increased a client's analgesia dosage without a prescription d. A nurse who neglected to supervise a client, leading to a fall e. A nurse who threatened an elderly client when the client did not participate in care

ANS: A, B, E Feedback: Whereas professional negligence is considered to be an unintentional tort, assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts. Failing to supervise a client or practicing outside the scope of practice (changing a medication dose) would be classified as unintentional torts. Slapping a client is battery. Threatening a client is assault, and applying restraints inappropriately is a form of false imprisonment

A nurse is off-duty, in the community, and witnesses an adult suddenly collapse. The individual appears to be unconscious. How should the nurse apply Good Samaritan laws to this situation? a. The nurse should intervene because of the legal obligation to do so. b. The nurse is not required to intervene, even though intervening is an ethical act. c. The nurse should attempt to contact emergency services before intervening. d. The nurse attempt to determine if the individual has an advance directive before intervening.

ANS: B Feedback: Good Samaritan laws vary by jurisdiction, but they generally do not create a legal requirement for a nurse to intervene, although the ethical obligations for beneficence still apply to nurses. A nurse is not obliged to contact emergency services before acting. It is rarely possible or practical to determine a stranger's end-of-life wishes in a situation like this

The nurse-manager oversees the care of several dozen nurses. With which nurse should the manager review the provisions of the Health Insurance Portability and Accountability Act (HIPAA)? a. A nurse who has discussed a client's status with a physician over the telephone b. A nurse who confirmed a new client's admission to the unit to a relative who telephoned c. A nurse who completed a client's documentation outside of the client's room d. A nurse who has initiated contact with the social worker to discuss a client's discharge planning

ANS: B Feedback: HIPAA states that a client's privacy and confidentiality must be maintained. Confirming a new client's presence on a unit can be problematic because the identity of the person speaking cannot be confirmed. Communicating by telephone with other members of the care team is acceptable, provided efforts are taken to protect the client's privacy from others who may overhear. Documentation can be completed in any setting, provided it is guarded from view of unauthorized persons. There is no prohibition against initiating contact for referrals

A charge nurse has discovered that a medication error was made on the previous shift. What is the nurse's best action? a. Share that information with the charge nurse on the previous shift. b. Document the incident and follow it up as per hospital policy. c. Write a memo to the nurse who made the error requesting an incident report be written. d. Document in the client's chart that an incident report will be completed.

ANS: B Feedback: It is the responsibility as manager to immediately document the error according to hospital policy. Because policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the client's chart. Speaking to another nurse or manager is not a sufficient response, although this may be one part of the follow-up process.

Which action should the nurse prioritize when trying to prevent malpractice claims? a. Always carrying a personal liability insurance policy b. Always functioning with the scope of the nursing practice act c. Asking for assistance when engaged in complicated procedures d. Devoting time to establishing an effective nurse-client relationship

ANS: B Feedback: Nurses can reduce the risk of malpractice claims by practicing within the scope of the Nurse Practice Act. Nurses should purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help to protect a nurse from financial ruin should there be a malpractice claim. Asking for assistance when needed is prudent nursing practice, but staying within the scope of practice is a more important guideline. Similarly, good nurse-client relationship has been shown to reduce the likelihood of malpractice, but this is a less significant guideline than staying in the scope of practice, which is paramount.

Which statement best describes the impact that the concept of respondeat superior has on the issue of nursing liability? a. It allows for equal liability among physicians, nurses, and health-care organizations. b. It supports the sharing of blame among all involved sources of health-care services. c. It encourages legal intervention when health care is thought to be substandard. d. It implies that the institution is responsible for errors, not the employee.

ANS: B Feedback: Nurses must remember that the purpose of respondeat superior is not to shift the burden of blame from the employee to the organization but rather to share the blame, increasing the possibility of larger financial compensation to the injured party. Liability is not always apportioned equally in every situation, and it does not wholly release employees from liability

The nurse is admitting a client to the health-care facility who is in the late stages of pancreatic cancer. In order to comply with the terms of the Patient Self-Determination Act (PSDA), the nurse should: a. ensure the client clearly understands each treatment option. b. determine whether the client has established an advance directive. c. document that the client's family has been included in care planning. d. assess the client's expectations for recovery.

ANS: B Feedback: The PSDA requires acute care facilities to document on the medical record whether a patient has an AD and to provide written information to patients who do not. This legislation does not directly address such matters as ensuring the client's understanding of treatment options, including the family in care planning, and determining the client's expectations, even though each of the actions is necessary for providing quality care

The nurse made a medication error that injured a hospital client. The nurse's attorney has cited the concept of respondeat superior during the trial. This argument would focus on: a. the resources that were available to the nurse. b. the intent of the nurse's actions. c. the hospital's responsibility for the injury. d. the provisions of the nurse's malpractice insurance.

ANS: C Feedback: The legal concept of respondeat superior states that an employer should be held legally liable for the conduct of employees whose actions he or she has a right to direct or control. Consequently, there is no direct reference to the nurse's resources, intent, or insurance coverage.

What is the best reason that nurse-managers have an ongoing responsibility to be aware of legislation affecting nursing practice? a. Laws are created by people who are not nurses. b. Laws are fluid and subject to change. c. Awareness will help ensure ethical practice. d. Awareness is included in nursing standards of practice.

ANS: B Feedback: When using doctrines as a guide for nursing practice, the nurse must remember that all laws are fluid and subject to change. Laws are not static. It is the responsibility of each manager to keep abreast of legislation and laws affecting both nursing practice and management practice. It is true that laws are made by people who are not nurses, but this does not necessarily create a need for managers to stay abreast of laws. Standards of practice do not explicitly guide nurses to remain aware of changes in legislation. Awareness is unlikely to have a direct effect on ethical practice, which is rooted in values and beliefs about what is good

A nurse has been hired to manage a busy medical-surgical unit. What actions should the nurse-manager perform to ensure compliance with legal issues? Select all that apply. a. Develop a vision for the organization's future and communicates this vision. b. Remain current on all institutional policies and procedures. c. Delegate with consideration to appropriate scopes of practice. d. Require physical proof of appropriate professional licensure. e. Ensure client-nurse ratios do not exceed 3:1.

ANS: B, C, D Feedback: Sound management functions regarding legal issues include understanding and adhering to institutional policies and procedures; delegating to subordinates wisely; and monitoring subordinates to ensure they have a valid, current, and appropriate license to practice nursing. Some jurisdictions have legal requirements around client-nurse ratios, but these ratios vary according to the care setting; in many cases, a ratio of greater than 3:1 is permitted. Developing and communicating a vision is an essential leadership function, but this does not apply to management of legal matters

A nurse failed to supervise a confused client, and the client fell while transferring to the bathroom. The client was unharmed, but the client's family has launched a malpractice suit, citing the nurse's breach of duty. What is the most likely outcome of this case? a. The outcome will depend on the extent to which the client was responsible for the incident. b. It will likely be successful, provided the family can prove the event was reasonably foreseeable. c. It will likely be unsuccessful because the client was not injured. d. The outcome will depend on how the nurse's actions compare to the established standard of care.

ANS: C Feedback: A malpractice suit requires evidence of actual injury to the offended party. The fact that this client was unharmed would likely jeopardize the suit, regardless of the client's role or the standard of care. Even if the event was foreseeable, the absence of injury removes a key criterion of malpractice

A client is preparing to be discharged from the health-care facility and has told the nurse that he would like to read his medical record. What is the nurse's best initial action? a. Arrange for the medical record to be provided to the client. b. Inform the client that this request will be communicated to the facility's ethics committee. c. Confirm the facility's policy around providing medical records to clients. d. Check whether this provision is included in the jurisdiction's Nurse Practice Act.

ANS: C Feedback: Clients possess a right to view their medical records, but the protocols for facilitating this vary. Consequently, the nurse should check this facility's policy before acting. It would likely be premature for the nurse to provide the medical record to the client before communicating with other members of the care team or administrators to ensure policy is followed. This matter is outside the purview of ethics committees because it does not involve a dilemma. The Nurse Practice Act focuses on scope of practice and other regulatory issues, not client rights

The nurse has been caring for a medical client for several shifts and the client has expressed frustration with his slow recovery. At the beginning of the shift, the client states to the nurse, "That's it. I want to read what they've written in my chart." What is the nurse's best response? a. "Certainly. I'll go and get it for you." b. "You'll have to get permission to do so, but I'll definitely pass on your request to the care team." c. "It sounds like you might have some questions about your health and your care. Can we talk about that?" d. "That's definitely within your rights, but you'll likely find that it's difficult to understand because of medical jargon."

ANS: C Feedback: Clients' requests to read their health records are often motivated by confusion or dissatisfaction with care. The nurse should offer to address the clients concerns. Doing so is not a refusal of the client's right to view his or her health records. Protocol must be followed when a client requests access, so it would be inappropriate for the nurse to immediately provide the client with the record. Even though protocol must be followed, clients still have the right to view their records and do not require permission under normal circumstances. The nurse should not attempt to dissuade the client by warning him or her about medical jargon, even though this is likely to be a barrier to understanding.

The novice nurse can reduce the likelihood of being sued for malpractice by: a. beginning his or her career in a lower acuity setting. b. avoiding performing interventions without a witness present. c. establishing positive, therapeutic relationships with clients and families. d. engaging in lifelong learning.

ANS: C Feedback: It has been shown that despite technical competence, nurses who have difficulty establishing positive interpersonal relationships with patients and their families are at greater risk for being sued. Relationship building is a skill that consequently has the potential to reduce a nurse's risk of a lawsuit. Many malpractice suits originate in lower acuity settings, such as long-term care, so practicing in such an environment may not necessarily reduce the nurse's risk of a lawsuit. It is unrealistic and unnecessary to perform all interventions with a witness, and there is no evidence that this would reduce the risk of a lawsuit. Lifelong learning is beneficial but is not noted to reduce the nurse's risk of a lawsuit

A client has provided informed consent for surgery and is being assessed by the nurse. What statement by the client should prompt the nurse to contact the surgeon? a. "Why am I not allowed to eat and drink before the surgery?" b. "How long do you think I'll stay in the recovery room?" c. "Do you think this surgery is actually safe and necessary?" d. "What is the difference between the surgeon and the anesthesiologist?"

ANS: C Feedback: Nurses are obligated to provide teaching and to clarify information given to patients by their physicians. This could include such topics as the different roles of the OR team, typical recovery times, and the rationale for fasting. However, nurses must be careful not to give new information or to go outside the scope of practice. Addressing the safety and relative risks of a surgery, or the necessity for surgery, would be beyond the nurse's scope

A health care provider prescribes a medical procedure that the staff nurse has reason to believe will harm the client. Which principle should guide the nurses choice of action? a. The staff nurse cannot be held legally liable for any harm to the client if the procedure is carried out with due care. b. The nurse may lose his or her license by refusing to carry out the procedure. c. The nurse can be held legally liable for any harm if the procedure is carried out without questioning it. d. Liability rests with the health-care provider, not the nurse.

ANS: C Feedback: The rule of personal liability says that every person is liable for his or her own conduct, even if someone else prescribed the intervention. The law does not permit a wrongdoer to avoid legal liability for his or her own wrongdoing, even though someone else also may be sued and held legally liable. "Due care" does not negate the consequences of the nurse's actions or release the nurse from liability if he or she knowingly committed an unsafe act. Refusal to carry out the procedure would not be a basis for losing a nursing license.

A nurse is being sued for malpractice after a client completed suicide on the medical-surgical unit. The nurse's attorney has pointed out that the client had no history of suicide attempts, had no history of mental illness, and denied suicidality on the standard intake assessment. This argument calls into question what component of a malpractice suit? a. Breach of duty b. Failure to meet standard of care c. Foreseeability of harm d. A causal relationship

ANS: C Feedback: This argument suggests that there is no obvious reason why the nurse should have predicted a suicide attempt. This may negate the criterion of foreseeability. There is no evidence that the attorney is addressing the nurse's standards of care or the nurse's ability to perform his or her duties. The attorney is not questioning the relationship between the nurse's actions and the outcomes

Which statements accurately describe the implications of a Good Samaritan law for a registered nurse? Select all that apply. a. A nurse has a legal responsibility to provide emergency services. b. Such laws are universally worded so as to minimize differences between jurisdictions. c. To be protected, nurses must provide care that is within their legal scope of practice. d. A nurse who provided out-of-scope care is not protected by the Good Samaritan law. e. A nurse can be held responsible for a person's injuries if he or she does not intervene

ANS: C, D Feedback: Nurses are not required to stop and provide emergency services as a matter of law, although most health-care workers feel ethically compelled to do so. Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. Good Samaritan laws vary between jurisdictions

For which client are the provisions of the Patient Self-Determination Act (PSDA) most likely to be significant? a. A client who has recently been diagnosed with HIV b. A client whose neonate has just died of sudden infant death syndrome (SIDS) c. A client whose reduced ability to perform activities of daily living (ADLs) has required an admission to long-term care d. A client who has just experienced an ischemic stroke and whose prognosis is poor

ANS: D Feedback: The PSDA applies to all clients, but it is especially relevant to clients and families who are facing decisions around end-of-life care. A client whose infant has died, a client with a new HIV diagnosis, and a client whose ADLs are compromised are not facing imminent decisions about end-of-life care. However, this is not the case for a client with a fresh stroke and poor prognosis