Legal Implications PREP U
A nurse is caring for a client following endotracheal intubation. Before applying soft wrist restraints to prevent the client from pulling out the endotracheal tube, what is the most appropriate action of the nurse?
Obtain a medical order.
A medical surgical client is in the radiology department. The client's cousin arrives on the medical surgical unit and asks to speak with the nurse caring for his cousin. The visitor asks the nurse to provide a brief outline of the client's illness. Which response, if given by the nurse, would demonstrate application of legal safeguard in her practice?
"I cannot give you that information due to client confidentiality."
A medical-surgical client is in the radiology department. The client's cousin arrives on the medical-surgical unit and asks to speak with the nurse caring for his cousin. The visitor asks the nurse to provide a brief outline of the client's illness. Which response, if given by the nurse, would demonstrate application of legal safeguard in her practice?
"I cannot give you that information due to client confidentiality."
A client admitted with Hodgkin disease has a handwritten prescription for vinblastine 3.7 mg intravenously (IV) weekly. The nurse interprets the prescription as vincristine 3.7 mg and administers the wrong medication. The client becomes neurovascularly compromised and has a fatal reaction to the medication. The client's family begins a litigious suit against the facility and the nurse's license is suspended by the board of nursing. In preparation for the lawsuit, the nurse meets with the nurse attorney to review the events. Which appropriate statement, if given by the nurse, indicates he has an understanding of the lawsuit?
"I had a duty and it was my responsibility to get clarification before administering the medication, which I did not."
The nurse educator is presenting an in-service on nursing and malpractice. Which statements made by the nursing staff would indicate to the educator that further teaching is required? Select all that apply.
"If I make a mistake, I will not tell anyone." "I will have the supervisor fill out the incident report when I make an error."
A client being discharged from the hospital asks the nurse, "When I go visit my family out of state, should I take my living will with me, or do I need a new one for that state?" What is the most appropriate response made by the nurse?
"Take it with you. It is recognized universally in the United States."
A nurse hired to work in an ambulatory setting attends new employee orientation. The nurse never worked in ambulatory before and is concerned about the Scope and Standards of Practice for Professional Ambulatory Care Nursing. Which response, given by the nurse educator, would further explain the Scope and Standards of Practice for Professional Care Nursing to the new nurse?
"The Scope and Standards of Practice for Professional Ambulatory Care Nursing deal with the professional obligations of a nurse working in the ambulatory setting."
The nurse attempts to notify a health care provider about a client's elevated temperature, but does not get a response. Which statement, if documented by the nurse, would indicate that the nurse is following proper protocol for nursing documentation?
1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified.
The nursing faculty is lecturing on unintentional and intentional torts. The faculty asks a nursing student to provide an example of an unintentional tort. Which example would indicate the student has a clear understanding of torts?
A nurse gives a medication and client has an adverse reaction.
Which scenario is an example of certification?
A nurse who demonstrates advanced expertise in a content area of nursing through special testing
Which nursing student would most likely be held liable for negligence?
A nursing student administers medication to a resident while working as an unlicensed assistive personnel (UAP) at a local nursing home.
Which of the following nursing students would most likely be held liable for negligence?
A nursing student administers medication to a resident, while working as a nursing assistant at a local nursing home.
Which process evaluates and recognizes educational programs as having met certain standards?
Accreditation
A client informs the nurse that he is leaving the health care facility because he is not satisfied with the treatment. The nurse knows that the client's treatment is incomplete and further testing and evaluations are scheduled. Which action by the nurse would be most appropriate to prevent false imprisonment?
Ask the client to sign a release without medical approval.
The charge nurse overhears a staff nurse threatening to restrain a verbally abusive client if the abuse continues. The charge nurse meets with the staff nurse to discuss this behavior. Which legal tort, if identified by the charge nurse, would alert the staff nurse to potential criminal charges?
Assault
A nurse fails to communicate a change in the client's condition to the physician. Which element related to proving malpractice has been met?
Breach of duty
The nurse fails to contact the physician regarding a client who had an open-reduction internal fixation of the tibia and has experienced increasing leg pain (unrelieved by pain medication) for the past four hours. Which element of liability has been violated?
Breach of duty
Nurses practicing in a critical care unit must acquire specialized skills and knowledge to provide care to the critically ill client. These nurses can validate this specialty competence through what process?
Certification
A client is scheduled for a colonoscopy. The nurse realizes immediately after administering medications to induce conscious sedation that the client has not signed the informed consent. If the nurse has the client sign the informed consent, which element of informed consent would be violated?
Competence
A nurse assesses a client with psychotic symptoms and determines that the client needs vest restraints. However, the client asks the nurse not to put on vest restraints. What would be the best nursing action?
Contact the physician and obtain necessary orders.
A client states that his recent fall was caused by the fact that his scheduled antihypertensive medications were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow?
Document the client's claims and the events surrounding the alleged incident.
A client states that his recent fall was caused by the fact that his scheduled antihypertensives were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which of the following measures should the nurses prioritize when anticipating that legal action may follow?
Document the client's claims and the events surrounding the alleged incident.
In some cases, the act of providing nursing care in unexpected situations is covered by the Good Samaritan laws. Which nursing actions would most likely be covered by these laws?
Emergency care for a choking victim in a restaurant
A nurse who obtains a license to practice nursing by misrepresenting him or herself is guilty of what tort?
Fraud
The nurse educator is presenting a lecture on the Occupational Safety and Health Act. Which situations, if identified by the nursing staff, would indicate to the educator that the staff understands which actions about the Occupational Safety and Health Act?
Helps reduce workforce injuries and illness in the workplace
A client informs the nurse that he wants to discontinue his treatment and go home. Later, the nurse finds the client dressed to leave. What action should the nurse take in this situation?
Let the client go after signing a document stating he is going against medical advice.
The nursing student talks with her family about an AIDS client from the clinical experience. Which tort has the student committed?
Invasion of privacy
The nursing student talks with the student's family about an AIDS client from the clinical experience. Which tort has the student committed?
Invasion of privacy
When the nurse informs a client's employer of his autoimmune deficiency disease, the nurse is committing the tort of:
Invasion of privacy
When the nurse reports for duty, she finds out her neighbor is admitted to one of the units in her facility. The nurse asks a coworker about the neighbor's condition. The coworker is uncomfortable with the nurse's request and confers with the charge nurse. The charge nurse informs the coworker of which potential tort violation she could be charged with if she honors the nurse's request for client information?
Invasion of privacy
When the nurse reports for duty, she finds out her neighbor is admitted to one of units in her facility. The nurse asks a coworker about the neighbor's condition. The coworker is uncomfortable with the nurse's request and confers with the charge nurse. The charge nurse informs the coworker of which potential tort violation she could be charged with if she honors the nurse's request for client information?
Invasion of privacy
A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit?
Malpractice
While caring for an infant, the nurse hears another child screaming in the next room. She rushes to the other room to check on the screaming child, forgetting to put the side rails up on the infant's crib. She returns to the room to find the infant has fallen out of the crib and sustained a head injury. Based on the nurse's action, which tort is the nurse liable for?
Malpractice
The health care provider prescribes orders for a client with newly diagnosed uncontrolled seizure activity. When reviewing the prescriptions, the nurse correctly identifies which prescription, if followed, puts him at risk for negligence charges?
Restrain all four extremities
A client who is scheduled for hernioplasty needs clarification regarding the procedure. The nurse calls the physician at the client's insistence. The physician, who is in a bad mood, is overheard telling the client that the nurse does not know anything. Which of the following legal torts has the physician committed?
Slander
A nurse is overheard in the hospital cafeteria making false comments about a client. The nurse is guilty of:
Slander
A nurse who comments to her coworkers at lunch that her patient with a sexually transmitted disease has been sexually active in the community may be guilty of what tort?
Slander
A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged?
Slander
A client on a surgical unit asks for the nurse's opinion of the surgeon. The nurse replies, "He is rude. His clients always end up with infections." The nurse is at risk of being accused of which of the following?
Slander/defamation
After reporting to work for a night shift, the nurse learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute clients in addition to his or her regular client assignment. Which of the following statements is true for this nurse when working in understaffed circumstances?
The nurse will be legally held to the same standards of care as when staffing levels are normal.
A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which statement is true regarding the Good Samaritan law?
The Good Samaritan law will provide legal immunity to the nurse.
Injuries related to lifting or transferring patients occur in the health care setting and may be considered a work-related injury. Which law was intended to reduce work-related injuries and illnesses?
The Occupational Safety and Health Act of 1970
A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license?
The State Board of Nurse Examiners
A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which of the following legal terms describes the case?
Tort
When making client rounds, the charge nurse observes which action by a staff nurse that would constitute battery?
The elderly client refuses the intramuscular injection, but the staff nurse administered it.
The health care facility is involved in litigation by four clients. When reviewing the cases, which legal case would the nurse attorney identify to best describe malpractice?
The nurse administers amoxicillin (Amicar) to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest.
A nurse comes across a screaming child in the park. The child was hit by a baseball bat, resulting in a swollen and reddened left arm. Any attempt to move the child's left arm results in the child screaming intensely. The nurse used two baseball bats to make a split, which she applied to the child's left arm. The child is transported to the hospital and later develops compartmental syndrome of the left arm. The nurse requests a meeting with the nurse attorney to discuss the possibility of being involved in a litigious suit by the child's family. After a review of the events, which important information will the attorney share with the nurse concerning the case?
The nurse is protected by the Good Samaritan Act, which states the nurse may give emergency care using good judgment.
Legal safeguards are in place in the nursing practice to protect the nurse from exposure to legal risks as well as to protect the client from harm. What are examples of legal safeguards for the nurse? Select all that apply.
The nurse obtains informed consent from a client to perform a procedure. The nurse educates the client about The Patient Care Partnership. The nurse documents all client care in a timely manner.
A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the atenolol to 12.5 mg. However, since the physician is late for another visit, she requests that the nurse write down the order for her. What should be the appropriate nursing action in this situation?
The nurse should ask the physician to come back and write the order.
A client is unhappy with the health care provided to him. He approaches the nurse and informs her that he is leaving the facility. The client has not been discharged by the physician. The nurse finds that the client has dressed and is ready to go. What would the nurse's action be in this situation?
The nurse should call the nursing supervisor and inform her about the situation.
After reporting to work for a night shift, the nurse learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute clients, in addition to her regular client assignment. Which statement is true for this nurse when working in understaffed circumstances?
The nurse will be legally held to the same standards of care as when staffing levels are normal.
A student nurse is assisting an older adult client to ambulate following hip replacement surgery when the client falls and reinjures the hip. Who is potentially responsible for the injury to this client?
The student nurse, the nurse instructor, and the hospital
A nurse enters the client's room and finds the client lying on the floor experiencing a seizure activity. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report?
To evaluate quality care and potential risks for injury to the client
A nurse enters the client's room and finds the client lying on the floor experiencing a seizure. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report?
To evaluate quality care and potential risks for injury to the client
Professional regulations and laws that govern nursing practice are primarily in place for which of the following reasons?
To protect the safety of the public
A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which legal term describes the case?
Tort
A nurse is caring for a client who has undergone coronary angioplasty. The cardiac monitor is showing abnormal ECG waves, indicating arterial fibrillation. The nurse does not recognize the importance of the sign; as a result, the client's condition deteriorates and the client has to be taken up for an emergency procedure. Which of the following describes the nurse's legal liability?
Tort
The client being admitted to the oncology unit conveys his wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in his best interest to obtain which document?
a living will
Nurse Practice Acts are examples of which type of laws? a) statutory laws b) common law c) constitutional laws d) administrative laws
a) statutory laws Nurse Practice Acts are statutory laws. Statutory laws must be in keeping with both the federal constitution and the state constitution.
A legal document that states a client's health-related wishes — such as a preference for pain management if the client becomes terminally ill — and also allows the client's daughter to direct his care, is a(an):
advance directive.
A nurse and the facility have been named as defendants in a malpractice lawsuit. The nurse is working with an attorney in preparation for the court case. In addition to the nurse's attorney, which individual would be appropriate for the nurse to talk with about the case?
agency's risk manager
A patient states that his recent fall was caused by the fact that his scheduled antihypertensives were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the patient. Which of the following measure should the nurses prioritize when anticipating that legal action may follow? a) Enlist support from nursing and nonnursing colleagues from the unit. b) Document the patient's claims and the events surrounding the alleged incident. c) Consult with practice advisors from the state board of nursing. d) Liaise with the hospital's legal department as soon as possible.
b) Document the patient's claims and the events surrounding the alleged incident. It is imperative for nurses to carefully and accurately document assessment findings and the nursing care that they provide, a fact that is especially salient when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.
After reporting to work for a night shift, Nurse L. learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute patients in addition to his or her regular patient assignment. Which of the following statements is true of Nurse L. when working in understaffed circumstances? a) Nurse L. must document that float staff, nurses on overtime, and part-time staff were contacted in an effort to fill the gaps in care. b) Nurse L. will be legally held to the same standards of care as when staffing levels are normal. c) Nurse L. is legally obliged to refuse to provide care when understaffing creates the potential for unsafe conditions. d) Understaffing constitutes an extenuating circumstance that creates a temporarily lower expectation for care for Nurse L.
b) Nurse L. will be legally held to the same standards of care as when staffing levels are normal. The claim of being overworked does not constitute a legal defense, and both the potential for liability and standards of care remain unchanged despite and increased patient assignment. While it is prudent to make all realistic attempts to fill the gaps in staffing, documenting these efforts does not change Nurse L.'s legal position. A nurse has the right to refuse an unsafe patient assignment but the nurse is not legally obliged to withhold care.
The student nurse tells the family about a client with AIDS whom the student cared for in clinical yesterday. Which tort has the student committed?
invasion of privacy
An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor?
battery
A friend tells you not to even think about carrying your own insurance because "you'll be a magnet for attorneys trying to make a buck." When you seek the advice of the American Nurses Association, you are likely to read which of the following reasons for purchasing a personal professional liability insurance policy? (1) Protection of the nurse's best interests (2) Limitations of employer's coverage (3) Care or advice given outside of work (4) Protection of the institution's best interests a) (1) b) (1) and (2) c) (1), (2), (3) d) All of the above
c) (1) Protection of the nurse's best interests (2) Limitations of employer's coverage (3) Care or advice given outside of work The ANA (1990) lists these for purchasing a personal professional liability insurance policy.
Which of the following aspects of nursing would be most likely defined by legislation at a state level? a) The process that nurses must follow when handling and administering medications. b) The criteria that patients must meet in order to qualify for Medicare or Medicaid. c) The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs). d) The criteria that a nurse must consider when delegating tasks to unlicensed care providers.
c) The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs). The scope of practice defines the parameters within which nurses provide care and is established by state legislation, most commonly in the form of a Nurse Practice Act. The criteria and due process for delegation in the clinical setting is addressed by a stated board of nursing. Qualification criteria for programs such as Medicare and Medicaid are established by federal legislation while the process for safe and appropriate medication administration is defined and monitored by a stated board of nursing.
A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license? a) The National League for Nursing b) The Supreme Court c) The employing healthcare institution d) The State Board of Nurse Examiners
d) The State Board of Nurse Examiners The State Board of Nurse Examiners in the United States may revoke or suspend a nurse's license or registration for drug or alcohol abuse, which is the most common reason.
A client has been in the emergency department for three hours for treatment of a migraine headache. Care has been delayed due to a multicasualty car accident. The client gets up to go to the bathroom unattended, faints, and suffers a subdural hematoma. The family threatens to sue for malpractice. Which element of malpractice will be the most difficult for the attorney to prove?
causation
The nurse recognizes liability requires specific elements that must be established to prove that malpractice or negligence has occurred. Identify the specific elements. Select all that apply.
causation damages duty breach of duty
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which of the following guidelines is true regarding a nurse's role is witnessing a testator's signature? a) Witnesses do not need to observe the signing of the will and can sign it at a later time. b) A beneficiary to a will is allowed to act as a witness. c) A single witness is sufficient for a will. d) Witnesses to a signature do not need to read the will.
d) Witnesses to a signature do not need to read the will. Witnesses to the signature on a will do not need to read it, but they should be sure the document being signed is a will and not some other document. Witnesses should watch the testator sign the will, and they should sign in the presence of each other. A beneficiary to a will is not allowed to act as a witness in most states. Two or three witnesses are most commonly required on a will.
When a state attorney decides to charge a nurse with manslaughter for allegedly administering a lethal medication order, this is an example of what type of law? a) public law b) private law c) civil law d) criminal law
d) criminal law Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs.
While riding in the elevator, a nurse discusses the HIV-positive status of a client with other colleagues. The nurse's action reflects:
invasion of privacy
An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which offense has the nurse committed?
invasion of privacy
A nurse has applied soft wrist restraints to a client following endotracheal intubation. Which documentation is essential while using restraints? Select all that apply.
patient assessment findings every 2 hours foley catheter draining clear yellow urine .9NS IV infusing at 100 ml/hr
In comparison with licensure, which measures entry-level competence, what does certification validate?
specialty knowledge and clinical judgment
A client is in a persistent vegetative state. The client has no immediate family and is a ward of the state. Under these circumstances, who will speak on this client's behalf?
surrogate decision maker
A student is preparing to graduate from nursing school and understands that professional regulations and laws that govern nursing practice are in place. These regulations and laws are in place for which reason?
to protect the safety of the public
A nurse is being sued for malpractice in a court of law. What elements must be established to prove that malpractice or negligence has occurred? (Select all that apply.)
• Duty • Breach of duty • Causation
The nurse educator provides an educational session to the nursing staff on protection of a client's privacy. Which circumstances, identified by the staff, would indicate to the educator that the teaching was effective? Select all that apply.
• With the client's permission, the nurse explained the client's diagnosis to the client's spouse. • The nurse removed the client from the emergency department waiting room into a private area to collect assessment data.
A nurse enters a client's room and finds that the client is lying on the floor. The nurse makes the client comfortable on the bed and completes an examination. She informs the physician and the nursing supervisor about this incident and also completes an incident report. Which of the following actions by the nurse indicates correct knowledge of handling an incident report?
Documents a complete description of the happenings in the client's records
If you wanted to find a list of the violations that can result in disciplinary actions against a nurse, you should read which of the following? a) Nurse Practice Act b) Code of Ethics for Nurses c) Nurses' Bill of Rights d) American Journal of Nursing
a) Nurse Practice Act Each stated has a Nurse Practice Act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes you vulnerable to charges of violating the state Nurse Practice Act. Nurse Practice Acts list the violations that can result in disciplinary actions against a nurse and also serve to exclude untrained or unlicensed people from practicing nursing.
Which of the following clinical events constitute areas of potential liability for the nurses involved? Select all that apply. a) An elderly patient develops skin breakdown on his coccyx because he was turned infrequently. b) A patient with no known cardiac history suffers an unwitnessed cardiac arrest and dies. c) An anemic patient experiences a febrile reaction to a transfusion of packed red blood cells. d) A patient experiences a seizure after a missed dose of his scheduled anticonvulsant. e) A confused patient experiences a fall because her bedrails were left in a lowered position.
a) An elderly patient develops skin breakdown on his coccyx because he was turned infrequently. d) A patient experiences a seizure after a missed dose of his scheduled anticonvulsant. e) A confused patient experiences a fall because her bedrails were left in a lowered position. Liability exists when the elements of duty, breach of duty, causation, and damages exist. Failure to turn an immobile patient, missing a dose of medication, and leaving a vulnerable patient's bedrails lowered all constitute breaches of nurses' duties that result in damages. Not every untoward event is evidence of liability; however, febrile blood reactions or unexpected cardiac arrests may occur without any inappropriate causation by care providers.
During the orientation to the hospital, the staff development educator discusses unit and institutional-based policies. What is the source of the practice rules that result in unit and institutional-based policies? a) Healthcare institution b) Federal legislation c) State legislation d) Board of nursing
a) Healthcare institution The healthcare institution determines the unit and institutional policies. These policies may vary from institution to institution. Such policies may include clinical procedures, policies specific to the institution, and personnel and employment policies.
During a clinical placement on a subacute, geriatric medicine unit, a student nurse fed a stroke patient some beef broth despite the fact that the patient's diet was restricted to thickened fluids. As a result, the patient aspirated and developed pneumonia. Which of the following statements underlies the student's potential liability in this situation? a) The same standards of care that apply to a registered nurse apply to the student. b) The patient's primary nurse is liable for failing to ensure that delegated care was appropriate. c) The student and the nursing instructor share liability for this lapse in care. d) The student's potential liability is likely negated by the insurance carried by the school of nursing.
a) The same standards of care that apply to a registered nurse apply to the student. Despite the fact that their knowledge and skills are still under development, nursing students are held to the same standards of care as registered nurses. Consequently, primary liability does not lie with the student's instructor or the patient's primary nurse. Insurance may be carried by the school of nursing, but this does not negate the student's legal responsibility to provide care at a high standard.
A nurse exits the room of a confused patient without raising the side rails on the bed. The failure to raise the side rails would be which of the following elements of liability related to malpractice? a) breach of duty b) damages c) causation d) duty
a) breach of duty Breach of duty is failing to meet the standard of care, and in this case, it was the failure to execute and document the use of appropriate safety measures. Causation is the failure to use appropriate safety measures that results in injury to the patient. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-patient relationship. Damages are the actual harm or injury resulting to the patient.
A malpractice case involving an incident in the operating room has entered litigation. A scrub nurse has been asked to present her firsthand knowledge of the incident based upon recollection of the incident and documentation in the patient record. The nurse's role in this malpractice case is: a) nurse as a fact witness. b) nurse as the plaintiff. c) nurse as the defendant. d) nurse as an expert witness.
a) nurse as a fact witness. The nurse will act as a fact witness. Fact witnesses, who are placed under oath, must base their testimony on only firsthand knowledge of the incident and not on assumptions. The nurse will be asked if the testimony is based on independent recollection of the incident or on documentation in the patient's record. The nurse as defendant will work closely with an attorney while preparing the defense. The nurse as an expert witness will explain to the judge and jury what happened based upon the patient's record and offer an opinion about whether the nursing care met acceptable standards.
Which of the following clinical events is addressed by the provisions of the Health Insurance Portability and Accountability Act (HIPAA)? a) A patient with suicidal ideation is admitted for treatment despite being adamantly opposed to the admission. b) A patient develops a stage II pressure ulcer after several consecutive shifts where the hospital was short of safe staffing levels. c) A patient believes that the healthcare team is withholding information about her diagnosis and wishes to read her medical chart. d) A patient develops a nosocomial infection after sharing a room with another patient who had vancomycin-resistant enterococcus (VRE).
c) A patient believes that the healthcare team is withholding information about her diagnosis and wishes to read her medical chart. HIPAA defines a number of rights that patients possess within the domains of privacy and disclosure. Among these is the right that patients have to see and copy their health record. HIPAA does not address issues of possible negligence or unsafe care, such as the consequences of staffing shortages or lapses in infection control procedures. Patients who are deemed a genuine threat to themselves or to others may legally be admitted for care against their will.
A patient's morning blood work indicates a significant decline in his hemoglobin and hematocrit, prompting the primary care provider to order a blood transfusion. As a component of the informed consent process, the potential risks and benefits have been explained to the patient. How should the patient's comprehension of this information be determined? a) Supplement the spoken teaching with written materials. b) Ask the patient if he understands the risks and benefits of transfusion. c) Ask the patient to explain the risks and benefits in his own words. d) Provide an opportunity for the patient to ask any questions about the procedure.
c) Ask the patient to explain the risks and benefits in his own words. When determining a patient's comprehension of information, it is insufficient to simply ask if he or she understands. Rather, the patient should be asked to paraphrase or repeat the information that was provided. Supplementing teaching with written materials may enhance the patient's comprehension, but this does not determine whether or not the teaching was understood. Encouraging the patient to ask questions is an important aspect of teaching, but the absence of questions should not be construed as comprehension.
Which process evaluates and recognizes educational programs as having met certain standards? a) licensure b) credentialing c) accreditation d) certification
c) accreditation Accreditation is the process by which an educational program is evaluated and recognized as having met certain standards. Credentialing refers to ways in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants the license to do so. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area.
A registered nurse enters a patient's room and observes the nursing assistant pushing a patient down on the bed. The patient starts crying and informs the nursing assistant that he needs to go to the bathroom. The nursing assistant holds the patient down and tells him he was just in the bathroom. The nurse observing this incident is aware that the nursing assistant's action is an example of which of the following? a) fraud b) defamation of character c) battery d) assault
c) battery The nursing assistant is engaging in battery, which is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to or held by that other person. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that diminishes the other party's reputation.
Having recently completed a specialty nursing program in neonatal care, a nurse is now preparing to leave her current position on a medical unit and begin providing care in the hospital's neonatal intensive care unit (NICU). The nurse has completed which of the following processes of credentialing? a) accreditation b) licensure c) certification d) validation
c) certification The process of certification involves the attainment and validation of specialized nursing knowledge and skills. Certification is often necessary in order to ensure that the nursing care that is provided in specialized and high-acuity settings is safe and appropriate. Accreditation is the process by which an educational program, rather than an individual nurse, identifies that standards are being met. The process of licensure involves the determination that a nurse meets minimum requirements to practice, but not necessarily the specialized knowledge that is necessary for some care settings.Validation is not a specific aspect of the process of credentialing.
The results of a patient's most recent computed tomography (CT) scan indicate that his renal tumor has most likely metastasized to his liver and lungs. The healthcare team has scheduled a family meeting in order to discuss these findings with the patient and his family. Because a vacant meeting room is unavailable at short notice, the family meeting will take place shortly in the patient's room, which is shared by two other patients. This may constitute a direct violation of which of the following? a) the hospital's policies and procedures b) the hospital's risk management program c) the Health Insurance Portability and Accountability Act (HIPAA) d) the state's Nurse Practice Act
c) the Health Insurance Portability and Accountability Act (HIPAA) HIPAA guarantees patients' rights to privacy, and discussion of this patient's health status in a venue where others may overhear the proceedings is likely a contravention of HIPAA. Nurse Practice Acts focus primarily on issues related to scope of practice and professional discipline rather than the ethics of privacy. The hospital's policies and procedures may not directly address invasion of privacy and a risk management program exists primarily to reduce malpractice claims rather than ensure privacy.
Which of the following parties is responsible for obtaining informed consent from a patient? a) the patient's family or significant other b) the patient's nurse c) the person performing the procedure, study, or treatment d) the nursing supervisor
c) the person performing the procedure, study, or treatment Obtaining informed consent is the responsibility of the person who will be performing the diagnostic or treatment procedure or the research study. The nurse's roles are to confirm that a signed consent form is present in the patient's chart and to answer any patient questions about the consent.
A fellow student asks you about your legal liability when you do your clinical practice. Which of the following are true? (1) Student nurses are responsible for their own acts of negligence if these result in patient injury. (2) Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. (3) A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. (4) Nursing instructors may share a student's responsibility for damages in the event of patient injury if the instructor failed to provide reasonable and prudent clinical supervision. a) (1) and (3) b) (2) and (4) c) (1), (2), (3) d) All of the above
d) All of the answers are true.
If you harm a patient by administering a medication (wrong drug, wrong dose, etc.) ordered by a physician, which of the following is true? a) You are not responsible, since you were merely following the doctor's orders. b) Only you are responsible, since you actually administered the medication. c) Only the physician is responsible, since he or she actually ordered the drug. d) Both you and the physician are responsible for your respective actions.
d) Both you and the physician are responsible for your respective actions. Nurses are legally responsible for carrying out the orders of the physician in charge of a patient unless an order would lead a reasonable person to anticipate injury if it were carried out. If the nurse should have anticipated injury and did not, both the prescribing physician and the administering nurse are responsible for the harms to which they contributed.
Injuries related to lifting or transferring patients occur in the healthcare setting and may be considered a work-related injury. Which law was intended to reduce work-related injuries and illnesses? a) The Health Care Quality Improvement Act of 1986 b) Americans with Disabilities Act of 1990 c) Title VII of the Civil Rights Act of 1964 d) The Occupational Safety and Health Act of 1970
d) The Occupational Safety and Health Act of 1970 The Occupational Safety and Health Act of 1970 set legal standards in the United States in an effort to ensure safe and healthful working conditions for men and women. The Health Care Quality Improvement Act of 1986 was enacted to encourage healthcare practitioners to identify and discipline practitioners who engage in unprofessional conduct and to restrict the ability of incompetent practitioners to move from state to state without disclosure of the practitioner's previous performance. Title VII of the Civil Rights Act of 1964 protects employees from discrimination. The Americans with Disabilities Act of 1990 prohibits discrimination against disabled people and requires covered entities to reasonably accommodate individuals who are protected by the Act.
During the admission assessment of 40-year-old female patient with a suspected mandibular fracture, the patient discloses to the nurse that her injury came as a result of her husband hitting her. Which of the following actions should the nurse prioritize when responding to this disclosure? a) Informing the patient of her right to keep this information private b) performing an assessment to confirm the patient's statement c) ensuring the patient's statement is confirmed by another nurse d) reporting the abuse to the appropriate authorities
d) reporting the abuse to the appropriate authorities Nurses have a legal and ethical obligation to report cases of abuse. It would be inappropriate and likely unethical to require a third party witness to the statement or to withhold action pending assessment results. The nurse's obligation to report abuse legally supersedes the patient's right to privacy.
A nurse is caring for a client who has undergone coronary angioplasty. The cardiac monitor is showing abnormal ECG waves, indicating atrial fibrillation. The nurse does not recognize the importance of the sign; as a result, the client's condition deteriorates and the client has to be taken up for an emergency procedure. Which of the following describes the nurse's legal liability?
tort
