NU270 Legal Issues
A nurse observes another nurse place an unused dose of an opioid in the nurse's pocket. If caught, the nurse could be charged with which type of crime? felony tort misdemeanor negligence
felony Explanation: A felony is a serious criminal offense, and includes actions such as stealing opioids, murder, falsifying medical records, and insurance fraud. A misdemeanor is a minor criminal offense; a tort is a lawsuit in which a plaintiff charges that a defendant committed a deliberately aggressive act. Negligence is harm that results because a person did not act reasonably.
Which type of medication order might read "Vitamin K 10 mg I.M. daily × 3 days?" as-needed order one-time order standing order stat order
standing order Explanation: This example is a standing order. Prescribers write a one-time order for medications given only once. A stat order is written for medications given immediately for an urgent client problem. An as-needed order doesn't indicate a specific administration time; it gives guidelines for when to administer the medication. Many pain medication orders are as-needed orders.
A nurse is performing an admission assessment on a client admitted with a pelvic fracture. Which statement by the client requires the nurse to seek more information from a legal standpoint? "I'm going to need help at home after I'm discharged." "Sometimes my spouse gets so angry with me." "I'm so clumsy." "I'm afraid I'll lose my job because I'm going to miss so much work."
"Sometimes my spouse gets so angry with me." Explanation: Legally, the nurse must further investigate the client's statement concerning the spouse's anger. This statement suggests that the client's injury might be caused by domestic abuse. The other statements are common and don't require further investigation, from a legal standpoint, by the nurse.
A couple has just been notified that their unborn child carries a genetic disorder. The couple expresses concern that the insurance company will not cover the costs associated with the medical bills for the child. What is the most appropriate response by the nurse? "They will charge you a higher premium every month." "The insurance company may ask you to change policies once the baby is born." "The insurance company may consider it a preexisting condition since you know." "There are laws in place that prohibit that from happening."
"There are laws in place that prohibit that from happening." Explanation: The Genetic Information Nondiscrimination Act of 2008 prohibits insurance companies from denying coverage or charging higher premiums based solely on genetic predisposition.
The school nurse is conducting health assessments for a group of children. Which of the following situations encountered by the nurse raises suspicion of child neglect? A child doesn't want to play with others. A child tries to get attention from the nurse. A child reports of constant hunger. A child states, "I don't like my mother."
A child reports of constant hunger. Explanation: Constant hunger is a possible indicator that a child is being neglected. The other options would all be considered relatively age appropriate behaviors rather than being indicative of a more serious situation.
Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime? A client who is receiving care involuntarily on a community hospital's psychiatric unit A client who has been released into the community with strict limits on activity A client with a history of mental illness who is serving a lengthy term in a federal prison A client who is being held involuntarily in a secure psychiatric setting
A client who is being held involuntarily in a secure psychiatric setting Explanation: Individuals found not guilty of a crime but mentally ill are normally held in a secure psychiatric setting, not a community hospital, prison, or in the community.
Which is an example of an unintentional tort? A nurse gives the client a medication, and the client has an adverse reaction to it. A nurse threatens to restrain a client if the client does not stop talking. A nurse tells a client that the client cannot leave the hospital until the client pays the bill. Nurses discuss a client's laboratory values in the elevator.
A nurse gives the client a medication, and the client has an adverse reaction to it. Explanation: An unintentional tort occurs when the nurse does not intend harm, but harm occurs (e.g., the nurse administers a medication and the client has an adverse reaction to it). The other three responses are intentional torts.
A psychiatric mental health facility is undergoing a change from paper-based health records to electronic records. What action should the nurse prioritize in order to ensure client rights are protected? Teaching clients that they may lose the right to view their health records under the new system Ensuring clients know that they have the right to opt out of the proposed system Being vigilant to identify any potential threats to client confidentiality Educating clients and families about the potential benefits of the new system
Being vigilant to identify any potential threats to client confidentiality Explanation: Electronic health records present potential threats to confidentiality that must be addressed. It would not be possible for a client to opt out of a documentation system. Teaching clients about the benefits of health records does not directly address client rights. Clients never lose the right to view their health records.
The nurse is caring for an adolescent with cancer who is well informed about the medical condition and treatment. The adolescent refused the morning medications and states intentions of refusing all future medications. What is the best action by the nurse? Ask the adolescent's parents to encourage the adolescent to take the medication. Ensure that the adolescent understands the rationale for taking the medication. Document the adolescent's choice and offer to discuss feelings about the medication. Persuade the adolescent to take the medication as ordered.
Document the adolescent's choice and offer to discuss feelings about the medication. Explanation: The client has the right to choose whether to take the medication. The nurse should try to determine the reason for the adolescent not wanting the medication other than choice (e.g., side effects, fear of falling asleep and not waking). The other options do not support the autonomy of the adolescent to make an informed decision.
To properly assist a victim of intimate partner violence, which action would be most appropriate for the nurse to do? Document the details. Summarize the details of the incident. Confront the abuser about the details. Discuss the details with the victim.
Document the details. Explanation: Accurate documentation is critical because this evidence may support the client's case in court. Documentation must include details about the frequency and severity of violence; location, extent, and outcome of injuries; and any treatments or interventions. Documentation should always use direct quotes, and be very specific.
A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should: Not accept the client's request. File for a civil commitment to detain. Allow the client to go home. Ask the caregivers of the client for consent.
File for a civil commitment to detain. Explanation: Every client in a health care facility has a right to request to be discharged. If a client has suicidal ideations or is a danger to others, then the client should be under close supervision at all times. The health care provider should file a civil commitment to detain the client against the client's will until a hearing takes place to decide the matter. The caregivers may not understand the situation of the client and the danger that the client poses for the family. Thus, it would be inappropriate for the health care provider to ask the caregivers for consent.
A nurse is reluctant to provide care at an accident scene. Which legal definition is true regarding the provision of nursing care? Scope of practice involves general guidelines that define nursing. Good Samaritan laws are designed to protect the caregiver in emergency situations. Negligence is intentional failure to act responsibly or deliberate omission of a professional act. Malpractice is failure to perform professional duties that result in client injury.
Good Samaritan laws are designed to protect the caregiver in emergency situations. Explanation: Good Samaritan laws are designed to protect the caregiver in emergency situations. If the nurse stopped to provide care, legally there is protection. Failure to stop would constitute an issue. Malpractice involves the failure to perform professional duties; it may involve omissions of important care measures or performing care measures that are not appropriate in the situation. Negligence is failure to act professionally. Scope of practice includes specific guidelines of professional conduct.
A nurse talks with family members about an AIDS client from the clinic where the nurse works. Which tort has the nurse committed? Assault Slander Invasion of privacy Fraud
Invasion of privacy Explanation: Invasion of privacy involves a breach of keeping client information confidential. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Slander is oral defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent.
What is true of nursing responsibilities with regard to a physician-initiated intervention (physician's order)? Nurses are responsible for reminding physicians to implement orders. Nurses do carry out interventions in response to a physician's order. Nurses do not carry out physician-initiated interventions. Nurses are not legally responsible for these interventions.
Nurses do carry out interventions in response to a physician's order. Explanation: A physician-initiated intervention is initiated in response to a medical diagnosis, but carried out by a nurse in response to a doctor's order. Both the physician and the nurse are legally responsible for these interventions. Although nurses are not responsible for reminding physicians to implement orders, nurses may request a physician to implement an order or question an existing order by the physician if the nurse believes it is in the client's best interests.
DNA fingerprinting is based in part on recombinant DNA technology and in part on those techniques originally used in medical genetics to detect slight variations in the genomes of different individuals. These techniques are used in forensic pathology to compare specimens from the suspect with those of the forensic specimen. What is being compared when DNA fingerprinting is used in forensic pathology? The chromosomes The triplet code The banding pattern The haplotypes
The banding pattern Explanation: Banding patterns are analyzed to see if they match. Four bases—guanine, adenine, cytosine, and thymine (uracil is substituted for thymine in RNA)—make up the alphabet of the genetic code. A sequence of three of these bases forms the fundamental triplet code used in transmitting the genetic information needed for protein synthesis. The small variation in gene sequence (termed a haplotype) is thought to account for the individual differences in physical traits, behaviors, and disease susceptibility. Chromosomes contain all the genetic content of the genome.
The client is to receive a unit of packed red blood cells. What is the nurse's first action? Ensure that the intravenous site has a 20-gauge or larger needle. Observe for gas bubbles in the unit of packed red blood cells. Check the label on the unit of blood with another registered nurse. Verify that the client has signed a written consent form.
Verify that the client has signed a written consent form. Explanation: All the options are interventions the nurse will do to ensure the blood transfusion is safe. The question asks about the first action of the nurse. The first action would be verifying that the client has signed a written consent form. Then, the nurse would ensure the intravenous site has a 20-gauge or larger needle. The nurse would proceed to obtain the unit of blood, check the blood with another registered nurse, and observe for gas bubbles in the unit of blood.
While riding in the elevator, a nurse discusses the HIV-positive status of a client with other colleagues. The nurse's action reflects: professional negligence. false imprisonment. defamation of character. invasion of privacy.
invasion of privacy. Explanation: The nurse's action reflects an invasion of the client's privacy. Disclosing confidential information to an unauthorized third party subjects the nurse to liability for invasion of privacy, even if the information is true. Defamation of character includes false communication that results in injury to a person's reputation. Negligence is an act of omission or commission. Prevention of movement or unjustified retention of a person without consent may be false imprisonment.
A mentally incapacitated client is scheduled for surgery. Considering the principle of autonomy, who should give the consent for surgery? operating surgeon surrogate decision maker client attending nurse
surrogate decision maker Explanation: A surrogate decision maker should be identified to give consent for the mentally incapacitated client. Infants, young children, people who are severely mentally handicapped or incapacitated, and people in a persistent vegetative state or coma do not have the capacity to participate in decision making about their healthcare. For such people, a surrogate decision maker must be identified to act on their behalf. The surgeon and the nurse are not eligible to give consent for the client.
While responding to a client's call for help, the nurse finds the client lying on the floor. After assisting the client to bed and performing an assessment, the nurse informs the healthcare provider. In completing an incident report, the nurse documents that the client: was attempting to get out of bed. was found lying on the floor. appears to be unharmed. is a fall risk.
was found lying on the floor. Explanation: An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. All the details given in the incident report should be accurate and not assumed. Accurate and detailed documentation helps to prove that the nurse acted reasonably or appropriately in the circumstance. The nurse should document that the client was found lying on the floor. The other statements are assumptions and should not be included in the incident report.
A client who tested positive for human immunodeficiency virus (HIV) and has pancreatitis is admitted to the medical unit. The nurse director from another unit comes into the medical unit nurses' station and begins reading the client's chart. The staff nurse questions the director about reading the client's chart. The director states that the client is a neighbor's son. What action should the nurse take? Inform the nurse director reading the chart is a violation of the client's right to privacy and ask the nurse director to return the chart. Report the incident to the medical director and document the nurse director's actions. Remind the nurse director that permission from the medical director must be provided before access can be granted. Remind the nurse director not to share the client's medical information with anyone because of the client's HIV status.
Inform the nurse director reading the chart is a violation of the client's right to privacy and ask the nurse director to return the chart. Explanation: Personal health information may not be used for purposes not related to health care. The nurse director found reading the chart is not providing health care to the client and therefore does not require access to the chart. The nurse should confront the nurse director and request the return of the client's chart. The director should not have access to this client's health care information regardless of the client's HIV status. If the nurse director does not comply with the nurse's request, the nurse should report the incident to the nurse manager, so the infraction can be reported through the proper channels. The staff nurse should not report the incident to the medical director. Asking the nurse director about permission from a medical director to read the chart does not protect client confidentiality.
A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case? Pharmacologic interventions should not be initiated. The client should be resuscitated if he experiences respiratory arrest. The client should be treated with antibiotics for pneumonia. The wishes of his family should be followed.
The client should be treated with antibiotics for pneumonia. Explanation: The client has signed a document indicating a wish not to be resuscitated. Treating the pneumonia with antibiotics is not a resuscitation measure. The other options do not respect the client's right to choice.
The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained? learning the mother is not the custodial parent finding out the mother is younger than 18 years of age establishing the mother was never married determining the mother cannot read the form
learning the mother is not the custodial parent Explanation: It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood.
Which guidelines define and regulate what the nurse may and may not do as a professional? state legislature standards of care nurse practice act facility policies and procedures
nurse practice act Explanation: Each state legislature has enacted a nurse practice act. These statutes outline the legal scope of nursing practice within a particular state. State boards of nursing oversee the statutory law. State legislatures create boards of nursing within each state; the state legislature itself doesn't regulate the scope of nursing. Facility policies govern the practice within a particular facility. Nurse practice acts set educational requirements for the nurse, distinguish between nursing practice and medical practice, and define the scope of nursing practice in that state. Standards of care, criteria that serve as a basis for evaluating the quality of nursing practice, are established by federal organizations, accreditation organizations, state organizations, and professional organizations.
A staff nurse is caring for a client who is a potential heart donor. The client's family is concerned that the recipient will have access to personal donor information. Which response by the nurse demonstrates knowledge of the organ donation process? "The recipient is allowed to ask questions about the donor and have them answered." "It is important that the recipient knows how to reach the family of the donor if health problems arise after the transplant." "There is never contact between the donor's family and the recipient." "I will have the transplant coordinator speak with you to answer your questions."
"I will have the transplant coordinator speak with you to answer your questions." Explanation: The transplant coordinator, a specially trained person with knowledge of the donation, procurement, and transplantation processes, typically speaks to family members about organ donation and answers their questions. Contact is permitted after the procedure with consent from the donor's family and the recipient. Typically, the transplant organization coordinates the communication. Confidentiality of the potential donor is always maintained unless the recipient and donor families both sign confidentiality waivers.
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?" Which is the most appropriate response by the nurse? "As long as your family knows your medical wishes, you will not need it." "We have it on file here, so any hospital can call and get a copy." "Take it with you. It is recognized universally in the United States." "A living will can only be used in the state in which it was created."
"Take it with you. It is recognized universally in the United States." Explanation: A separate or different advance directive is not needed for each state; an advance directive can be used in any state, regardless of where it was created. The nurse should advise the client to take it when travelling out of state. The client should not assume that the family knows the client's wishes; the whole purpose of having an advance directive is to avoid the ambiguity and potential confusion that making such assumptions can cause. Other hospitals may not know who to contact to request a copy of the advance directive; therefore, it would be much safer for the client to take a copy of it while travelling.
After replacing a fentanyl 25 mcg patch for a client with chronic pain, what is the priority action by the nurse? Fold the adhesive edges together of the used patch and flush down the toilet. Wrap the used patch in a nonsterile glove and place in the trash. Dissolve the used patch in water and dispose of in the sink. Wrap the used patch in a nonsterile glove and place in a sharps container.
Fold the adhesive edges together of the used patch and flush down the toilet. Explanation: A fentanyl transdermal patch is a controlled substance with a high risk for abuse. Federal law requires proper disposal of all controlled substances to prevent diversion and misuse. The recommended procedure for disposal of the used fentanyl patch is to fold the adhesive edges together and flush down the toilet to prevent the misuse of any remaining medication in the patch. The trash and the sharps container are not secure and therefore would not prevent the misuse of the medication remaining in the patch. The patch will not dissolve in water in a reasonable amount of time. The patch should be disposed of immediately.
A nurse notices the smell of marijuana on a nursing colleague upon return from lunch break. The colleague is having difficulty drawing up a dose of insulin, appears uncoordinated, and is unaware that the needle has been contaminated. What is the best action for the nurse to take? Reassign the responsibilities, and inform the colleague that the unit manager will be notified if it occurs again. Take the syringe and insulin vials, draw up the insulin, and instruct the colleague to focus more clearly when giving the injection. Stop the colleague from drawing up the insulin. Notify the supervisor about the incident, and document the observations. Take the insulin vials and needle, draw up the insulin, and administer it. Ask a colleague to observe the nurse for the remainder of the shift.
Stop the colleague from drawing up the insulin. Notify the supervisor about the incident, and document the observations. Explanation: Acknowledging that there is a problem and protecting the client is a professional responsibility. Calling the supervisor is important so the client can be reassigned and the supervisor can deal with the problem. Taking over the nurse's responsibilities is not appropriate. The problem then will not be addressed. The incident needs to be reported because client care is in jeopardy.
The nurse is writing a medication order that a health care provider provided by telephone. Which should be included when writing the order? Select all that apply. route of administration date the order is written client allergies code status medication dosage medication ordered
date the order is written medication dosage route of administration medication ordered Explanation: When writing a verbally received order, the medication needs to be included in the order so the pharmacy and nurse know what medication the health care provider ordered. The date needs to be included so there is a record of when the order was written. The medication dosage needs to be included so the pharmacist knows how much to dispense and the nurse knows how much to give the client. The route of administration needs to be included so the pharmacist knows what dosage form to dispense and the nurse knows by what route to administer the medication. The code status and allergies are important for the nurse to know, but they are not included when writing a medication order.
In which circumstance may the nurse legally and ethically disclose confidential information about a client? A single client's human immunodeficiency virus (HIV) status to the family members A taxi driver's diagnosis of an uncontrolled seizure disorder to a state agency A diagnosis of pancreatic cancer to a client's significant other The fact that a woman is 32 weeks pregnant with twins to the partner from whom she is legally separated
A taxi driver's diagnosis of an uncontrolled seizure disorder to a state agency Explanation: A nurse may lawfully disclose confidential information about a client when the welfare of a person or group of people is at stake. A healthcare provider must inform the Department of Motor Vehicles that the taxi driver has an uncontrolled seizure disorder; disclosing the condition is in the best interest of public safety and the client's well-being. Confidentiality of HIV testing is required, but the client, who's HIV positive, should be encouraged to share the information with family. Many state legislatures require maintaining confidentiality of HIV testing. The nurse may not disclose a diagnosis of pancreatic cancer or a pregnancy because these situations don't affect the welfare of a group of people.
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 Defamation of character Fraud Assault
Battery Explanation: The UAP 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 harm the other party's reputation.
A client has designated her daughter as a person to make healthcare decisions for the client if he is not able to do so. What type of advance directive is this considered? Living will Do-not-resuscitate order (DNR) Power of attorney Durable power of attorney (DPOA) for healthcare
Durable power of attorney (DPOA) for healthcare Explanation: A client may designate another person to be the DPOA for healthcare or healthcare proxy. This person has the authority to make healthcare decisions for the client if he or she is no longer competent or able to make these decisions. A general power of attorney does not give that designated person the ability to make healthcare decision. In DNR order, the client wishes to have no resuscitative action taken if he or she experiences a cardiac or respiratory arrest. A living will is a document that states a client's wishes regarding healthcare if he or she is terminally ill.
The nurse is providing care to several clients. In which situation would the nurse be able to accept a verbal order from the healthcare provider? The client has just been admitted to the unit from the emergency department. The client reports new onset headache and has a blood pressure of 90/50 mm Hg. The client is being transported to the cardiac catheterization department. The client is hemorrhaging from a surgical wound.
The client is hemorrhaging from a surgical wound. Explanation: In most facilities, the only circumstance in which an attending healthcare provider may issue orders verbally is in a medical emergency, when the healthcare provider is present but finds it impossible to write the order. The postoperative hemorrhage is the only scenario that could be considered an emergency. Although the one client's blood pressure is low, there is no evidence there this is a potentially life-threatening situation. When clients are transferred between facilities or departments, there is time to write prescriptions, so the healthcare provider should enter these directly into the medical record as the safest form of documentation.
A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking? "We are amazed that he'll be up and walking around the day after surgery." "He might miss some school afterwards, but he'll be feeling much better." "We had to sign the form right away so the surgery could get scheduled." "Although there are risks involved, our son needs the surgery to cure the problem."
"We had to sign the form right away so the surgery could get scheduled." Explanation: The statement about signing the form right away suggests that the family was coerced into agreeing to the surgery without being fully informed about the risks and benefits. The key ethical issues related to informed consent for treatment have similarities to those required for research participation: Consent must be voluntary and based upon shared information about the risks and benefits of the treatment. Furthermore, the parent must understand the information and be cognitively and mentally competent to make the decision. The statements about risks, activity limitations, and postoperative care indicate that information was shared with them and that they understood it.
A client has designated her daughter as a person to make healthcare decisions for the client if he is not able to do so. What type of advance directive is this considered? Power of attorney Durable power of attorney (DPOA) for healthcare Do-not-resuscitate order (DNR) Living will
Durable power of attorney (DPOA) for healthcare Explanation: A client may designate another person to be the DPOA for healthcare or healthcare proxy. This person has the authority to make healthcare decisions for the client if he or she is no longer competent or able to make these decisions. A general power of attorney does not give that designated person the ability to make healthcare decision. In DNR order, the client wishes to have no resuscitative action taken if he or she experiences a cardiac or respiratory arrest. A living will is a document that states a client's wishes regarding healthcare if he or she is terminally ill.
A nurse must restrain a client to ensure the safety of other clients. When using restraints, which principle is a priority? Use an organized, efficient team approach to apply and secure the restraints. Have three staff members present, one to restrain each side of the client's body and one for the head. Tie restraints securely to the side rails. Secure restraints to the bed with knots to prevent the client from escaping.
Use an organized, efficient team approach to apply and secure the restraints. Explanation: Emergency department personnel should use an organized, team approach when restraining violent clients so that no one is injured in the process. The leader, located at the client's head, should take charge; four staff members are required to hold and restrain the limbs. For safety reasons, restraints should be fastened to the bed frame instead of the side rails. For quick release, loops should be used instead of knots.
While caring for an infant, the nurse hears another child screaming in the next room and rushes there, forgetting to put the side rails up on the infant's crib. The nurse returns to the room to find that 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? Battery Defamation Assault Malpractice
Malpractice Explanation: The nurse did not ensure the safety of the infant by pulling up the side rails before leaving the infant unattended. Therefore, the nurse may be charged with malpractice because the nurse had a duty and breached it, which resulted in harm to the infant. Assault occurs when a person threatens to touch a client without consent. Battery is actually touching the client without consent. Defamation occurs when one makes a statement about another person that can damage the person's reputation.
A nurse is considering using restraint and seclusion for a client who is acting out. Which is the primary guideline for the use of restraint and seclusion? Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent. Use should be limited to times when medications have been unsuccessful in de-escalating a situation. Use should be limited to times when a client has demonstrated violence and has inflicted harm to self or others. Use should be limited to emergency situations in which the client is demonstrating a potential to be violent.
Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent. Explanation: Because of the risks of restraint and seclusion, a primary guideline is that use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent. Furthermore, restraint and seclusion should be applied only when other less restrictive methods to ensure client safety have failed. Nonphysical interventions are the first choice.
