PrepU NSG204 Chapter 07: Legal Dimensions of Nursing Practice

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. defamation of character. professional negligence. false imprisonment.

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 nurse confides in a nurse friend, "I never report minor incidents. The charge nurse always wants a variance report filled out and they take so much time." Which responses by the friend are indicated? Select all that apply. "As long as no one is hurt, I don't see a problem with not reporting minor incidences." "I don't blame you, I think the charge nurse is just trying to get us in trouble." "Having documentation might keep you out of trouble someday." "Reporting helps us fix problems that result in danger to clients." "I usually document the problem in the chart, but don't fill out a report."

Correct response: "Having documentation might keep you out of trouble someday." "Reporting helps us fix problems that result in danger to clients." Explanation: Incident or variance reports serve as a tool for trending to identify risk and avoid it in the future. Having correct documentation is very beneficial if error or injuries lead to litigation. Simply documenting problems in a client chart is not enough, as they may apply to more than just that client and may be overlooked. Injury is not always immediately obvious. Variance reports should not be used punitively.

A nursing student administers an overdose of an opioid to a client and the client arrests. When discussing the incident with nursing faculty, which statements made by the student indicate the need for further teaching? Select all that apply. "I realize that I am held to the same standards as a registered nurse." "I have also put the nursing faculty at risk with my action." "I am glad I am a student because nursing faculty will be blamed, not me." "I should have informed you that I felt unprepared for my assignment." "I cannot be held liable because this is only my second time at this facility."

Correct response: "I am glad I am a student because nursing faculty will be blamed, not me." "I cannot be held liable because this is only my second time at this facility." Explanation: A nursing student is responsible and held liable for his or her own actions. The student is responsible for being familiar with the facility's policies and procedures. The student is held to the same standards as a registered nurse, and should inform faculty when unprepared for an assignment. The student nurse puts the clinical faculty at risk by performing actions that are deemed negligent.

While a client admitted to the medical-surgical unit is in the radiology department, a visitor claiming to be the client's cousin arrives on the medical-surgical unit and asks the nurse to provide a brief outline of the client's illness. Which response by the nurse would be most appropriate, both legally and professionally? "I will call the client and ask for permission to share this information with you." "I cannot give you that information due to client confidentiality." "Do you have any identification proving that you are related to the client?" "I'm busy right now but can talk later."

Correct response: "I cannot give you that information due to client confidentiality." Explanation: Sharing a client's information without the client's consent is an invasion of privacy. The nurse should not give out the information even if the visitor provides proof of a relationship without the client's consent. It is inappropriate to call the client to ask for permission. The nurse claiming to be busy and offering to talk later does not address the issue but only delays it, perhaps leading the visitor to assume that the nurse will disclose information then.

Which statement made by the nurse providing care to a group of clients indicates that the nurse requires further education regarding negligence? "Please avoid bringing fresh fruit to a client with neutropenia." "I am going to assess for collateral circulation before preforming an arterial blood gas (ABG)." "I am going to auscultate breath sounds every 8 hours on a client receiving enteral feedings." "I don't need to assess distal pulses on a client after a femoral arteriography."

Correct response: "I don't need to assess distal pulses on a client after a femoral arteriography." Explanation: Distal pulses should be checked immediately after a femoral arteriography; therefore, the nurse is negligent for checking three hours after the procedure. Fresh fruit may contain bacteria and further compromise a client with neutropenia. The Allen test confirms that there is proper circulation to the hand before drawing an ABG. The nurse checks breath sounds at least every 8 hours for adventitious sounds that may indicate aspiration.

Which statements made by a nurse would indicate to a nurse manager that the nurse requires further training? Select all that apply. "If I make a mistake, I will not tell anyone." "When I document, I make sure it is factual, accurate, complete, and timely." "I will have the supervisor fill out the incident report when I make an error." "I am accountable for any task that I delegate." "The nursing plan of care must be accurate and must be followed. It is part of the client's permanent record."

Correct response: "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." Explanation: Nurses should report errors and mistakes and complete incident reports themselves, not have supervisors do it. Documentation should be accurate, factual, complete, and timely. Nurses are accountable for any designated task. The nursing plan is part of the client's permanent record.

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? "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." "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."

Correct response: "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.

A nurse from the postanesthesia care unit (PACU) transports a client in the elevator with a nurse from the intensive care unit (ICU). There are staff members and visitors in the elevator as well. Which response from the ICU nurse is appropriate when the PACU nurse begins the report? "Before you begin we need to ensure a family member is present." "You can just put the report on the foot of the bed and I will look at it when I get to the room." "I will look at the EHR when I get to the nurse's station." "Wait and give me a report in the room at the bedside."

Correct response: "Wait and give me a report in the room at the bedside." Explanation: It is appropriate for the ICU nurse to ask the PACU nurse to wait to give a report at the bedside. Discussing client information in the elevator with family or other workers violates client confidentiality and must be avoided. This also prevents discussions even in the presence of family members. If the report is left on the foot of the bed others may be able to see information. The electronic health record (EHR) is not the place to obtain transfer information so this would not be appropriate.

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 3 times. As usual, health care provider did not respond. 1300: Client temperature elevated. Health care provider paged, but did not respond. Administered acetaminophen without an order because I knew this health care provider does not return calls. 1300: Client temperature elevated. Telephoned health care provider's service several times with no response. Will notify nursing supervisor during rounds. 1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified.

Correct response: 1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified. Explanation: Documentation must have the correct, factual, and timely information. The nurse must document when the health care provider was called and response or lack of response; what nursing action was done, if any, and notification of appropriate personnel. The nurse cannot administer medication without an order. The nurse should be careful to not make incriminating statements, such as, "as usual, health care provider did not respond." The nurse should not wait until rounds are made to inform the supervisor.

The client being admitted to the oncology unit conveys wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in the client's best interest to obtain which document? A will A living will Proof of health care power of attorney A proxy directive

Correct response: A living will Explanation: A living will is an advance directive that specifies the type of medical treatment clients do or do not want to receive should they be unable to speak for themselves in a terminal or otherwise unconscious condition. A will is a legal document detailing how to dispose of one's assets and belongings upon death. Proof of health care power of attorney and a proxy directive are documents identifying another person to legally make health care decisions for the client. In this case the client is stating the client's own decisions in advance of potential incapacitation.

When talking with family over dinner, the nurse shares about a client with infertility at the hospital, identifying the person by name. Which tort has the nurse committed? Slander Assault Invasion of privacy Fraud

Correct response: Invasion of privacy Explanation: Invasion of privacy involves a breach in keeping client information confidential. Slander is oral defamation of character. Assault is a threat or 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.

Nurses may commit both intentional and unintentional torts when practicing within the profession. What intentional torts may occur in nursing practice? Select all that apply. A nurse forgets to put the side rails up on a crib and the toddler falls out. A nurse does not report a change in client condition in a timely manner. A nurse threatens to hit an older client who has dementia and is screaming. A nurse seeks employment in a hospital after falsifying credentials on a resume. A nurse places a client who is a fall risk in restraints without an order from the health care provider. A nurse makes disparaging remarks to the staff about a client who has a sexually transmitted infection (STI).

Correct response: A nurse threatens to hit an older client who has dementia and is screaming. A nurse seeks employment in a hospital after falsifying credentials on a resume. A nurse places a client who is a fall risk in restraints without an order from the health care provider. A nurse makes disparaging remarks to the staff about a client who has a sexually transmitted infection (STI). Explanation: Torts may be intentional or unintentional acts of wrongdoing. Some of the intentional torts for which nurses may be held liable include assault and battery. Examples of intentional torts would include a nurse threatening to hit an older client who has dementia and who is wailing; a nurse seeking employment in a hospital after falsifying credentials on a resume; a nurse placing a client who is a fall risk in restraints without the proper order; a nurse making disparaging remarks to the staff about a client who has a sexually transmitted infection. A nurse forgetting to put the side rail up on a crib would be an example of an unintentional tort, as would a nurse not reporting a change in client condition in a timely manner.

.Which scenario is an example of certification? A nurse who demonstrates advanced expertise in a content area of nursing through special testing A hospital that meets the standards of the Joint Commission An education program that meets the standards of the National League for Nursing A graduate of a nursing education program who passes the NCLEX-RN

Correct response: A nurse who demonstrates advanced expertise in a content area of nursing through special testing Explanation: Certification is a voluntary process whereby a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes the NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the NLN Commission for Nursing Education Accreditation and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit health care agencies.

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? A surrogate decision maker A church-appointed guardian A significant other A best friend

Correct response: A surrogate decision maker Explanation: Infants, young children, people with severe cognitive impairment or who are incapacitated, and people in a persistent vegetative state or coma do not have the capacity to participate in decision-making about their health care. For such people, a surrogate decision maker must be legally designated to act on their behalf. The surrogate decision maker may be any one of the individuals listed in the other answers, if properly identified by the hospital authorities.

Which process evaluates and recognizes educational programs as having met certain standards? Accreditation Credentialing Licensure Certification

Correct response: Accreditation Explanation: 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 that person 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.

Which action constitutes battery? An older adult client refuses an intramuscular injection, but the nurse administers it. The nurse threatens to restrain a client if the client does not take a medication. While bathing a client behind pulled curtains, two nurses discuss a different client. The nurse tells a client that the client cannot leave the hospital because the client is seriously ill.

Correct response: An older adult client refuses an intramuscular injection, but the nurse administers it. Explanation: If the client refuses a procedure or medication and the nurse proceeds with it, it is battery. Threatening to touch a client without consent is assault. Discussing a client within earshot of others is an invasion of privacy. Keeping a client against the client's wishes, regardless of health status, is false imprisonment.

An RN is working on a medical-surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action by the RN is considered negligent if injury results from this action? Asking the LPN/LVN to teach a new diabetic client how to administer insulin Calling the health care provider about abnormal lab results Obtaining vital signs on a newly admitted client Delegating oral medication administration to the LPN/LVN

Correct response: Asking the LPN/LVN to teach a new diabetic client how to administer insulin Explanation: Negligence is harm that results because a person did not act reasonably. As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular health care providers to perform (scope of practice), as well as the policy for the facility at which they are employed. Teaching is not in the current scope of practice for a LPN/LVN, and thus the RN's delegation of this task to the LPN/LVN could be considered negligence. The other actions are within the scope of practice for a LPN/LVN.

While walking down the hall, a nurse manager overhears a staff member telling a client, "If you don't stay in this chair and stop wandering, I'm going to tie you to it." The nurse manager pulls the staff member aside and discusses what was said. The nurse manager intervenes because the staff member's statement is which type of tort? Assault Battery False imprisonment Invasion of privacy

Correct response: Assault Explanation: The staff member's statement reflects a threat of contact with another person without the person's consent. This is considered assault. Battery is an assault that is carried out and includes willful, angry, and violent or negligent touching of another's body or clothes (or anything attached to or held by that person). False imprisonment is the unjustified retention or prevention of the movement of another person without proper consent. This would apply if the staff member did in fact tie the client to the chair. Invasion of privacy involves the disclosure of information without the person's consent.

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 Assault Fraud Defamation of character

Correct response: 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.

The nurse is providing care to a client who had orthopedic surgery. The nurse has medicated the client for pain. However, the client reports that the pain is unrelieved. The nurse takes no further action regarding assessment and intervention for the client's pain. The nurse does not notify the surgeon regarding the client's pain. The nurse's failure to take further action represents which element of liability in this case? Breach of duty Causation Damages Duty

Correct response: Breach of duty Explanation: Breach of duty is the failure to assess, intervene, or notify the health care provider regarding the client's condition. It does not meet the expected standard of care. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Causation is when the failure to meet the standard of care caused injury. Damages are the harm or injury to the client.

The evening nurse received a change-of-shift report from the day nurse. The day nurse's report states, "The client required intubation for respiratory distress this morning, but has been stable all day." The evening nurse collects the following information during the first assessment: Skin flushed. Client lethargic. Temperature 103.0°F (39.4°C). A review of the client's chart reveals that the client's last assessment was done 7 hours earlier. A review of the findings by the nurse attorney determines which facts might be in place regarding liability? Select all that apply. Duty has not occurred since the evening nurse just started the shift. The facility will have to fire the nurse for malpractice. Breach of duty has occurred. The facility will settle the case. The spouse was notified of the change in condition.

Correct response: Breach of duty has occurred. Explanation: The nurses had a duty to care for the client and breached duty by not assessing the client in 7 hours. No determination of the nurse or facility's response is made until a complete investigation is done.

The nurse is preparing to administer a prescribed medication and notes the dosage is well above the suggested therapeutic range. Which action should the nurse take? Follow the facility medication reconciliation procedure. Document the occurrence in the client's medical record. Fill out an incident report and hold the medication. Call the provider to clarify the medication prescription.

Correct response: Call the provider to clarify the medication prescription. Explanation: Nurse practice acts report that nurses are responsible for their own actions regardless of the provider's written prescription. As such, the nurse should call the provider to clarify the medication prescription, because it is out of the suggested therapeutic range. Medication reconciliation is the process of comparing home medications with prescriptions on the medical record. Although reconciliation should be done, the nurse has a legal duty to clarify the prescription. Documenting the occurrence in the client's medical record does not ensure client safety. Filling out an incident report and holding the medication is not addressing the incorrect dosage.

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 Accreditation Licensure Litigation

Correct response: Certification Explanation: Certification validates specialty knowledge, experience, and clinical judgment. A nurse in a critical care unit having specialized skills and knowledge to provide care would be an example of certification. Licensure is a specialized form of credentialing based on laws passed by a state legislature. Licensure endorses entry-level competence. Legal accreditation is granted to educational programs by state agencies endorsing the approval of the program's design and mission to meet the needs of state requirements. Litigation is not a method for validation.

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. Restrain the client with vest restraints. Apply restraints after giving a sedative. Apply wrist restraints instead of vest restraints.

Correct response: Contact the physician and obtain necessary orders. Explanation: If a nurse feels that a client needs to be restrained, the nurse should inform the physician and obtain necessary orders. The nurse should also discuss this with the client's family members and ask their opinion. The nurse should not sedate the client and then restrain him, as the nurse could be charged with battery if there is restraint without orders. Applying a wrist restraint instead of a vest restraint is like compromising with the client, which is unethical.

A nurse is named as a defendant in a malpractice lawsuit. Which action would be recommended for this nurse? Discuss the case with the plaintiff to ensure understanding of each other's positions. If a mistake was made on a chart, change it to read appropriately. Be prepared to tell your side to the press, if necessary. Do not volunteer any information on the witness stand.

Correct response: Do not volunteer any information on the witness stand. Explanation: The nurse on the witness stand should be polite, but not volunteer any information. The nurse should only answer the questions asked. The other answers are not examples of what a nurse should do in a malpractice lawsuit.

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? Health care institution Federal legislation State legislation Board of nursing

Correct response: Health care institution Explanation: The health care 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. Unit and institutional-based policies are not derived from federal legislation, state legislation, or the board of nursing.

A client states that the client's recent fall was caused by his scheduled antihypertensive medications being 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. Consult with the hospital's legal department as soon as possible. Consult with practice advisors from the state board of nursing. Enlist support from nursing and non-nursing colleagues from the unit.

Correct response: Document the client's claims and the events surrounding the alleged incident. Explanation: It is imperative for nurses to carefully and accurately document assessment findings and the nursing care that they provide, especially when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.

The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated? Duty Breach of duty Causation Damages

Correct response: Duty Explanation: Duty refers to an obligation to use due care. The nurse assessed the client and made appropriate interventions and notifications. Breach of duty is the failure to meet the standard of care. An example of breach of duty would be not performing assessments, appropriate interventions, and notifications of the health care provider. Causation is when the breach of duty caused the injury. An example of causation would be failure to perform assessment and appropriate interventions when providing client care, and this caused injury to the client. Damages are the harm or injury that occurred to the client. In this situation, it would be the death of the client.

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 Intent to harm Breach of duty Causation Punitive damages Fraud

Correct response: Duty Breach of duty Causation Explanation: The elements that must be established to prove that malpractice or negligence have occurred include duty, breach of duty, and causation. Intent to harm would be intentional torts. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Punitive damages are monetary compensation awarded in a legal case to the injured party.

The nurse is concerned about a potential malpractice or negligence lawsuit regarding a client who was cared for on the unit. What specific elements must be established to prove that malpractice or negligence has occurred in this client? Select all that apply. Duty Breach of duty Causation Damages Misrepresentation Breach of confidentiality

Correct response: Duty Breach of duty Causation Damages Explanation: Elements of liability are duty, breach of duty, causation, and damages. Misrepresentation occurs in fraud. Breach of confidentiality is a type of invasion of privacy and a violation of HIPAA.

In some cases, the act of providing nursing care in unexpected situations is covered by the Good Samaritan laws. Which nursing action would most likely be covered by these laws? Any emergency care given when consent is obtained A negligent act performed in an emergency situation Medical advice given to a neighbor regarding a child's rash Emergency care for a choking victim in a restaurant

Correct response: Emergency care for a choking victim in a restaurant Explanation: Good Samaritan laws are designed to protect health practitioners when they give aid to people in emergency situations in which the practitioner is off duty, such as providing emergency care to a choking victim in a restaurant. The other examples listed are not situations covered by the Good Samaritan law. Reference:

A client is to undergo surgery for removal of the gallbladder. Which action related to the client's informed consent falls within the nurse's scope of practice? Select all that apply. Ensuring the signed form is on the chart Acting as a witness to the client's signature on the form Answering questions about elements of the consent Explaining the details about the procedure to be done Identifying the risks and benefits associated with the procedure

Correct response: Ensuring the signed form is on the chart Acting as a witness to the client's signature on the form Answering questions about elements of the consent Explanation: Obtaining informed consent is the responsibility of the person who will perform the diagnostic or treatment procedure or the research study. This person is responsible for explaining the procedure along with any risks and benefits associated with it. The nurse's role is to confirm that a signed consent form is present in the client's chart and to answer client questions about the elements of the consent. Unless the nurse is obtaining consent for a nurse-prescribed and nurse-initiated intervention, the nurse signs the consent form as a witness to having seen the client sign the form, not as having obtained the consent.

A nurse has applied soft wrist restraints to a client following endotracheal intubation. Documentation of which information is essential when using restraints on a client? Select all that apply. Findings from patient assessment, performed every 2 hours Family presence at the bedside Foley catheter draining clear yellow urine 0.9 normal saline infusing intravenously at 100 mL/hr Chest physiotherapy completed

Correct response: Findings from patient assessment, performed every 2 hours Foley catheter draining clear yellow urine 0.9 normal saline infusing intravenously at 100 mL/hr Explanation: When restraints are applied, charting must indicate regular client assessment findings; provision or administration of fluids and nutrition; bowel and bladder elimination; and attempts to release the client from the restraints for a trial period. Additional order completion and presence of family in the room are not required documentation for client restraint.

A nurse working on a busy medical-surgical unit does not take the vital signs of client who is preparing for discharge but instead documents the same vital signs obtained for this client earlier in the morning. For which tort would the nurse be potentially liable? Fraud False imprisonment Battery Assault

Correct response: Fraud Explanation: Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Nurses who report vital signs or other assessment data that were not obtained are acting fraudulently. Unjustified retention or prevention of the movement of another person without proper consent can constitute false imprisonment. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Battery 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).

A nurse talks with family members about an AIDS client from the clinic where the nurse works. Which tort has the nurse committed? Invasion of privacy Fraud Assault Slander

Correct response: 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.

A nurse asks a coworker about the condition of the nurse's next-door neighbor, who has been admitted to the unit. If the coworker shares the neighbor's client information with the nurse, the coworker could be held liable for committing which act? Invasion of privacy Negligence Assault Defamation of character

Correct response: Invasion of privacy Explanation: Sharing a client's confidential information without consent is an invasion of privacy. Assault is threatening to touch a person, such as applying restraints, without consent. When a person performs an act that a reasonable person would not do under the same circumstances, it is negligence. Defamation of character occurs when one makes statements about a person that could damage that person's reputation.

A registered nurse who has an associate degree would like to obtain a baccalaureate degree in nursing. The nurse works full time and has several family obligations and would like to find a program that fits into that lifestyle. What is the nurse's priority question about an educational program? How much does it cost? Is it online? What is the NCLEX pass rate? Is the program accredited?

Correct response: Is the program accredited? Explanation: The most important consideration is whether the program is accredited. Unaccredited programs should be avoided. Cost is important and method of delivery may be very important to this student. They are not as important as whether the program is accredited. NCLEX pass rate is not important in this case as the nurse is already registered.

Which is true of the Occupational Safety and Health Act? It requires nurses to report abuse of infants, children, and adults of all ages. It helps to reduce workforce injuries and illness in the workplace. It establishes an information clearinghouse for nurses who engage in unprofessional conduct. It protects nurses who are recovering from drug or alcohol addiction or have communicable diseases.

Correct response: It helps to reduce workforce injuries and illness in the workplace. Explanation: The Occupational Safety and Health Act of 1970 helps to reduce injuries and illness in the workplace. The National Practitioner Data Bank is a clearinghouse for health care practitioners who engage in unprofessional conduct and prevents them from moving from state to state. Mandatory reporting laws, not the Occupational Safety and Health Act, require nurses to report abuse. The Americans with Disabilities Act protects people with communicable diseases and those recovering from drug or alcohol addiction.

The nursing supervisor is preparing to delegate some aspects of the nursing care plan interventions to other healthcare providers on the unit. Which are the responsibilities of nursing supervisors? Select all that apply. Knowing the job descriptions and capabilities of each person on the team in depth Assigning tasks to staff according to each member's preference to improve staff moral Delegating the ultimate responsibility for the care provided to each staff member Assigning to registered nurses rather than nonprofessional staff the practice-pervasive functions of assessment Ensuring that care is delivered accurately and appropriately

Correct response: Knowing the job descriptions and capabilities of each person on the team in depth Assigning to registered nurses rather than nonprofessional staff the practice-pervasive functions of assessment Ensuring that care is delivered accurately and appropriately Explanation: Nursing supervisors must know the job descriptions and capabilities of each person on the team in depth. Nursing supervisors should not assign tasks to staff according to each member's preference to improve staff moral but rather according to each member's capabilities and scope of practice. Nursing supervisors and other registered nurses may delegate specific aspects of care to nonprofessional staff but must select appropriate nursing care measures for these personnel to perform are held accountable ultimately for the care that is provided. Nursing supervisors and other registered nurses may not delegate the practice-pervasive functions of assessment, planning, diagnosis, evaluation, and nursing judgment to nonprofessional staff (NCSBN, 2005). Nursing supervisors and other registered nurses may delegate technical activities (i.e., feeding, ambulating) or provision of amenities (i.e., hospitality services, including making beds, setting up meals, cleaning the care environment), but the activities must not require critical thinking or professional judgment (American Nurses Association, 2005). Nursing supervisors also must ensure that nursing care measures have been carried out correctly.

A client informs the nurse that the client wants to discontinue treatment and go home. Later, the nurse finds the client dressed to leave. Which action should the nurse take in this situation? Let the client go after signing a document stating that the client is going against medical advice. Restrain the client until medical treatment is over. Call the physician and get the discharge paper signed. Warn the client that the client may not be able to access health care again.

Correct response: Let the client go after signing a document stating that the client is going against medical advice. Explanation: If a client wishes to go before the client's medical treatment is finished, the nurse should have the client sign a document indicating personal responsibility for leaving against medical advice. The nurse should not restrain the client, as it would make the nurse liable for legal action. The nurse may call the physician and get the discharge paper signed, but this is not appropriate. The nurse should not warn the client that the client will be denied health care in the future, because it is the client's right to access the health care facility whenever needed.

A nurse is caring for a client with hypertension whose blood pressure has increased from 154/78 mmHg to 196/98 mmHg with a heart rate of 110 beats per minute during the past hour. The nurse goes to lunch without reporting the change to the health care provider, and the client experiences a cardiac arrest. What tort has the nurse likely committed? Negligence Battery Invasion of privacy False imprisonment

Correct response: Negligence Explanation: Negligence, such as not reporting a change in a client condition, is harm that results because a person did not act reasonably. Based on the definition of negligence, harm resulted due to the nurse's lack of action (omission). Battery, invasion of privacy, and false imprisonment did not occur in this scenario. Battery 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. Invasion of privacy is a breach in confidentiality in which one's personal information is given to another without the person's consent. False imprisonment is unjustified retention or prevention of the movement of another person without proper consent.

Which statement about laws governing the distribution of controlled substances is true? When a nurse misuses controlled substances in the workplace and gets help, the nurse will not be charged with a criminal act. Nurses are responsible for adhering to specific documentation about controlled substances. Substance use is not treatable. The nurse is only at risk if diverting medication from the client; a nurse using the nurse's own personal drugs is not at risk.

Correct response: Nurses are responsible for adhering to specific documentation about controlled substances. Explanation: Nurses have specific responsibilities regarding controlled substances, including specific documentation. Violation of controlled substances laws at the workplace is serious and a criminal act. Substance use is treatable, and the objective is to detect and treat the problem early. It does not matter where the nurse obtains the drugs; the nurse is still liable for personal actions.

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? Sedate the client. Get written consent. Obtain a medical order. Notify the family.

Correct response: Obtain a medical order. Explanation: Nurses must obtain a medical order before each and every instance in which they use restraints. Due to the severity of the client illness requiring endotracheal intubation, the client may not be able to provide a written consent. The client does not need to be sedated unless medically necessary, and although it is appropriate to notify the family, this is not the priority.

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? Libel Slander Negligence Malpractice

Correct response: Slander Explanation: The nurse can be charged with slander, which is a verbal attack on a person's character. Libel pertains to damaging written statements read by others. Both libel and slander are considered defamation of character-an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. To be found guilty of slander or libel, the statement must be proved false. Negligence and malpractice pertain to actions which are committed or omitted, thereby causing physical harm to a client.

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 how the Good Samaritan law applies to this case? The Good Samaritan law will provide legal immunity to the nurse. The Good Samaritan law will not protect the nurse because the nurse did not accept compensation. The Good Samaritan law is not applicable to health care workers. The Good Samaritan law will provide absolute exemption from prosecution.

Correct response: The Good Samaritan law will provide legal immunity to the nurse. Explanation: The Good Samaritan laws provide legal immunity to passersby who provide emergency first aid to victims of accidents. Therefore, the law is applicable to the nurse in this scenario; moreover, Good Samaritan laws apply to those who do not accept any compensation for services provided. The law is equally applicable to everyone but does not provide absolute exemption from prosecution in cases of negligence. Paramedics, ambulance personnel, physicians, and nurses who stop to provide assistance are still held to a higher standard of care because they have training above and beyond that of average lay people. In cases of gross negligence, health care workers may be charged with a criminal offense.

A nurse and the facility have been named as defendants in a malpractice lawsuit. In addition to the nurse's attorney, whom else would be appropriate for the nurse to talk with about the case? A colleague The agency's risk manager The plaintiff's lawyer The local press

Correct response: The agency's risk manager Explanation: A nurse who is named a defendant should work closely with an attorney while preparing the defense. With the exception of the nurse's attorney and the agency's risk manager, the nurse should not discuss the case with anyone, including anyone at the agency, the plaintiff, the plaintiff's lawyer, anyone testifying for the plaintiff, or reporters.

While at a coworker's house, a nurse discusses with the coworker a client whom the nurse suspects of physically abusing the client's child. The next day, the client is moved to another nursing unit after a surgical procedure and comes under the care of the coworker, who is also a nurse. The coworker confronts the client about the alleged physical abuse. The client is shocked and angered by the accusation and denies it categorically. What would be the charge if the client were to file a suit? The first nurse could be charged with slander. The second nurse could be charged with libel. No charges are valid because the revelation took place during off-duty hours and off-site. No charges are valid because both nurses are involved in the client's care.

Correct response: The first nurse could be charged with slander. Explanation: Slander is a character attack uttered orally in the presence of others. Injury is considered to occur because the derogatory remarks attack a person's character and good name. In this case, the first nurse (and possibly the second, depending on context) could be charged with slander. If the defamation had been written, it would be libel. Even though the discussion took place offsite and during off-duty hours and both nurses are involved in the client's care, the defamatory remarks could constitute slander.

Which best exemplifies malpractice? The nurse applies an ice pack to a client's lower back without an order and the client feels better. The nurse, using proper body mechanics, assists a client into a locked bed. The client slips and breaks a femur. The nurse administers amoxicillin to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. The nurse administers the wrong medication to a client, who then has one episode of vomiting 5 minutes later but no further adverse reactions.

Correct response: The nurse administers amoxicillin to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. Explanation: All elements of liability are in place for the scenario involving a nurse administering amoxicillin to a client with documented allergies to penicillin: the nurse had a duty and breached it by giving the medication (amoxicillin), which caused the client harm (seizures and respiratory arrest). The nurse is negligent when applying an ice pack without an order. The nurse assisting the client into bed used proper body mechanics, so the client fall is an accident even though harm occurred. Giving the wrong medication could be cause for malpractice, but in this case, the client was not harmed.

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 is an example(s) of legal safeguards for the nurse? Select all that apply. The nurse confirms informed consent was give by the client to perform a procedure. The health care provider is responsible for administration of a wrongly prescribed medication. The nurse educates the client about what to expect during the hospital stay. The nurse executes the health care provider's prescriptions without questioning them. The nurse documents all client care in a timely manner. The nurse claims management is responsible for inadequate staffing leading to negligence.

Correct response: The nurse confirms informed consent was give by the client to perform a procedure. The nurse educates the client about what to expect during the hospital stay. The nurse documents all client care in a timely manner. Explanation: Examples of legal safeguards for the nurse include the nurse confirming that informed consent was obtained from a client, the nurse educating the client about what to expect during the hospital stay, and the nurse documenting all client care in a timely manner. Legal safeguards for the nurse would not include the nurse executing health care provider's prescriptions without questioning them. Legal safeguards for the nurse would not include the nurse claiming management is responsible for inadequate staffing leading to negligence. Legal safeguards for the nurse would not include the health care provider being responsible for administration of a wrongly prescribed medication.

After reporting to work for a night shift, the nurse learns that the unit is understaffed because two RNs called out sick. As a result, each nurse on the unit must provide care for four acute clients in addition to the nurse's regular clients. Which statement is true for this nurse when working in understaffed circumstances? The nurse is legally held to the same standards of care as when staffing levels are normal. Understaffing constitutes an extenuating circumstance that creates a temporarily lower expectation for care for the nurse. The nurse must document that float staff, nurses on overtime, and part-time staff were contacted in an effort to fill the gaps in care. The nurse is legally obliged to refuse to provide care when understaffing creates the potential for unsafe conditions.

Correct response: The nurse is legally held to the same standards of care as when staffing levels are normal. Explanation: The claim of being overworked does not constitute a legal defense, and both the potential for liability and standards of care remain unchanged despite an increased client assignment. Although it is prudent to make all realistic attempts to fill the gaps in staffing, documenting these efforts does not change the nurse's legal position. A nurse has the right to refuse an unsafe client assignment but the nurse is not legally obliged to withhold care.

While walking through a park, the nurse encounters a child with a swollen and reddened arm that hurts to move due to being struck with a baseball bat. The nurse splints the arm using two baseball bats. The child is transported to the hospital and later develops compartmental syndrome in the arm. Which statement regarding the nurse's liability in this case is accurate? The nurse was negligent because the client developed compartmental syndrome due to the nurse's treatment at the scene. The nurse should have waited for help because the Good Samaritan Act states that the nurse is not obligated to assist. The nurse is protected by the Good Samaritan Act, which states that the nurse may give emergency care using good judgment. The nurse is not protected by the Good Samaritan Act because the nurse was negligent in the care rendered.

Correct response: The nurse is protected by the Good Samaritan Act, which states that the nurse may give emergency care using good judgment. Explanation: The nurse is protected by the Good Samaritan Act, which states the health practitioner may give emergency care in a prudent manner using good judgment. The nurse used two sturdy objects to immobilize the child's arm; therefore, the nurse was not grossly negligent. A prudent nurse would have done the same. The Good Samaritan Act states that the health care practitioner is not obligated to assist; however, it protects the practitioner if the practitioner decides to render emergency car

A client is unhappy with the health care provided and informs the nurse that the client 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 should the nurse's action be in this situation? The nurse should have the client restrained and call the physician. The nurse should let the client go because the nurse cannot do anything. The nurse should call and inform the nursing supervisor of the situation. The nurse should warn the client that the client cannot come to the hospital again.

Correct response: The nurse should call and inform the nursing supervisor of the situation. Explanation: The nurse should call and inform the nursing supervisor of the situation. The client should be made to sign the document stating that the client is responsible for the client's own actions. The nurse cannot restrain the client because that would be false imprisonment. Likewise, the nurse cannot overlook the incident because there is a responsibility for client care. Additionally, the nurse cannot warn the client that the client will not be allowed to come back to the hospital because it is the client's right to access health care whenever required

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 The hospital The student nurse, the nurse instructor, and the hospital

Correct response: The student nurse, the nurse instructor, and the hospital Explanation: As a student nurse, you are responsible for your own acts, including any negligence that may result in client injury. 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. The status of students enrolled in college and university programs is less clear, as is the liability of the educational institution in which they are enrolled and the health care agency offering a site for clinical practice. Nursing instructors may share responsibility for damages in the event of client injury if an assignment called for clinical skills beyond a student's competency, or the instructor failed to provide reasonable and prudent clinical supervision.

Nurses complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report? To document everyday occurrences To document the need for disciplinary action To improve quality of care To initiate litigation

Correct response: To improve quality of care Explanation: The primary reason to fill out an incident report is to improve the quality of care. Incident reports are not designed to be a means for disciplinary action. Incident reports are designed to identify actual or potential risks that can be addressed to improve quality of care. Incident reports are not intended to initiate litigation or document everyday occurrences.

Professional regulations and laws that govern nursing practice are in place for which reason? To limit the number of nurses in practice To ensure that practicing nurses are of good moral standing To protect the safety of the public To ensure that enough new nurses are always available

Correct response: To protect the safety of the public Explanation: Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.

Which are examples of a nurse appropriately protecting a client's privacy? Select all that apply. During a bed bath, the nurse exposes the client's upper torso while washing the client's face. With the client's permission, the nurse explains the client's diagnosis to the client's spouse. The nurse questions the client about the client's social life even though it does not affect care planning. The nurse moves the client from the emergency department waiting room to a private area to collect assessment data. Because the facility is a teaching facility, the nurse allows a nursing student to photograph a client for a care plan.

Correct response: With the client's permission, the nurse explains the client's diagnosis to the client's spouse. The nurse moves the client from the emergency department waiting room to a private area to collect assessment data. Explanation: To prevent invasion of privacy, all client information is considered confidential and private; this includes name and all identifiers (e.g., social security number, address, date of birth). With the client's permission, the nurse may share information with the client's spouse. A client should be taken to a private, soundproof area to collect data. Unnecessary exposure of a client's body, taking photos of a client, and questioning a client's social life when it does not affect care planning are examples of invasion of privacy.

Nurses are occasionally asked to witness a testator's (person who makes the will) signing of a will. Which guideline is true regarding a nurse's role in witnessing a testator's signature? Witnesses to a signature do not need to read the will. Witnesses do not need to observe the signing of the will and can sign it at a later time. A beneficiary to a will is allowed to act as a witness. A single witness is sufficient for a will.

Correct response: Witnesses to a signature do not need to read the will. Explanation: 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 it 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.

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 adult child to direct the client's care, is: a will. a standard of care. a license. an advance directive.

Correct response: an advance directive. Explanation: Clients communicate their wishes to health care providers by verbally participating in health care decision making and by employing written documents called advance directives. A will is a legal document where one communicates wishes of how to dispose of personal effects and belongings upon one's death. The terms license and standard of care have no application in this scenario.

A client with end-stage renal disease decides against further treatment and requests a "Do Not Resuscitate" (DNR) order. The DNR status is part of the change-of-shift report. The client stops breathing and a nurse begins cardiopulmonary resuscitation. The family is upset and makes a complaint to the charge nurse. The charge nurse appropriately identifies that nurse has committed: defamation. battery. assault. fraud.

Correct response: battery. Explanation: The nurse has committed battery by performing CPR against the client's wishes. Assault occurs when a person threatens to touch a client without consent. Fraud is a willful and purposeful misrepresentation, whereas defamation occurs when a derogatory remark is made about another person.

When the nurse informs a client's employer of the client's autoimmune deficiency disease, the nurse is committing the tort of: breach of contract. assault. invasion of privacy. battery.

Correct response: invasion of privacy. Explanation: Nurses have access to information recorded in the medical record, shared or observed through care or interactions with the client's friends and family, and obtained through access to the client's body. A loss of privacy occurs if others obtain unauthorized information about someone from a nurse. Assault and battery refer to verbal and physical actions that are not described in this scenario. Details revealed as described here do not reflect a breach of the contract between nurse and client.

An HIV-positive client discovers that the client's name is published in a research report on HIV care prepared by the client's nurse. The client is hurt and files a lawsuit against the nurse. Which offense has the nurse committed? Unintentional tort Invasion of privacy Defamation of character Negligence of duty

Invasion of privacy Explanation: The nurse has committed the tort of invasion of privacy. Personal names and identities should be concealed or obliterated in case studies or research work. Invasion of privacy is a type of intentional tort. Defamation is an act in which untrue information harms a person's reputation and is therefore not applicable here. Negligence is the harm that results because a person did not act reasonably

A client on a surgical unit asks for the nurse's opinion of the surgeon. The nurse says that the surgeon is rude and that the surgeon's clients always end up with infections. The nurse is at risk of being accused of which? Libel Slander Negligence Assault

Slander Explanation: Slander involves words communicated verbally to a third party that harm or injure the personal or professional reputation of another person. Libel involves words communicated in writing to a third party that harm or injure the personal or professional reputation of another person. Negligence is performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do. Assault a threat or an attempt to make bodily contact with another person without that person's consent.

Injuries related to lifting or transferring clients 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 The Health Care Quality Improvement Act of 1986 Title VII of the Civil Rights Act of 1964 Americans with Disabilities Act of 1990

The Occupational Safety and Health Act of 1970 Explanation: 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 health care 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.