Chapter 23 EAQs Continued
The nurse is assessing a post-surgical patient who is in acute pain. The patient is not willing to change position for x-rays. The nurse tells the patient that a sedative injection will be administered if the patient does not cooperate for the procedure. Which tort is indicated? Assault Battery Invasion of privacy False imprisonment
Assault Rationale Assault places an apprehensive patient within harmful or offensive contact without consent. In this case, the nurse is threatening to give sedative injections if the patient does not cooperate with the procedure. This is an example of an assault on the patient. Battery is intentional touching without consent. Invasion of privacy refers to the unwanted intrusion into the private affairs of the patient. False imprisonment is an intentional tort in which a patient is restrained without a legal warrant. p. 308
The nurse has failed to obtain informed consent before performing a procedure on a patient. Which type of torts result from this nursing action? Select all that apply. Assault Battery Negligence False imprisonment Libel
Battery Negligence Rationale Negligence is performing an action that falls below a standard of care. Failure to obtain informed consent is an act of negligence. Assault refers to an action that places a person within harmful or offensive contact without consent. Battery is any intentional touching without consent. Because the nurse has failed to obtain informed consent, doing any intervention on the patient would be considered as battery. False imprisonment is the unjustified restraint of a person without legal warrant. Failure to obtain informed consent would not result in assault or false imprisonment. Libel is written defamation of character. p. 308
A nursing student is learning about the role of the State Board of Nursing. Which are functions of the State Board of Nursing? Select all that apply. Provides for the rights of patients and protects employees Gives nursing home residents the right to be free of restraints Can suspend the license of the nurse who violates licensing provisions Licenses all registered nurses in the state in which they practice Has to follow due process before revoking or suspending a license
Can suspend the license of the nurse who violates licensing provisions Licenses all registered nurses in the state in which they practice Has to follow due process before revoking or suspending a license Rationale The State Board of Nursing can suspend or revoke a license if the nurse's conduct violates provisions in the licensing statute. The State Board of Nursing is the governing body and issues licenses to all registered nurses in the state in which they practice. The State Board has to follow due process before revoking or suspending a license; nurses must be notified of the charges against them and be given an opportunity to defend themselves in a hearing. The rights of patients and protection of employees were formulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The right of residents of registered nursing homes to be free of restraints was granted by the Federal Nursing Home Reform Act (1987). p. 307
The nurse is learning about the legal implications in nursing practice. Which statements are true about the various sources of law? Select all that apply. Civil laws protect the rights of individuals in the society. Common law presents decisions made by administrative bodies. Criminal laws protect society by providing punishment for crimes. Criminal laws are passed to protect society from nursing negligence. Regulatory law reflects decisions made by administrative bodies when they pass rules.
Civil laws protect the rights of individuals in the society. Criminal laws protect society by providing punishment for crimes. Regulatory law reflects decisions made by administrative bodies when they pass rules. Rationale Civil laws protect the rights of individuals in the society and provide fair treatment in case of civil violations. Criminal laws protect society by providing punishment for crimes. These punishments are defined by municipal, state, and federal legislations. Regulatory laws are administrative laws and hence reflect decisions made by administrative bodies when they pass rules. Common law results from judicial decisions made in court when individual cases are decided. Civil laws are passed to protect society, such as in the case of nursing negligence. pp. 302-303
When witnessing a patient giving informed consent prior to undergoing surgery, which actions should the nurse perform? Select all that apply. If the patient refuses to sign the consent, leave the situation as it is. Confirm that the patient has understood the information about the surgery. Inform the healthcare provider if the patient refuses to undergo the surgery. Sign the consent form as a witness, once the patient voluntarily gives consent. Ask a nursing student to witness the informed consent if the nurse is busy.
Confirm that the patient has understood the information about the surgery. Inform the healthcare provider if the patient refuses to undergo the surgery. Sign the consent form as a witness, once the patient voluntarily gives consent. Rationale The patient needs to understand the surgical procedure and voluntarily give consent, so the nurse should enquire about the patient's understanding and answer any questions. If the patient refuses to undergo the surgery, the nurse should inform the healthcare provider, so any harmful consequences of refusal can be explained to the patient. The nurse's signature witnessing the consent means that the patient voluntarily gave consent, that the signature is authentic, and that the patient appears to be competent to give consent. If the patient refuses to sign the consent in spite of repeated explanations, this rejection should be documented, signed, and witnessed. Due to the legal nature of the document, a nursing student should not be asked to witness informed consent forms. p. 309
A nursing student has learned about advance directives for healthcare. Which documents should the student classify as advance directives? Select all that apply. Living wills Informed consent Health care proxies Witnesses' depositions Durable powers of attorney for health care
Living wills Health care proxies Durable powers of attorney for health care Rationale Advance directives are based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over the dying process. Living wills are the written documents that direct treatment per the patient's wishes in the event of a terminal illness. The healthcare proxy and durable power of attorney are legal documents that designate a person to make health care decisions on the patient's behalf when the patient is not able to make his or her own decisions. Informed consent is not considered an advance directive; it is a patient's agreement to allow a diagnostic or treatment procedure after understanding the risks, benefits, alternatives, and consequences of refusal. Witnesses' depositions also are not advance directives; they are transcriptions of questions posed to a witness under oath to obtain information about a case. p. 305
Which criteria can be used to establish nursing malpractice? Select all that apply. The nurse owed a duty to a patient. The nurse followed the instructions given for a patient. The nurse did not follow an ordered intervention for a patient. The nurse conveyed appropriate discharge instructions to the patient. The nurse's failure to carry out the duty caused an injury to the patient.
The nurse owed a duty to a patient. The nurse did not follow an ordered intervention for a patient. The nurse's failure to carry out the duty caused an injury to the patient. Rationale If the nurse owed a duty to a patient, did not perform the given duty, and if failure to perform that duty caused injury to the patient, then the nurse could be liable for nursing malpractice. Following the given instructions for a patient and conveying appropriate discharge instructions are both examples of good and ethical nursing practice. These actions would not make the nurse liable for nursing malpractice. p. 309
The nurse has been charged for committing a misdemeanor. Which action will be taken against the nurse? The nurse will be given a warning. The nurse will be asked to pay a fine. The nurse will be suspended from duty. The nurse will be imprisoned for more than 1 year.
The nurse will be asked to pay a fine. Rationale A misdemeanor is a crime that has a penalty of a fine or imprisonment of less than 1 year. Therefore, the nurse will be asked to pay a fine. The nurse has committed a crime so a warning is an inadequate legal action. A felony is a serious crime that has a penalty of imprisonment for more than 1 year or suspension from duty. The nurse's action is not a felony and does not call for penalty of imprisonment for more than 1 year. p. 303
Test-Taking Tip: To distinguish assault from battery in your mind,
think of battery as batting; battery involves intentional touching without consent. No contact is necessary for assault to take place.
The nurse is caring for a patient who is extremely irritable and agitated. The nurse first transfers the patient forcefully to an isolated room to avoid disturbing other patients in the ward. The nurse then sedates the patient by giving a morphine injection. Which torts has the nurse committed? Select all that apply. Assault Battery False imprisonment Invasion of privacy Defamation of character
Battery False imprisonment Rationale The nurse has committed battery and false imprisonment. Battery is intentional touching without the patient's consent. The nurse gives a morphine injection without requesting consent. This is indicative of battery. Transferring the patient to an isolated room indicates false imprisonment. The tort of false imprisonment refers to the unjustified restraint of a person without legal warrant. Assault is an action that places an apprehensive patient within harmful or offensive contact without consent. Threatening the patient to give the injection is an example of assault. Invasion of privacy refers to the unwanted intrusion into the personal matters of the patient. Defamation of character is the publication of false statements about a person that could damage a person's reputation. p. 308
The nurse assesses a child in a psychiatric facility. The nurse finds that the child has suicidal thoughts. How should the nurse instruct the child's parents? "You should punish your child for saying such things." "Your child needs to be admitted to the facility immediately." "Don't worry; your child will become normal with medication." "You should carefully observe every movement of your child makes at home."
"Your child needs to be admitted to the facility immediately." Rationale According to the Mental Health Parity Act, patients having suicidal tendencies are to be admitted to the mental health units for supervision. The nurse should instruct the parents that their child should be admitted to the facility, because the child has suicidal tendencies. Punishing the child would not avoid suicidal behavior and may aggravate the tendencies. Having suicidal ideation is life threatening and requires close monitoring of the patient; medications would be of no use in this case. Letting the child go home despite knowing that the child has suicidal tendencies would violate the Mental Health Parity Act. pp. 304-305
An 8-year-old girl is brought to the emergency room with severe abdominal pain. The nurse has to get consent before medical treatment can begin. The parents of the child are divorced and the mother has custody. The patient is accompanied by her mother, father, and sister, the latter aged 19 years old. What information should be provided before the patient's guardian gives consent? Select all that apply. A complete explanation of the procedure or treatment Names and qualifications of the people performing the treatment The exact number of days required for complete cure and treatment A description of possible adverse effects or side effects of the treatment An explanation that once the guardian signs the consent, treatment must be given
A complete explanation of the procedure or treatment Names and qualifications of the people performing the treatment A description of possible adverse effects or side effects of the treatment Rationale The patient or the patient's guardian should give consent only after receiving information about the procedure or treatment. The information should also include the names of the people who will be treating the patient and the possible side effects of the treatment or procedure. The nurse should also inform the guardian that she can later refuse treatment even if she initially signed consent. It is not practical for the nurse to anticipate the exact number of days required for a cure, and such information is not provided before the guardian gives consent. p. 310
The nurse notes that an advance directive is on a patient's medical record. Which statement best describes an advance directive guideline? A living will allows an appointed person to make healthcare decisions when the patient is in an incapacitated state. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. The patient cannot make changes in the advance directive once admitted to the hospital. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. Rationale A living will does not assign another individual to make decisions for the patient. A durable power of attorney for healthcare is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time. p. 305
The nurse is caring for a patient who is in early stages of cardiac failure. The patient tells the healthcare provider and the nurse that he wishes to end his life without any suffering as soon as possible. Which would be the most appropriate action? Assist the patient in suicide as per his wish. Explain to the patient that his life can be extended. Ask the patient's family to make decisions regarding the patient's death. Ask the patient to wait for court orders regarding the decision.
Explain to the patient that his life can be extended. Rationale The patient does not have end-stage cardiac failure; thus medical interventions would be of help for the patient to extend his life. Assisted suicide violates the Code of Ethics for nurses, is illegal in most states, and is not appropriate in a patient with a non-terminal disease. Because the patient could be managed by means of drugs and other medical interventions, there is no need for the patient's family to make decisions concerning the patient's death. p. 308 Test-Taking Tip: Do not choose answers that are illegal, controversial, or that violate the Code of Ethics for nurses.
The nurse is learning about negligence in unintentional torts. Which actions would the nurse consider as common acts of negligence? Select all that apply. Failure to follow orders Failure to perform malpractice Failure to document monitoring Failure to follow policies and guidelines Failure to explain the risks of a surgery to a patient
Failure to follow orders Failure to document monitoring Failure to follow policies and guidelines Rationale Failure to follow orders is an act of negligence because it is the duty of the nurse to follow all given orders. Documentation of monitoring is one of the best practices to prevent legal issues and is important to communicate with other healthcare team members. Policies and guidelines are created in accordance with laws and regulations, so they should be followed. Malpractice is professional negligence and should be avoided. Explaining the risks of a medical procedure to a patient is not the nurse's responsibility. p. 309
The nurse is caring for a surgical patient in the preoperative area. The nurse witnesses the patient's informed consent for the surgical procedure. Which statements are true regarding informed consent? Select all that apply. It must be signed while the patient is free from mind-altering medications. It can be witnessed by the nurse or nursing student. It may be withdrawn at any time. It must be signed by patients age 16 and older. It is usually obtained by the healthcare provider and not the nurse.
It must be signed while the patient is free from mind-altering medications. It may be withdrawn at any time. It is usually obtained by the healthcare provider and not the nurse. Rationale An informed consent must be signed while the patient is free from mind-altering medications and after the patient has received all information necessary to make an informed decision. In most situations, the healthcare provider, not the nurse, obtains informed consent, because the nurse does not perform surgery or direct medical procedures. Signed consent must be witnessed by the nurse, but never by a nursing student because of the legal nature of the document. Informed consent may be withdrawn at any time before the procedure and must be signed by patients age 18 and older. A parent or guardian's signature is required for minors. p. 309
A nursing student is learning about the standards of care for nursing. Which should the student do to maintain high nursing standards? Select all that apply. Learn about the Nurse Practice Act in the state. Follow updates in laws and policies practiced. Read current nursing literature in specified practice areas. Avoid using procedures given by the employment agency. Understand current legal issues affecting nursing practice.
Learn about the Nurse Practice Act in the state. Follow updates in laws and policies practiced. Read current nursing literature in specified practice areas. Understand current legal issues affecting nursing practice. Rationale The Nurse Practice Act defines the scope of nursing practice, and all nurses should be aware of the particular laws in their respective states. Laws and policies can change with time, so keeping current with them is important. Reading current nursing literature in specified practice areas keeps the nurse up to date with the latest nursing knowledge; ignorance of such updates is not an acceptable excuse for malpractice. Understanding current legal issues affecting nursing practice is important; doing so helps the nurse practice in a fashion that avoids legal problems. Nurses should follow procedures given by the employment agency. pp. 302-303
A patient is abusive and rude with the student nurse. The student nurse documents that the patient is uncooperative and shows symptoms of alcohol withdrawal. As a result the patient will be transferred to a different floor. Which is the best classification of this nurse's error? Libel Slander Malpractice Invasion of privacy
Libel Rationale Libel is documentation of false entries or defamation of character. The nurse is offended by the patient's behavior, so the nurse documents signs of alcohol withdrawal, even though this is not indicated by rude behavior alone. Slander is oral defamation of character. The nurse is documenting the report, but not verbalizing it, so this is not considered slander. Malpractice is negligence of a professional role. This nursing action does not indicate negligence. Invasion of privacy typically involves releasing a patient's private information without the patient's consent. The nurse has not violated the patient's privacy in this instance. p. 309
The nurse is caring for a patient who recently had coronary bypass surgery. Which legal sources of standards of care should the nurse use to deliver safe healthcare? Select all that apply. Information provided by the nurse manager Policies and procedures of the employing hospital State Nurse Practice Act Regulations identified in The Joint Commission's manual The American Nurses Association standards of nursing practice
Policies and procedures of the employing hospital State Nurse Practice Act Regulations identified in The Joint Commission's manual The American Nurses Association standards of nursing practice Rationale Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care. p. 303
What should the nurse do to avoid malpractice and the resulting professional negligence? Select all that apply. Strictly follow the given standards of care. Regularly update current nursing knowledge. Properly document all assessments and interventions. Avoid explaining medical procedures to patients. Complete health documentation at the end of the shift.
Strictly follow the given standards of care. Regularly update current nursing knowledge. Properly document all assessments and interventions. Rationale As a rule, nurses should follow given standards of care to avoid malpractice. Regularly updating current nursing knowledge keeps nurses well informed of the latest medical knowledge and techniques and health care policies and laws. Properly documenting all assessments, interventions, and evaluations is necessary for future reference and communication with other healthcare team members. Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other healthcare team members and to avoid negligence. p. 309 Test-Taking Tip: Another way to evaluate a choice is to ask yourself the question, "Would it be right to...?" So for the option "Avoid explaining medical procedures to patients," you would ask, "Would it be right to avoid explaining medical procedures to patients?" Certainly not! So you can eliminate that choice.
Which actions, if performed by a registered nurse, would result in both criminal and administrative sanctions against the nurse? Select all that apply. Taking or selling controlled substances Refusing to provide healthcare information to a patient's child Reporting suspected abuse and neglect of children Applying physical restraints without a written physician's order Administering the wrong medication to the patient
Taking or selling controlled substances Applying physical restraints without a written physician's order Rationale The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a healthcare provider based on Joint Commission and Medicare guidelines. Refusing to provide healthcare information to a patient's child, reporting suspected abuse and neglect of children, and administering the wrong medication to a patient would not result in both criminal and administrative sanctions against the nurse. p. 307
In which situations is the nurse allowed to use physical restraints? Select all that apply. The patient is extremely irritated. The patient has suicidal ideation. The healthcare provider has given a written order. The patient is potentially dangerous to other patients. The patient's family members have asked to restrain the patient.
The healthcare provider has given a written order. The patient is potentially dangerous to other patients. Rationale The nurse can use physical restraints on a patient only if the healthcare provider has given an order to do so or to ensure the safety of other patients. If the patient is irritated, the nurse should use other measures of restraining the patient, such as counseling. Patients exhibiting suicidal ideation should be monitored closely and should receive psychotherapy. The nurse should not restrain the patient just because family members have asked the nurse to do so. p. 308
Hospital administrators have warned the healthcare team about invasion of a patient's privacy. Which could have been the reason for this warning? The nurse read text messages on the patient's cell phone. The health care provider asked the nurse to catheterize the patient. The nurse published a report on the patient's condition without his or her consent. The healthcare team provided cardiopulmonary resuscitation (CPR) without the family's consent.
The nurse read text messages on the patient's cell phone. Rationale Privacy refers to the patient's right of keeping personal information from being disclosed. Reading text messages on the patient's cell phone is an invasion of the patient's privacy. The healthcare provider asking the nurse to catheterize a patient is an example of collaborative care by the healthcare team. Publishing a report on the patient's condition without consent is a breach of confidentiality. Confidentiality protects the patient's information once it has been disclosed in the healthcare setting. According to the health care law in the United States, cardiopulmonary resuscitation (CPR) should be provided to the patient when required unless the patient has given a Do Not Resuscitate (DNR) order. Consent need not be obtained from the family when providing CPR. p. 306
The nurse is sued for failure to monitor a patient appropriately after a procedure. Which statements are correct about this lawsuit? Select all that apply. The nurse represents the plaintiff. The defendant must prove injury, damage, or loss. The person filing the lawsuit has the burden of proof. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. The nurse is a witness.
The person filing the lawsuit has the burden of proof. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. Rationale The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage. Thus, the plaintiff has the burden of proof. The nurse is the defendant, not a witness. p. 304
The nurse is working the night shift in an emergency room. The nurse receives a patient who is violent toward the staff. The patient is uncooperative and hysterical. The nurse decides to use restraints on this patient. Which are indications for using restraints? Select all that apply. There is a written order from the healthcare provider. The patient is hysterical. All other less restrictive interventions are unsuccessful. The patient may harm other patients. The nurse and three other nurses agree on restraining.
There is a written order from the healthcare provider. All other less restrictive interventions are unsuccessful. The patient may harm other patients. Rationale The Centers for Medicare and Medicaid Services and The Joint Commission have stipulated that the nurse may apply restraints only when absolutely necessary. Restraints are allowed when the patient poses a danger to other residents, all other means of restriction have failed, and there is a written directive from a healthcare practitioner. It is against the law and unethical to restrain a patient who is hysterical. The nurse cannot restrain any patient without orders from the healthcare provider, even with the agreement of three other nurses. p. 306