Chapter 23 Legal Implications in Nursing Practice
Risk management
A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs.
2
A terminally ill patient does not want to be resuscitated if complications arise. Which document would record the patient's wishes regarding treatment? 1 Nurse's records 2 Living will 3 Health care proxies 4 Durable powers of attorney
4
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 be started. The parents of the child are divorced, and the mother has custody. The patient is accompanied by her mother, father, and elder sister, who is 19 years old. Who should sign the consent form of the patient? 1 The patient's father 2 The patient's sister 3 The patient herself 4 The patient's mother
Uniform anatomical gift act
An individual older than the age of 18 years has the right to make an organ donation; the person needs to make the gift in writing with his or her signature.
The nurse puts restraints on a patient without the patient's permission and without a physician's order. The nurse may be guilty of: 1. Battery 2. Assault 3. Neglect 4. Invasion of privacy
Answer: 1. Battery Rationale: Unintentional touching without consent.
Assault
Any intentional threat to bring about harmful or offensive contact.
Battery
Any intentional touching without consent.
Living will
Are written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition.
Torts
Civil wrong made against a person or property.
Negligence
Conduct that falls below the standard of care.
Patient protection and accountable care act (PPACA or ACO)
Consumer rights and protection, affordable health care coverage, increase access to care, stronger Medicare.
Nurse Practice Acts
Describe and define the legal boundaries of nursing practice within each state.
Good Samaritan laws
Encourage health care professionals to assist in emergencies, limit liability, and offer legal immunity for nurses who help at the scene of an accident.
Licensure
The Board of Nursing licenses all RN's in the state in which they practice and can suspend or revoke a license if a nurse's conduct violates provisions in the licensing statute based on administrative law rules that implement and enforce the statutes.
False imprisonment
Unjustified restraining of a person without legal warrant.
1, 2, 3
What should the nurse do to avoid malpractice and the resulting professional negligence? Select all that apply. 1 Strictly follow the given standards of care. 2 Regularly update current nursing knowledge. 3 Properly document all assessments and interventions. 4 Avoid explaining medical procedures to patients. 5 Complete health documentation at the end of the shift.
Slander
When one person speaks falsely about another person.
2, 3, 4
When witnessing a patient giving informed consent prior to undergoing surgery, which actions should the nurse perform? Select all that apply. 1 If the patient refuses to sign the consent, leave the situation as it is. 2 Confirm that the patient has understood the information about the surgery. 3 Inform the healthcare provider if the patient refuses to undergo the surgery. 4 Sign the consent form as a witness, once the patient voluntarily gives consent. 5 Ask a nursing student to witness the informed consent if the nurse is busy.
1, 4
Which actions, if performed by a registered nurse, would result in both criminal and administrative sanctions against the nurse? Select all that apply. 1 Taking or selling controlled substances 2 Refusing to provide healthcare information to a patient's child 3 Reporting suspected abuse and neglect of children 4 Applying physical restraints without a written physician's order 5 Administering the wrong medication to the patient
1, 3, 5
Which essential criteria are used to establish nursing malpractice? Select all that apply. 1 The nurse owed a duty to a patient. 2 The nurse followed the instructions given for a patient. 3 The nurse did not follow an ordered intervention for a patient. 4 The nurse conveyed appropriate discharge instructions to the patient. 5 The nurse's failure to carry out the duty caused an injury to the patient.
1
Which is an example of statutory law? 1 Americans with Disabilities Act 2 Laws about the patient's right to refuse treatment 3 Laws about acquiring informed consent from the patient 4 Laws about the need to report unethical nursing conduct to the State Board of Nursing
1, 3
Which statements best describe a consent form? Select all that apply. 1 It may be signed by an emancipated minor. 2 It protects the healthcare facility but not the healthcare provider. 3 It signifies that the patient understands all aspects of the procedure. 4 It signifies that the patient and family have been told about the procedure. 5 It must be signed by the patient or responsible party at the healthcare facility, and consent may not be obtained by phone or fax.
1
While caring for an 8-year-old patient, the nurse finds that the child appears scared of the parents and has bruises on the soles of the feet and on the back. Which laws obligate the nurse to report suspected abuse to law enforcement authorities? 1 Public health laws 2 Good Samaritan Act 3 Mental Health Parity Act 4 Failure to act laws
Libel
Written defamation of character.
Patient self-determination act
Requires care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.
Mental health parity act as enacted under PPACA
Requires compliance with Mental Health Parity and Addiction Equity Act and strengthens mental health services by requiring patients to obtain insurance.
Uniform Determination of Death Act
Requires irreversible cessation of circulatory and respiratory functions or that there is irreversible cessation of all functions of the entire brain, including the brainstem.
Physician-assisted suicide
Statute that stated that a competent individual with a terminal disease could make an oral and written request for medication to end his or her life in a humane and dignified manner.
4
A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The healthcare provider ordered two units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. What is the nurse's responsibility? 1 Obtain a court order to give the blood. 2 Coerce the husband into giving the blood. 3 Call security and have the husband removed from the hospital. 4 Abide by the husband's wishes and inform the healthcare provider.
3
A student nurse is gossiping with colleagues about a patient's many romantic relationships. The registered nurse warns the student nurse about talking about the patient's personal life in a public place. The nurse's warning is intended to prevent which error? 1 Assault 2 Libel 3 Invasion of privacy 4 Defamation of character
4
A confused patient who fell out of bed because side rails were not used is an example of which type of liability? 1. Felony 2. Battery 3. Assault 4. Negligence of care.
Felony
A crime of a serious nature that has a penalty of imprisonment for greater than 1 year or even death.
1
A group of nurses makes a list of patients who require organ transplantation. Which patient would be given priority for organ transplantation? 1 The patient who is most critically ill 2 The patient who is a very young age 3 The patient who will pay more for the intervention 4 The patient who lives in close proximity to the healthcare center
2
A student nurse who has not been trained to administer medications is assisting a registered nurse while caring for various patients in the general ward. Which intervention by the student nurse may result in a malpractice lawsuit? 1 Collecting the vital signs of a patient 2 Administering a subcutaneous injection 3 Checking the body mass index of a patient 4 Assisting the registered nurse with an enteral nutrition feeding
3
A student nurse who is employed as a nursing assistant may perform any functions that: 1. Have been learned in school 2. Are expected of a nurse at that level 3. Are identified in the position's job 4. Require technical rather than professional skill.t.
2
A surgeon obtains patient consent for an appendectomy. While operating, the surgeon also removes the patient's gall bladder. This mistake could be classified as which type of tort? 1 Assault 2 Battery 3 False imprisonment 4 Defamation of character
3, 4, 5
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. 1 Provides for the rights of patients and protects employees 2 Gives nursing home residents the right to be free of restraints 3 Can suspend the license of the nurse who violates licensing provisions 4 Licenses all registered nurses in the state in which they practice 5 Has to follow due process before revoking or suspending a license
2
A patient dies after receiving care from the nurse. In what circumstance would the nurse be legally protected by the Good Samaritan Act? 1 The nurse provides standard care in the hospital setting, but the patient cannot be saved due to severe injury. 2 The nurse provides emergency care outside the hospital, performing a procedure for which the nurse has been trained. 3 The nurse performs an emergency procedure that is normally outside the nurse's scope of practice because no one else is available at the scene. 4 The nurse does not provide care at the scene but puts the patient in a car heading to the hospital.
1, 5
A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which statements regarding a breach of duty apply to this situation? Select all that apply. 1 Failure to document a change in assessment data 2 Failure to provide discharge instructions 3 Failure to follow the six rights of medication administration 4 Failure to use proper medical equipment ordered for patient monitoring 5 Failure to notify a health care provider about a change in the patient's condition
3
A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy? 1 Inform the patient's spouse about the disease. 2 Do not inform the patient or the family members about the disease. 3 Obtain permission from the patient to inform the patient's spouse about the disease. 4 Obtain informed consent from the spouse to reveal the illness to the patient.
1
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? 1 Libel 2 Slander 3 Malpractice 4 Invasion of privacy
4
A patient is brought to the hospital after a motor vehicle accident. Which law makes it mandatory for the healthcare facility to provide emergency care to patients before transferring them to other hospitals? 1 Good Samaritan Law 2 Mental Health Parity Act 3 Americans with Disabilities Act 4 Emergency Medical Treatment and Active Labor Act
1
A patient suffering from cardiac arrest is brought to the hospital. The patient previously underwent a coronary artery bypass graft (CABG) and angioplasty, and the patient has been chronically ill since then. The patient has requested in writing that not to be resuscitated in case of emergency. What is the term for this request? 1 Living will 2 Implied consent 3 Informed consent 4 Power of attorney
4, 5
A patient was rushed to the emergency department and then to surgery to repair injuries sustained in a hit-and-run car accident. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The healthcare provider informs the nurse that the patient has a durable power of attorney for health care (DPAHC). How should the nurse interpret this information? Select all that apply. 1 The patient can decide which medical procedures not to undergo. 2 The patient has designated a person who is solely responsible for making financial decisions when the patient is unable. 3 The patient has expressed in written form the wish not to be sustained on life support. 4 The patient has designated a person who makes healthcare decisions when the patient is not able to make decisions. 5 The patient has designated a person who is solely responsible for making healthcare decisions according to the patient's wishes.
4
A patient who has tested positive for human immunodeficiency virus (HIV) tells the nurse, "I feel helpless. My boss fired me because I'm HIV positive." Which is the best response by the nurse? 1 "Don't worry. You're protected by Good Samaritan laws." 2 "Don't lose hope. Take this as an opportunity to spend time with your family." 3 "I understand your feelings, but I think you should concentrate on your health now." 4 "You should approach a lawyer. You're protected by the Americans with Disabilities Act."
4
A patient who is hospitalized with chronic illness is depressed and demands to go home. The nurse applies a physical restraint and administers medication to the patient. What does this nursing intervention indicate? 1 The nurse is following Good Samaritan laws. 2 The nurse may be charged with malpractice. 3 The nurse is guilty of invading the patient's privacy. 4 The nurse may be charged with false imprisonment.
4
Following an accident at a job site, a patient's employer contacts the hospital and asks the nurse about the patient's condition to determine the patient's likelihood of returning to work in the future. Which is the best response by the nurse to the employer? 1 "You need to speak to the primary healthcare provider." 2 "We can send the patient's medical records for your reference." 3 "The patient is doing well and will definitely be able to return to work." 4 "You will have to get the patient's permission to receive any related information."
1
Hospital administrators have warned the healthcare team about invasion of a patient's privacy. Which could have been the reason for this warning? 1 The nurse read text messages on the patient's cell phone. 2 The health care provider asked the nurse to catheterize the patient. 3 The nurse published a report on the patient's condition without his or her consent. 4 The healthcare team provided cardiopulmonary resuscitation (CPR) without the family's consent.
4
In a situation in which there is insufficient staff to implement competent care, a nurse should: 1. Organize a strike 2. Refuse the assignment 3. Inform the patients of the situation 4. Accept the assignment but make a protest in writing to the administration.
Health information technology act (HITECH)
In conjunction with HIPPA and in response to new technology and social media.
Durable power of attorney for health care (DPAHC)
Is a legal document that designates a person or persons of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf.
Americans with disabilities act
It protects the rights of people with disabilities. It also is the most extensive law on how employers must treat health care workers and patients infected with HIV.
Common law
Judicial decisions made in courts when individual legal cases are decided.
Misdemeanor
Less serious crime that has a penalty of a fine or imprisonment for less than 1 year.
What is the nurse's responsibility with health care providers order?
Nurses must follow the orders unless they believe the orders are in error or will harm the patients. If there is any controversy with the order, the nurse needs to also inform the supervising nurse or follow the established chain of command.
Informed consent
Person's agreement to allow something to happen based on disclosure.
Criminal laws
Prevent harm to society and provide punishment for crimes.
Civil laws
Protect the rights of individual persons within our society and encourage fair and equitable treatment.
Public health laws
Provide protection of the public's health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for the care provided.
Identify the purpose of the occurrence (incident report)
Provides a data base for further investigation in an attempt to determine deviations from standards of care; corrective measures are needed to prevent recurrence and to alert risk management to at potential claim situation.
Health insurance portability and accountability act of 1996 (HIPPA)
Provides rights to patients (protects individuals form losing their health insurance when changing jobs by providing portability) and protects employees. It also establishes the basis for privacy and confidentiality.
Malpractice
Referred to as professional negligence; below the standard of care.
Regulatory law
Reflects decisions made by administrative bodies.
3
The home health nurse notices significant bruising on a 2-year-old child's head, arms, abdomen, and legs. The patient's mother describes the child's frequent falls. Which is the best nursing action for the home health nurse to take? 1 Document the findings and treat the child. 2 Instruct the mother on safe handling of a 2-year-old child. 3 Contact a child abuse hotline. 4 Discuss this story with a colleague.
3
The hospital administrators warn the nurse about being negligent while providing patient care. Which is the most appropriate reason for the warning? 1 The nurse has threatened a patient with the use of physical restraints to control the patient. 2 The nurse has published the wrong assessment findings of a patient in a scientific journal. 3 The nurse has given an excessive dose of hepatotoxic drug to a patient with liver failure. 4 The nurse has informed the spouse about the patient's disease without the patient's consent.
Standards of care
The legal guidelines for nursing practice that describes the minimum acceptable nursing care.
2, 4, 5
The nurse attends to a patient who sustained injuries when crossing the street. The patient was hit by a car that failed to stop at a stop sign. The patient was rushed to the emergency department and then to surgery to repair injuries. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The healthcare provider informs the nurse that patient confidentiality should be strictly maintained. What should the nurse interpret from this? Select all that apply. 1 The nurse should respect that the patient has the right to keep personal information from being disclosed. 2 The nurse should avoid discussing the patient's medical reports in public areas with other healthcare professionals. 3 The nurse should not disclose information about a procedure to the patient. 4 The nurse must protect any private information about the patient, once it has been disclosed in healthcare settings. 5 Message boards where daily nursing care information is posted in the patient's room cannot contain information revealing the patient's medical condition.
2, 3
The nurse attends to a trauma patient who has been transferred from the intensive care unit (ICU). The nurse finds out that the ICU nurse provided a detailed explanation on the patient's condition to the family without consent from the patient. The ICU nurse also gave the patient a steroid shot even though the patient refused the medication. Which torts would the ICU nurse be guilty of? Select all that apply. 1 Malpractice 2 Battery 3 Invasion of privacy 4 Negligence 5 Defamation of character
2
The nurse has been falsely accused of providing inadequate care to a patient by another nurse. The nurse has received praise in the past for providing quality care to the patients. Which tort does this indicate? 1 Libel 2 Slander 3 Malpractice 4 Invasion of privacy
2, 3
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. 1 Assault 2 Battery 3 Negligence 4 False imprisonment 5 Libel
1
The nurse is assessing a postsurgical 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? 1 Assault 2 Battery 3 Invasion of privacy 4 False imprisonment
1
The nurse is caring for a 6-year-old child with hypovolemic shock. The child is a Jehovah's Witnesses. The child needs an immediate blood transfusion, but the child's parents refuse to provide consent. Which would be the most appropriate action? 1 Administer blood to the child. 2 Administer intravenous fluids. 3 Provide oral hydration and nutrition. 4 Seek court order for blood transfusion.
2
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? 1 Assist the patient in suicide as per his wish. 2 Explain to the patient that his life can be extended. 3 Ask the patient's family to make decisions regarding the patient's death. 4 Ask the patient to wait for court orders regarding the decision.
2, 3, 4, 5
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. 1 Information provided by the nurse manager 2 Policies and procedures of the employing hospital 3 State Nurse Practice Act 4 Regulations identified in The Joint Commission's manual 5 The American Nurses Association standards of nursing practice
1, 3, 5
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. 1 It must be signed while the patient is free from mind-altering medications. 2 It can be witnessed by the nurse or nursing student. 3 It may be withdrawn at any time. 4 It must be signed by patients age 16 and older. 5 It is usually obtained by the healthcare provider and not the nurse.
1, 2, 4, 5
The nurse is explaining the Americans with Disabilities Act (ADA) to a patient with human immunodeficiency virus (HIV). Which information should the nurse include? Select all that apply. 1 People with HIV who are asymptomatic also come under the category of disabled people. 2 People with HIV have the right to decide whether to disclose their infection. 3 Healthcare workers have the choice to not treat patients who are HIV positive. 4 Healthcare professionals who are HIV positive can also choose to decide whether to disclose their infection. 5 The motive of ADA is to provide equal opportunities for people with disabilities.
1, 3, 4
The nurse is learning about negligence in unintentional torts. Which actions would the nurse consider as common acts of negligence? Select all that apply. 1 Failure to follow orders 2 Failure to perform malpractice 3 Failure to document monitoring 4 Failure to follow policies and guidelines 5 Failure to explain the risks of a surgery to a patient
2, 3, 4
The nurse is learning about nursing malpractice. Which statements should the nurse consider as good nursing practice? Select all that apply. 1 Nursing notes can be illegible as long as the nurse can read them. 2 Nursing notes should be maintained properly. 3 Nursing records should be properly preserved. 4 Institutions should maintain complete nursing records. 5 Only basic duties should be recorded in nursing records.
1, 3, 5
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. 1 Civil laws protect the rights of individuals in the society. 2 Common law presents decisions made by administrative bodies. 3 Criminal laws protect society by providing punishment for crimes. 4 Criminal laws are passed to protect society from nursing negligence. 5 Regulatory law reflects decisions made by administrative bodies when they pass rules.
Identify what the nurse's responsibility is when he or she "floats" to another nursing unit.
The nurse needs to inform the supervisor of any lack of experience in caring for the type of patients on the unit. The nurse also needs to request and orientation to the unit.
2
The nurse notes that an advance directive is on a patient's medical record. Which statement best describes an advance directive guideline? 1 A living will allows an appointed person to make healthcare decisions when the patient is in an incapacitated state. 2 A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3 The patient cannot make changes in the advance directive once admitted to the hospital. 4 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.
3
The nurse notes that the healthcare unit keeps a listing of the patient names at the front desk in easy view for healthcare providers to more efficiently locate the patient. Which does this action violate? 1 Mental Health Parity Act (MHPA) 2 Patient Self-Determination Act (PSDA) 3 Health Insurance Portability and Accountability Act (HIPAA) 4 Emergency Medical Treatment and Active Labor Act (EMTALA)
3
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which action violates the Health Insurance Portability and Accountability Act (HIPAA)? 1 Discussing patient conditions in the nursing report room at the change of shift 2 Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3 Posting medical information about a patient on a message board in the patient's room 4 Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
3
The nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. Which would probably cover the nurse in this situation? 1 The nurse's automobile insurance 2 The nurse's homeowner's insurance 3 The Good Samaritan laws, which grant immunity from suit if there is no gross negligence 4 The Patient Care Partnership, which may grant immunity from suit if the injured party consents
1
The nurse wraps and ties a cloth to prevent bleeding from the site of injury for a patient who is a victim of a traffic accident. The patient is taken to the hospital and presents with signs of infection. Which action will be taken against the nurse? 1 The nurse will not face any action. 2 The nurse will be given a warning for gross negligence. 3 The nurse will face liable charges for not getting an informed consent. 4 The nurse will be sued for not obtaining orders from the primary healthcare provider before intervening.
3
The occupational nurse is speaking to a patient who has started a new job after working for a company for 6 months. The patient is worried about losing health insurance. Which advice should the nurse give to the patient? 1 "You should not have left the job." 2 "Don't worry. You will not lose insurance coverage." 3 "You should apply for your new health plan as soon as possible." 4 "I am not able to help you. Please consult with the health law advocate."
Invasion of privacy
The release of a patient's medical information to an unauthorized person.
1
The scope of nursing practice is legally defined by: 1. State Nurse Practice Act 2. Professional Nursing Organization 3. Hospital Policy and Procedure manuals 4. Health Care providers in the employing institutions.
2
The surgical nurse is collecting the necessary documents to obtain a patient's informed consent before a surgery. In which instance should the nurse refrain from obtaining informed consent? 1 The patient voices no concerns regarding the surgery. 2 The patient was administered morphine. 3 The patient's family members are not present. 4 The surgery is associated with risk for severe complications.
Prior to establishing a relationship, a nurse may refuse an assignment and is not considered abandonment when:
a. Lacks the knowledge or skill needed. b. Care exceeding the Nurse Practice Act is expected. c. Health of the nurse or her unborn child is directly threatened. d. Orientation to the unit has not been completed. e. Clearly states and documents a conscientious objection based on moral, ethical, or religious grounds. f. Clinical judgement is impaired due to fatigue.
The joint commission's specific guidelines for the use of restraints are:
a. Restraints should be used only to ensure physical safety of the resident or other residents. b. Restraints should be used only when less restrictive interventions are not successful. c. Restraints should be used only on the written order of a physician, which includes a specific episode with start and end times.
Identify the four criteria needed to establish nursing malpractice:
a. The nurse (defendant) owed a duty to the patient (plantiff). b. The nurse did not carry out that duty. c. The patient was injured. d. The nurse's failure to carry out the duty caused the injury.
Emergency medical treatment and active labor act (EMTALA)
states that when a patient comes to the ER or hospital, an appropriate medical screening occurs within the hospital's capacity. If an emergency exists, the hospital is not to discharge or transfer the patient until the condition stabilizes.