Chapter 23 - Legal Implications in Nursing Practice
13 A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1Document her findings and treat the patient 2Instruct the mother on safe handling of a 2-year-old child 3Contact a child abuse hotline 4Discuss this story with a colleague
13. Answer: 3. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.
1 A nurse is caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (Select all that apply.) 1Information provided by the head nurse 2Policies and procedures of the employing hospital 3State Nurse Practice Act 4Regulations identified in The Joint Commission's manual 5The American Nurses Association standards of nursing practice
1. Answer: 2, 3, 4, 5. Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.
Clinical Application Questions Preparing for Clinical Practice You are working the first shift on the hematology-oncology unit and receive report on your assigned team of four patients. You have a nursing assistive personnel assigned to help you with routine care. You make quick rounds on your patients to ensure that there are no immediate needs before you begin checking medications. Patient No. 1 is scheduled for surgery later in the morning for a biopsy and needs the surgical consent signed. Patient No. 2 is receiving blood products for an HIV complication and needs frequent vital sign monitoring. You find patient No. 3, an 83-year-old confused man, lying on the floor. He states that he needed to go to the restroom and no one was there to help. You call for help to get the patient back in bed and assess for further injuries. 1The nurse prepares the surgical consent form for patient No. 1. What key points does he or she need to ensure that the patient received before witnessing informed consent? 2The son of patient No. 2 calls to talk to the nurse caring for his father. The son asks questions about the reason for the blood administration. What guidelines does the nurse follow in responding to the son's questions about the father's condition? What federal statutes are involved in this scenario? 3One week after discharge from the hospital, the hospital received a written complaint from the family of patient No. 3 about the incident related to the fall and the intent to take legal action. aWhat must patient No. 3 establish to prove negligence against the nurse? bDescribe situations in which restraints may be legally applied to prevent falls.
1. The physician who is performing the biopsy is responsible for providing informed consent to the patient about the procedure. The nurse is responsible for witnessing the signing of the consent. The patient must be 18 years or older and legally competent to give and/or refuse consent. The nurse's signature witnessing the consent means that the patient voluntarily gave consent, the patient's signature is authentic, and the patient appears to be competent to give consent. The nurse should ask the patient if he or she understands the procedure. If the patient denies understanding or the nurse suspects that he or she does not understand, the nurse must notify the physician or nursing supervisor and make certain that the patient is informed before signing. Key elements of responsibility for the physician include the following: (1) the patient receives a brief, complete explanation of the procedure or treatment; (2) the patient receives the names and qualifications of persons performing and assisting in the procedure; (3) the patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort; (4) the patient receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing; (5) the patient knows that he or she has the right to refuse the procedure/treatment without discontinuing other supportive care; (6) the patient knows that he or she may refuse the procedure/ treatment even after the procedure has begun. 2. The main guidelines stem from the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA). The nurse would first want to check the patient's medical record for a release form indicating with whom medical information can be shared. The ADA is the federal statute that regulates the privacy of patients with human immunodeficiency virus (HIV). Patient No. 2 has the right to determine if he wants the information disclosed. The HIPAA is another federal statute that creates patient rights to consent to use and disclose protected health information. The son cannot receive any information from the nurse about his father unless the father has given permission that medical information can be released. 3. a. To prove negligence, (1) patient No. 3 needs to establish that the nurse (defendant) owed a duty to the patient (plaintiff), (2) the nurse did not carry out that duty, (3) the patient was injured, and (4) the nurse's failure to carry out the duty caused the injury. b. According to The Joint Commission (TJC), restraints may be applied only to ensure the physical safety of the patient or other patients and after less restrictive interventions have been attempted.
10 The 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 of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) 1Failure to document a change in assessment data 2Failure to provide discharge instructions 3Failure to follow the six rights of medication administration 4Failure to use proper medical equipment ordered for patient monitoring 5Failure to notify a health care provider about a change in the patient's condition
10. Answer: 1, 5. The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.
11 A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? 1Health Insurance Portability and Accountability Act (HIPAA) 2Americans with Disabilities Act (ADA) 3Patient Self-Determination Act (PSDA) 4Emergency Medical Treatment and Active Labor Act (EMTALA)
11. Answer: 4. The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.
12 You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the first nursing action to take? 1Give the family the record 2Give the patient the record 3Discuss the issues that concern the family with them 4Call the nursing supervisor
12. Answer: 3. Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how to best address their concerns.
14 A new graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which of the statements below indicates the new graduate understands ways to remain involved professionally? (Select all that apply.) 1"I am thinking about joining the health committee at my church." 2"I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3"I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing." 4"Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses.
14. Answer: 1, 2. Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees at all levels of their career, not just when they have experience. Nurses have a powerful voice in the legislature.
15 You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. What is the best nursing action to take first? 1Call the nursing supervisor to discuss the situation 2Discuss the problem with a colleague 3Leave the nursing unit and go home 4Say nothing and begin your work
15. Answer: 1. Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.
2 A nurse is sued for failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) 1The nurse represents the plaintiff. 2The defendant must prove injury, damage, or loss. 3The person filing the lawsuit has the burden of proof. 4The plaintiff must prove that a breach in the prevailing standard of care caused an injury.
2. Answer: 3, 4. 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.
3 A 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. What would probably cover the nurse in this situation? 1The nurse's automobile insurance 2The nurse's homeowner's insurance 3The Good Samaritan laws, which grant immunity from suit if there is no gross negligence 4The Patient Care Partnership, which may grant immunity from suit if the injured party consents
3. Answer: 3. The Good Samaritan law holds the health care provider immune from liability as long as he or she functions within the scope of his or her expertise.
4 A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1Family member 2Surgeon 3Nurse 4Nurse Manager
4. Answer: 2. The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.
5 A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 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? 1Obtain a court order to give the blood 2Coerce the husband into giving the blood 3Call security and have the husband removed from the hospital 4Abide by the husband's wishes and inform the health care provider
5. Answer: 4. Adult patients such as those who are Jehovah's Witnesses are able to refuse treatment for personal religious reasons.
6 The nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline the nurse will follow? 1A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. 2A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3The patient cannot make changes in the advance directive once admitted to the hospital. 4A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
6. Answer: 2. A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.
7 A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nursing manager because this action is a violation of which act? 1Mental Health Parity Act 2Patient Self-Determination Act (PSDA) 3Health Insurance Portability and Accountability Act (HIPAA) 4Emergency Medical Treatment and Active Labor Act
7. Answer: 3. The Privacy Rule of HIPAA requires that patient information be protected from unnecessary publication.
8 Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1Taking or selling controlled substances 2Refusing to provide health care information to a patient's child 3Reporting suspected abuse and neglect of children 4Applying physical restraints without a written physician's order
8. Answer: 1, 4. 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 health care provider based on Joint Commission and Medicare guidelines.
9 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 of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? 1Discussing patient conditions in the nursing report room at the change of shift 2Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3Posting medical information about the patient on a message board in the patient's room 4Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
9. Answer: 3. Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment.
