chapter 7

1. blank law is law in which the government is involved directly.

1. Public

1. A body of law that has evolved from accumulated judiciary decisions is known as which of the following? a. Statutory law b. Administrative law c. Common law d. Constitutional law

1. c

2. A state's blank protects the public by broadly defining the legal scope of nursing practice

2. Nurse Practice Act

3. Which of the following is the process in which specialty knowledge, experience, and clinical judgment are validated by many U.S. professional organizations? a. Certification b. Accreditation c. Licensure d. Litigation

3. a

4. A nurse pleads guilty to a misdemeanor negligence charge for failing to monitor a patient's vital signs during routine eye surgery, leading to the death of the patient. The nurse's attorney explained in court that the nurse was granted recognition in a specialty area of nursing. What is the term for this type of credential? a. Accreditation b. Licensure c. Certification d. Board approval

4. c. 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. Nursing is one of the groups operating under state laws that promote the general welfare by determining minimum standards of education through accreditation of schools of nursing. Licensure is a legal document that permits a person to offer to the public skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. State board of approval ensures that nurses have received the proper training to practice nursing.

7. When a nurse has met all the criteria necessary for recognition by the ANA, he/ she is said to have undergone which of the following processes? a. Licensure b. Accreditation c. Certification d. Registration

7. c

8. A nurse who comments to her coworkers at lunch that her patient with a sexually transmitted disease has been sexually active in the community may be guilty of which of the following torts? a. Slander b. Libel c. Fraud d. Assault

8. a

Which is the correct term for this nursing action: A nurse falsely imprisons a patient by an unauthorized use of restraints. A. Crime B. Tort C. Misdemeanor D. Felony

Answer: B. Tort Rationale: A tort is a wrong committed by a person against another person or that person's property. False imprisonment is an intentional tort. A crime is a wrong against a person or that person's property as well as the public. Crimes can be classified as misdemeanors or felonies.

A nurse in the operating room is obtaining consent for a procedure. She understands that the elements of informed consent does not include: A. Disclosure B. Comprehension C. Competence D. Code Status

Answer: D. Code Status Rationale: In all health care agencies, informed and voluntary consent is needed for admission, for specialized diagnostic procedures or medical-surgical treatment, and for any experimental treatments or procedures. Elements of informed consent includes disclosure, comprehension, competence, and voluntariness

REFLECTIVE PRACTICE USING CRITICAL THINKING SKILLS Use the following expanded scenario from Chapter 7 in your textbook to answer the questions below. Scenario: Meredith Bedford is the mother of a terminally ill young boy diagnosed with a brain tumor who is admitted to the pediatric oncology unit for a pain management program. One morning she comes out to the nurses' station and firmly says, "I'm very unhappy with the care my son is receiving. I'm going to talk with my attorney as soon as possible to press charges against the hospital." The nurse currently in charge of the boy's care is under investigation for malpractice in another case. 1. How might the nurses involved in this scenario respond to Ms. Bedford's disclosure that she will be pressing charges against the hospital?

1. How might the nurses involved in this scenario respond to Ms. Bedford's disclosure that she will be pressing charges against the hospital? The nurse speaking to Ms. Bedford should not volunteer any information regarding the case and should refer her to the legal department of the hospital. It would also be appropriate for the nurse to seek advice from legal counsel. The nurses providing the care may be named as defendants and will need to work closely with an attorney while preparing the defense. Either the defense or the prosecuting attorney may call the first nurse to testify as a fact witness if he or she has knowledge of the actual incident prompting the legal case. This nurse must base testimony on only firsthand knowledge of the incident and not on assumptions. When in doubt about facts, the nurses should simply testify, "I do not remember that."

SHORT ANSWER 1. Give an example of how nurses could avoid the following common allegations of malpractice. a. Failure to ensure patient safety: b. Improper treatment or performance of treatment: c. Failure to monitor and report: d. Medication errors and reactions: e. Failure to follow agency procedure: f. Equipment misuse: g. Adverse incidents: h. Improper use of infection control techniques:

1. Sample answers: a. Failure to ensure patient safety: Update knowledge on patient safety and new interventions to prevent and reduce injury. b. Improper treatment or performance of treatment: Use proper techniques when performing procedures and follow agency procedures. c. Failure to monitor and report: Follow physician orders regarding monitoring of patient unless changes in the patient's condition necessitate a change in the frequency of monitoring; report need for change to physician. d. Medication errors and reactions: Listen to patient's objections regarding medication and investigate patient concerns before administering the medication. e. Failure to follow agency procedure: Advise the appropriate person of procedures that need to be revised. f. Equipment misuse: Learn how to operate equipment in a safe and appropriate manner. Never operate equipment with which you are unfamiliar. g. Adverse incidents: Do not assume, voice, or record any blame for an incident. h. Improper use of infection control techniques: Know and follow agency policies and procedures for the care of patients with infectious disease.

ALTERNATE-FORMAT QUESTIONS Multiple Response Questions Circle the letters that correspond to the best answers for each question. 1. Which of the following are sources of laws at the federal and state level? (Select all that apply.) a. Constitutions b. Mandates c. Criminal law d. Common law e. Statutes f. Administrative law

1. a, d, e, f

1. A state attorney decides to charge a nurse with manslaughter for allegedly administering a lethal medication. This is an example of what type of law? a. Public law b. Private law c. Civil law d. Criminal law

1. d. Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Public law regulates relationships between people and the government. Private or civil law includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry.

MATCHING EXERCISES Match the type of tort listed in Part A with an example of the tort listed in Part B. PART A a. Assault b. Battery c. Slander d. Liability e. Invasion of privacy f. False imprisonment g. Fraud h. Negligence i. Libel PART B 1. A nurse seeking a middle-management position in long-term care claims to be certified in gerontologic nursing, which is not the case. 2. A nurse tapes an interview with a patient without his knowledge. 3. A nurse threatens to slap an elderly patient who refuses to clean up after herself. 4. A nurse spreads a rumor that a patient is a compulsive gambler. 5. A nurse forgets to replace an IV bag that is empty. 6. A nurse uses restraints on a patient unnecessarily. 7. A nurse physically attacks a patient who complains that she is not being cared for properly. 8. A nurse circulates a petition among her coworkers in an attempt to remove a coworker from her unit who has engaged in inappropriate behavior with a patient. This behavior is described at the top of the petition

1. g 2. e 3. a 4. c 5. h 6. f 7. b 8. i

10. A nursing student asks the charge nurse about legal liability when performing clinical practice. Which statement regarding liability is true? a. Students are not responsible for their acts of negligence resulting in patient injury. b. Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. c. Hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor. d. Most nursing programs carry group professional liability making student personal professional liability insurance unnecessary

10. b. Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. Student nurses are responsible for their own acts of negligence if these result in patient 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. Nursing instructors may share responsibility for damages in the event of patient injury if an assignment called for clinical skills beyond a student's competency or the instructor failed to provide reasonable and prudent clinical supervision. Most nursing programs require students to carry personal professional liability insurance

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

10. d

2. What intellectual, technical, interpersonal, and/or ethical/legal competencies are most likely to be used in this situation?

2. What intellectual, technical, interpersonal, and/or ethical/legal competencies are most likely to be used in this situation? Intellectual: knowledge of law and sources of law and ability to identify potential areas of liability in nursing Technical: ability to provide technical nursing assistance in a competent, legally appropriate manner Interpersonal: ability to work collaboratively with other members of the healthcare team and legal department Ethical/Legal: ability to identify errors in personal action

2. Newly hired nurses in a busy suburban hospital are required to read the state nurse practice act as part of their training. Which topics are covered by this act? Select all that apply. a. Violations that may result in disciplinary action b. Clinical procedures c. Medication administration d. Scope of practice e. Delegation policies f. Medicare reimbursement

2. a, d. Each state has a nurse practice act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes nurses vulnerable to charges of violating the state nurse practice act. Nurse practice acts also list the violations that can result in disciplinary actions against nurses. Clinical procedures are covered by the health care institutions themselves. Medication administration and delegation are topics covered by the board of nursing. Laws governing Medicare reimbursement are enacted through federal legislation

2. Explain the difference between voluntary standards of nursing practice and legal standards, and give an example of each. a. Voluntary standards: Example: b. Legal standards: Example:

2. a. Voluntary standards: Developed and implemented by the nursing profession itself; not mandatory; used for peer review. Example: professional nursing organizations. b. Legal standards: developed by legislative action; implemented by authority granted by the state (or province) to determine minimum standards for the education of nurses, set requirements for licensure or registration, and decide when to revoke or suspend nurse's licenses. Example: licensure

2. A nurse who misrepresents the outcome of a procedure or treatment may have committed which of the following torts? a. Slander b. Fraud c. Libel d. Assault

2. b

2. Which of the following statements accurately describe the process of litigation? (Select all that apply.) a. The person bringing suit against another is called the defendant. b. Litigation is the process of bringing and trying a lawsuit c. The defendant is presumed guilty until proven innocent. d. The appellate court, the first-level court, hears all the evidence in a case and makes a decision based on facts. e. The opinions of appellate judges are published and become common law. f. Common law is based on the principle of stare decisis.

2. b, e, f

Match the type of law listed in Part A with an example of the law listed in Part B. PART A a. Administrative law b. Common law c. Public law d. Private law e. Criminal law f. Constitutional law g. Statutory law PART B 20. Laws regulating relationships between individuals and the government 21. Nurse practice acts 22. Rules and regulations of boards of nursing 23. Malpractice law 24. Laws regulating relationships among people 25. Laws involving murder, manslaughter, criminal negligence, theft, and illegal possession of drugs

20. c 21. g 22. a 23. b 24. d 25. e

3. blank is a specialized form of credentialing based on laws passed by a state legislature.

3. Licensure

3. What resources might be helpful for the nurses in this case?

3. What resources might be helpful for the nurses in this case? Hospital legal department, liability insurance, risk management programs, malpractice arbitration pane

3. List four cases in which informed consent is needed from a patient: a. b. c. d.

3. a. For each specialized diagnostic procedure b. For experimentation involving patients c. On admission for routine treatment d. For medical or surgical treatment

3. Which of the following are examples of voluntary standards in nursing? (Select all that apply.) a. State nurse practice acts b. Rules and regulations of nursing c. American Nurses Association Standards of Practice d. Professional standards for certification of individual nurses in general practice e. Process of certification f. Process of licensure

3. c, d, e

3. A nurse in a NICU fails to monitor a premature newborn according to the protocols in place, and is charged with malpractice. What is the term for those bringing the charges against the nurse? a. Appellates b. Defendants c. Plaintiffs d. Attorneys

3. c. The person or government bringing suit against another is called the plaintiff. Appellates are courts of law, defendants are the ones being accused of a crime or tort, and attorneys are the lawyers representing both the plaintiff and defendant.

4. A nurse called by either attorney to explain to the judge and jury what happened, based on the patient's record, and to offer an opinion about whether the nursing care met acceptable standards is called a(n) blank .

4. Expert witness

4. Give three examples of invasion of privacy in a nurse-patient relationship: a. b. c. .

4. Sample answers: a. Talking with patients in rooms that are not soundproof b. Pressing the patient for information not necessary for care planning c. Using tape recorders, dictating machines, computer banks, and so on without taking precautions to ensure patient confidentiality

4. Which of the following statements accurately describe the components of the judicial system? (Select all that apply.) a. A crime is a wrong against a person or his or her property, but the act is considered to be against the public as well. b. People who break certain laws are not guilty of a crime if they did not intend it. c. In most cases, criminal law is statutory law. d. A misdemeanor is a more serious crime than a felony. e. Misdemeanors are commonly punishable with fines. f. A tort is punishable by the state.

4. a, c, e

4. Which of the following is the primary reason for filling out an incident report? a. To document everyday occurrences b. To document the need for disciplinary action c. To improve quality of care d. To initiate litigation

4. c

5. When the nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment, he/she is participating in a practice known as blank.

5. Collective bargaining

5. List three strengths a nurse must possess to testify competently as an expert witness: a. b. c

5. a. Solid educational background b. Understanding of the legal aspects of nursing and malpractice liability c. Knowledge of the state (or province) Nurse Practice Act and standard of nursing care where the incident occurred

5. Review of a patient's record revealed that no one obtained informed consent for the heart surgery that was performed on the patient. Which intentional tort has been committed? a. Assault b. Battery c. Invasion of privacy d. False imprisonment

5. b. 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. Every person is granted freedom from bodily contact by another person unless consent is granted. The Fourth Amendment gives citizens the right of privacy and the right to be left alone; a nurse who disregards these rights is guilty of invasion of privacy. Unjustified retention or prevention of the movement of another person without proper consent can constitute false imprisonment.

5. Which of the following are considered intentional torts in nursing practice? (Select all that apply.) a. Negligence b. Malpractice c. Assault and battery d. Fraud e. False imprisonment f. Defamation

5. c, d, e, f

5. The Good Samaritan laws would protect which of the following actions performed by a healthcare practitioner? a. Any emergency care where consent is given b. Negligent acts performed in an emergency situation c. Medical advice given to a neighbor regarding her child's rash d. Emergency care for a choking victim in a restaurant

5. d

6. What conditions are necessary for a contract to be valid?

6. A contract must contain real consent of the parties, a valid consideration, a lawful purpose, competent parties, and the form required by law

6. Protection of employees from discrimination based on race, color, religion, sex, and national origin is provided under which of the following government agencies? a. OSHA b. EEOC c. HUD d. NAACP

6. B

6. When a nurse documents the fall of an elderly patient, he or she is filing a(n) blank report.

6. Incident

6. Which of the following are elements that must be established to prove that malpractice or negligence has occurred? (Select all that apply.) a. Duty b. Intent to harm c. Breach of duty d. Causation e. Punitive damages f. Fraud

6. a, c, d

6. A veteran nurse, pleaded guilty to a misdemeanor negligence charge in the case of a 75-year-old woman who died after slipping into a coma during routine outpatient hernia surgery. The nurse admitted failing to monitor the woman's vital signs during the procedure. The surgeon who performed the procedure called the nurse's action pure negligence, stating that the patient could have been saved. The patient was a vibrant grandmother of 10 who had walked three quarters of a mile the morning of her surgery and had sung in her church choir the day before. What criteria must be established to prove that the nurse is guilty of malpractice or negligence in this case? a. The surgeon who performed the procedure called the nurse's action pure negligence, saying that the patient could have been saved. b. The fact that this patient should not have died since she was a healthy grandmother of 10, who was physically active and involved in her community. c. The nurse intended to harm the patient and was willfully negligent, as evidenced by the tragic outcome of routine hernia surgery. d. The nurse had a duty to monitor the patient's vital signs, and due to the nurse's failure to perform this duty in

6. d. Liability involves four elements that must be established to prove that malpractice or negligence has occurred: duty, breach of duty, causation, and damages. Duty refers to an obligation to use due care (what a reasonably prudent nurse would do) and is defined by the standard of care appropriate for the nurse-patient relationship. Breach of duty is the failure to meet the standard of care. Causation, the most difficult element of liability to prove, shows that the failure to meet the standard of care (breach) actually caused the injury. Damages are the actual harm or injury resulting to the patient.

7. Describe what conditions you, as a nurse, would require to accept a telephone order from a physician:

7. Sample answer: Limit telephone orders to true emergency situations; repeat a telephone order back to the physician; document the order, its time and date, situation necessitating order, physician prescribing, reconfirming the order as it is read back, and signing name; and VO or TO. If possible, two nurses should listen to a questionable telephone order, with both nurses countersigning the order.

7. The Joint Commission defines a(n) blank as an unexpected occurrence involving death or serious or psychological injury, or the risk thereof.

7. Sentinel event

7. An attorney is representing a patient's family who is suing a nurse for wrongful death. The attorney calls the nurse and asks to talk about the case to obtain a better understanding of the nurse's actions. How should the nurse respond? a. "I'm sorry, but I can't talk with you; you will have to contact my attorney." b. "I will answer your questions so you'll understand how the situation occurred. c. "I hope I won't be blamed for the death because it was so busy that day." d. "First tell me why you are doing this to me. This could ruin my career!"

7. a. The nurse should not discuss the case with anyone at the facility (with the exception of the risk manager), with the plaintiff, with the plaintiff 's lawyer, with anyone testifying for the plaintiff, or with reporters. This is one of the cardinal rules for nurse defendants

7. Which of the following are steps that occur when a malpractice suit is being litigated? (Select all that apply.) a. The basis for the claim is appropriate and timely, and at least one element of liability is present. b. All parties named as defendants, as well as insurance companies and attorneys, work toward a fair settlement. c. If the case is presented to a malpractice arbitration panel, the decision of the panel must be accepted by both parties. d. The defendants contest allegations, and pretrial discovery begins. e. A review of medical records is not allowed in pretrial discovery. f. If a verdict from a trial court is not accepted by both sides, it may be appealed to an appellate court.

7. b, d, f

8. Which of the following are legal safeguards for the nurse? (Select all that apply.) a. Informed consent b. Incompetent practice c. Patient education d. Executing physician orders without questioning them e. Documentation f. Inadequate staffing

8. a, c, e

8. List two cases in which it would be appropriate to question a physician's order: a. b.

8. a. Contraindicated by normal practice b. Contraindicated by patient's present condition

8. A nurse administers the wrong medication to a patient and the patient is harmed. The health care provider who ordered the medication did not read the documentation that the patient was allergic to the drug. Which statement is true regarding liability for the administration of the wrong medication? a. The nurse is not responsible, because the nurse was following the doctor's orders. b. Only the nurse is responsible, because the nurse actually administered the medication. c. Only the health care provider is responsible, because the health care provider actually ordered the drug. d. Both the nurse and the health care provider are responsible for their respective actions

8. d. Nurses are legally responsible for carrying out the orders of the health care provider in charge of a patient unless an order would lead a reasonable person to anticipate injury if it was carried out. If the nurse should have anticipated injury and did not, both the prescribing health care provider and the administering nurse are responsible for the harms to which they contributed

9. Mrs. Toole, age 85, is recovering from a hip replacement at home. When bathing Mrs. Toole, a visiting nurse practitioner forgets to replace her bed rails, and Mrs. Toole falls out of bed. Mrs. Toole is shaken up and sore from her fall, but there appears to be no further damage to her hip. a. What is the nurse's liability in this situation? b. What information should be included in the incident report? c. Do you feel the patient has a case for negligence? Explain why or why not, using the four elements of liability that must be present to prove that negligence has occurred (duty, breach of duty, causation, damages):

9. Sample answers: a. The nurse is liable for her actions and should file an incident report. b. The incident report should contain the name of the patient; all witnesses; a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person involved; and other relevant variables believed important to the incident. c. Answers will vary with student's experiences

9. A nurse answers a patient's call light and finds the patient on the floor by the bathroom door. After calling for assistance and examining the patient for injury, the nurse helps the patient back to bed and then fills out an incident report. Which statements accurately describe steps of this procedure and why it is performed? Select all that apply. a. An incident report is used as disciplinary action against staff members. b. An incident report is used as a means of identifying risks. c. An incident report is used for quality control. d. The facility manager completes the incident report. e. An incident report makes facts available in case litigation occurs. f. Filing of an incident report should be documented in the patient record.

9. b, c, e. Incident reports are used for quality improvement and should not be used for disciplinary action against staff members. They are a means of identifying risks and are filled out by the nurse responsible for the injured party. An incident report makes facts available in case litigation occurs; in some states, incident reports may be used in court as evidence. A health care provider completes the incident form with documentation of the medical examination of the patient, employee, or visitor with an actual or potential injury. Documentation in the patient record should not include the fact that an incident report was filed.

9. What is the process by which an educational program is evaluated and recognized as having met certain predetermined criteria? a. Licensure b. Registration c. Accreditation d. Certification

9. c

Match the terms listed in Part A with their definitions listed in Part B. PART A a. Litigation b. Plaintiff c. Defendant d. Crime e. Credentialing f. Felony g. Tort h. Contract i. Testator j. Beneficiary k. Misdemeanor l. Precedent PART B 9. The person who makes a will 10. The exchange of promises between two parties 11. The process of a lawsuit 12. The case that first sets down the rule by decision 13. The one being accused in a lawsuit 14. A wrong against a person or his/her property, considered to be against the public as well 15. Crimes that are commonly punishable with fines or imprisonment for less than 1 year, or with both, or with parole 16. The person or government bringing suit against another 17. A crime punishable by imprisonment in a state or federal penitentiary for more than 1 year 18. A wrong committed by a person against another person or his/her property that generally results in a civil trial 19. A person who receives money or property from a will

9. i 10. h 11. a 12. l 13. c 14. d 15. k 16. b 17. f 18. g 19. j

vA lawsuit has been brought against a nurse for malpractice. While hospitalized, a patient fell and suffered a skull fracture. When filing a lawsuit, which element of liability does the description of the patient and his injuries represent? A. Damages B. Causation C. Duty D. Breach of duty

A. Damages Rationale: "The patient fell and suffered a skull fracture." There is evidence of bodily injury, emotional distress, and discomfort the patient experienced. These all qualifies as damages.

Tell whether the following statement is true or false. A source of law that uses the court system, including plaintiff and defendant, is called the common law A. True B. False

Answer: A. True Rationale: A body of law known as common law has evolved from accumulated judiciary decisions. This includes the use of plaintiff and defendant. Most law involving malpractice is common law.

Tell whether the following statement is true or false. The state nurse practice act is the most important law affecting nursing practice. A. True B. False

Answer: A. True Rationale: The state nurse practice act is the most important law affecting nursing practice. Each nurse practice act protects the public by broadly defining the legal scope of nursing practice.

A nurse walks into a patient's room and finds them on the floor. The patient states, "I was trying to get to the bathroom and was lowering the siderail but slipped and fell." The nurse fills out an incident report that includes: A. The patient was trying to lower the side rails B. The patient was found lying on the floor C. The patient was trying to get out of bed D. The patient was trying to get to the bathroom

Answer: B. The patient was found lying on the floor Rationale: Incident reports must include factual account of incident. The other answers are subjective information, from the patient. The report should contain all the factors related to the incident. Examples of factors related to the incident would include whether the bed alarm was in use, if the patient had surgery or other physically or psychologically altered changes at the time of incident.

A patient developed a blood clot after surgery because the nurse did not get the patient up and walk them around, as directed by the surgeon. What charge might be brought against the nurse? A. Negligence B. Malpractice

Kind of both, right? When a medical provider's actions or inactions fail to meet the medical standard of care, their behavior constitutes medical negligence. If their medical negligence causes their patient to suffer an injury, it becomes medical malpractice.

Prioritization Question 1. Place the following steps involved in malpractice litigation in the order in which they would normally occur: a. Decision or verdict is reached. b. The basis for the claim is appropriate and timely; all elements of liability are present. c. Trial takes place. d. Pretrial discovery activities and review of medical records and deposition of plaintiff, defendants, and witnesses are performed. e. All parties named as defendants, as well as insurance companies and attorneys, work toward a fair settlement. f. If the verdict is not accepted by both sides, it may be appealed to an appellate court. g. The case is presented to a malpractice arbitration panel. The panel's decision is either accepted or rejected, in which case a complaint is filed in trial court. h. The defendants contest allegations.

b e g h d c a f