Evolve- Issues in Nursing
Facility admin that ID's/analyzes, evaluates steps taken & act to reduce/correction threats that could lead to injury of patients, staff members, or visitors and result in property loss or damage is
risk management
A student nurse who is employed as a nursing assistant may perform any functions that
Are identified in the position's job description
What does the nurse understand by the word felony?
A felony is a crime of a serious nature that has a penalty of imprisonment for longer than one year or even death.
The legal guidelines that nurses follow come from...
A) statutory law, B) regulatory law, C) common law
A nurse who promotes freedom of choice for clients in decision-making best supports which principle?
Autonomy
What are the important points to be considered when imparting practical knowledge to nursing students about preventing complications in the hospital? Select all that apply.
A. Nursing students are not accountable if a client is harmed. D. Nursing students can work as nursing assistants or nurse's aides when not attending classes. E. Nursing students should notify the nursing supervisor in case they are delegated tasks they are not prepared for.
A registered nurse is educating a nursing student on the various classifications of torts. What acts are classified as intentional torts in nursing practice? Select all that apply.
Battery Assault False Imprisionment
What purpose does block and parish nursing serve in preventive and primary care services?
Block and parish nursing provides services to older clients or those who are unable to leave their homes.
A nurse is helping a client to maintain and regain health, manage his or her disease and symptoms, and attain a maximal level of function and independence through the healing process. What role is the nurse playing?
Caregiver
Which of the following legal defenses are the most important for a nurse to develop?
Accountability
A nurse educates a client about the role played by an individual in taking responsibility for health and wellness and its impact. What instructions should the nurse give? Select all that apply
"An individual should know that lifestyle choices affect his or her quality of life and well-being." "An individual should take responsibility of health and wellness by making proper lifestyle choices." "An individual should realize that illness prevention has a positive economic impact on his or her life."
A nursing student is listing the points that need to be remembered regarding the United Network for Organ Sharing (UNOS) program. Which point listed by the nursing student is accurate?
"The United Network for Organ Sharing (UNOS) has a contract with the federal government."
A nurse is hired to work in a healthcare facility that has a completely computer-based client information system. The nurse in charge knows that the newly hired nurse is knowledgeable about this system when the nurse says what?
Client information is immediately available when this system is used.
What purpose does a community health center serve in preventive and primary care services?
Community health center are outpatient clinics that provide primary care to a specific population.
Moving from area a nurse is accustomed to, to another nursing unit is called...
Floating
A nurse administers intravenous (IV) therapy to the wrong client. What possible legal complications might the nurse face in such situation?
Malpractice
The nurse puts restraints on a patient without the patient's permission and without a physician's order; The nurse may be guilty of
battery because unintentional touching without consent; assault there is no touching, battery there is touching
If nurses are assigned to care for more patients than is reasonable, they need to
bring this information to the attention of the nursing supervisor
If someone requests students employed as nurse's aides to perform tasks that they are not prepared to complete safely, the student needs to
bring this information to the supervisor's attention so they are able to obtain the needed help
Do not walk out when staffing is inadequate because you may be
charged with patient abandonment
Nurses need to assess all orders if it is erroneous or harmful they should first
clarify order with HC provider
If a patient refuses to consent to procedure, the patient has to refuse consent
in writing, signed and witnessed
Failure to monitor in timely fashion, use proper equipment to monitor, & document the monitoring is an example of
negligent acts
The scope of nursing practice is legally defined by
state nursing practice act
Who determines if a procedure is complex and an informed consent is needed?
the physician
If there is a controversy about a physicians/APN order the nurse needs to also inform
the supervising nurse or follow the established chain of command
What information should the nurse provide when explaining the benefits of illness prevention activities to a client?
"These activities help protect clients from actual or potential health threats."
What should a nurse understand about healthcare proxies or a durable power of attorney for healthcare?
A proxy is a legal document that designates a person or persons to make health care decisions on behalf of the client.
An unemancipated pediatric client is to undergo a medical procedure. Who is the appropriate authority to provide consent?
Either of the child's parents
What does the nurse understand the term in-service education to mean?
It helps achieve an organization's required competencies.
A registered nurse is educating a nursing student about the process of resolving an ethical dilemma. What information should the nurse provide regarding negotiation of outcomes?
A nurse should provide a personal point of view.
What does a nurse understand by the Quality and Safety Education for Nurses (QSEN) competency called informatics?
A nurse should use information and technology to communicate, manage knowledge, mitigate error, and support decision-making.
What federal statute protects the rights of individuals who are disabled in the workplace, in educational institutions, and throughout our society
American with disabilities act (ADA)
Most states adopted uniform determination of death act; Name the two standards for the determination of death?
Health care providers can use the cardiopulmonary & Whole brain standard to determine death
According to the Institute of Medicine (IOM) competencies for the 21st century, what task should the nurse perform when working in interdisciplinary teams?
Integrate care to ensure that care is continuous and reliable
What is a living will?
It is a written document that directs treatment according to the client's wishes, in case of a terminal illness or condition.
A nursing student is listing risk factors that affect the health and wellness of a client. Which risk factors listed by the nursing student are accurate? Select all that apply.
Lifestyle Environmental Genetic and physiological factors
A registered nurse is teaching an economically challenged client about different healthcare plans. Which healthcare plan is the most expensive?
Long-term care insurance (LTC)
A client dies in the hospital 2 hours after being admitted. Who has the authority to decide if a post-mortem should be conducted?
Medical Examiner
A nursing student is recalling the definition of Nurse Practice Acts. What do the Nurse Practice Acts do?
Nurse Practice Acts describe and define the legal boundaries of nursing practice within each state.
Which nurse participates in the development of nursing policies and procedures?
Nurse educator
What is the nurse's responsibility with physicians' orders?
Nurses must follow physicians orders unless they believe the orders are in error or will harm the patient
According to the Institute of Medicine (IOM) competencies for the 21st century, what task should the nurse perform when using evidence-based practice?
Participate in research activities when possible
The ADA is a broad civil statute protecting rights of people w/ physical & mental disabilities & prohibits discrimination & ensures equal opportunity in?
State & local gov services, public accommodation, commercial facilities & transportation
A client with cancer is undergoing treatment in a hospital. The nurse finds the orders from the primary healthcare provider inappropriate. Clarification from the healthcare provider does not resolve the nurse's doubts. Who should the nurse contact and inform next?
Supervising nurse
A nursing student is evaluating statements regarding the five levels of proficiency set forth by Benner. Which statement indicates that a nurse is in the advanced beginner stage?
The nurse is able to identify the basic principles of nursing care through careful observation.
A person wanting an abortion has the right in the
1st trimester has right to abort (< than normal child birth)
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?
Call the nursing supervisor to discuss the situation
A nursing student notes that a nurse is required to integrate best current research with clinical expertise and client preferences and values in order to provide quality healthcare. Which Quality and Safety Education for Nurses (QSEN) competency does this comply with?
Research
Litigation resulting from improper restraint use is a common nursing legal issue. A nursing student is listing points related to the use of restraints. Which factor needs correction?
Restraints can be used anytime without a written order from the healthcare provider.
A registered nurse is educating a nursing student about the stages of changes in a client's health behavior. Which statement describes the stage of contemplation?
"The client considers a change within the next 6 months."
A nursing student lists the preventive and primary care services available in schools, primary healthcare provider's offices, occupational health clinics, community health centers, and nursing centers. Which service provided by these centers is most expensive?
Disease management
A nursing student is listing examples of active and passive health promotion strategies. Which strategy is an example of a passive health promotion strategy?
Fluoridation of municipal drinking water
A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching?
The application of force to another person without lawful justification
You are the night shift nurse & 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?
Discuss the issues that concern the family with them.
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?
Surgeon
What is the statutory law Nurses are required to know for the state they work in?
Nursing Practice Acts (NPA)
A registered nurse is teaching a nursing student about the standards of nursing practice. How would the nursing student define assessment?
Assessment is the process of collecting comprehensive data pertinent to the client's health and/or situation
What are the elements of discovery of a lawsuit? Select all that apply.
Experts Medical Records One more maybe witness
What services do community health centers provide in preventive and primary care services? Select all that apply.
Health screenings Physical assessments Disease management
A nursing student is recalling information about hospice care. What is hospice care?
Hospice care is a system of family-centered care that allows clients to remain at home in comfort while easing the pains of terminal illness.
What is the professional nurse's legal responsibility regarding child abuse?
Report any suspected abuse to local law enforcement authorities.
A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs is called:
Risk management
What does a nurse understand by the quality improvement competency, according to Quality and Safety Education (QSEN)?
Using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems
A nursing student is examining the health services pyramid. Keeping in mind that care services begin at the bottom of this pyramid, in which order should care services be arranged?
1. Population-based health care services 2. Clinical preventive services 3. Primary health care 4. Secondary health care 5. Tertiary health care
Marking of the operative site with indelible ink to mark left and right distinction, multiple structures (fingers), and levels of the spine is
2 of 2 guiding principles as protocol for procedures to reduce errors set by the TJC
A nurse notes that the HC unit keeps a listing of the patient names at the front desk in easy view for HC providers to more efficiently locate the patient; this action is a violation of which act
Health Insurance Portability and Accountability Act (HIPAA)
Briefly explain the process that a nurse needs to follow when a staffing assignment is unreasonable
Inform supervisor and make written protest to nursing administrators (Keep a copy)
A client is placed on a stretcher and restrained with straps while being transported to the x-ray department. A strap breaks, and the client falls to the floor, sustaining a fractured arm. Later the client shows the strap to the nurse manager, stating, "See, the strap is worn just at the spot where it snapped." What is the nurse's accountability regarding this incident?
Liable, along with the employer, for misapplication of equipment or use of defective equipment that harms the client.
An octogenarian client asks the nurse about the United States' government-funded national health insurance program. About which healthcare plan should the nurse inform the client?
Medicare
A student has learned to administer intramuscular medications in class, the student now working as a nurse's aide can they perform this task
NO, they may not perform this task
A confused patient who fell out of bed because side rails were not used is an example of which type of liability?
Negligence because nurse could have prevented; It is conduct that falls below the standard of care
A nursing student is listing the different aspects of the healthcare services pyramid. Under which type of healthcare services should the nursing student include family planning?
Primary care
A nurse stops to help in an emergency accident scene; injured party files a suit, & the nurse's employing institution insurance does not cover the nurse; What would probably cover the nurse in this situation?
The Good Samaritan laws, which grant immunity from suit if there is no gross negligence.
A client with end-stage renal disease needs a kidney transplant. Which statements regarding the National Organ Transplant Act are true? Select all that apply.
The National Organ Transplant Act of 1984 prohibits the purchase or sale of organs. The act provides civil and criminal immunity to the hospital and the healthcare provider. The act protects the donor's estate from liability for injuries or damage that results from the use of the gift.
What should a nurse understand regarding the Uniform Anatomical Gift Act?
The Uniform Anatomical Gift Act gives individuals who have reached 18 years of age the right to make an organ donation
What does the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 state?
The act states that the hospital should not discharge or transfer a client if an emergency condition exists.
An occurrence report is confidential and separate from
a patients the medical record
To inform provider properly a nurse should
perform a competent nursing assessment that determine significant signs & symptoms to help the provider diagnosis & treat
When students work as nursing assistants or nurse's aides when not attending classes, they should not...
perform tasks that do not appear in a job description for a nurse's aide or assistant
If you carry out inaccurate or inappropriate order legally you are
responsible for patient suffering because the nurse is obligated to keep the HC provider informed of patient condition
A "time out" just before starting a surgical procedure for final verification of the correct patient, procedure, site, and any implants is
the 3rd guiding principle to reduce errors as a protocol set by the TJC
A child of divorced parents being treated at the hospital consent has to be signed by
the parent with legal custody
When nurse provides consent form to patient they have to ask if
the patient understands the procedure they are consenting to
Patient's informed consent does not fall within the nursing duty, it is responsibility of
the person performing the procedure
It is important to note that nursing students cannot and should not be responsible for or asked to
witness consent forms because of the legal nature of the document
A homeless man enters the ER seeking health care; The HC 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?
Emergency Medical Treatment and Active Labor Act (EMTALA)
A pharmacy technician arrives on the nursing unit to deliver opioids and, following hospital protocol, asks the nurse to receive the medications. The nurse is assisting a confused and unsteady client back to the client's room. How should the nurse respond to the technician?
"I can't receive them right now. Please wait a few minutes or come back."
A registered nurse is explaining the term "just culture" to the student nurse. Which explanation provided by the registered nurse is accurate?
"It refers to promoting open discussion whenever error occurs without fear of recrimination."
The professional obligation of a nurse to assume responsibility for actions is referred to as what?
Accountability
A preoperative verification that ensures all relevant documents and studies are available before the start of the procedure and are consistent with the patient's expectations is
1 of 3 guiding principles as protocol for procedures to reduce errors set by the joint commission (TJC)
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?
A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state
A woman has severe life-threatening injuries; HC provider ordered 2 units of blood to treat anemia; husband refuses to allow the nurse to give his wife the blood; What is the nurse's responsibility?
Abide by the husband's wishes and inform the health care provider
In a situation in which there is insufficient staff to implement competent care, a nurse should
Accept the assignment but make a protest in writing to the administration
A client tells the nurse, "I keep reverting to my old habit of drinking soda, although I have stopped drinking as much." What stage of health behavior change has the client reached?
Action stage
A nursing student is listing the professional responsibilities and roles of the nurse. Who is the most independently functioning nurse?
Advanced practice registered nurse
A nurse is caring for a client with renal failure. The client wants to go back home but the family members want the client to undergo a kidney transplant. The nurse gives details about the possible threats and benefits of the surgery to the family and informs them that the client wants to stay home. What role does the nurse play here?
Advocate
What are the instances when an adult can give consent for medical treatment? Select all that apply.
Any guardian for the adult's ward Any parent for the adult's unemancipated minor A brother or sister of an adult's minor brother or sister
The nurse should understand the effects of internal and external variables to plan and deliver individualized care. Which variable is an internal variable?
Emotional Factors
A nurse is caring for a client with pain after surgery. The nurse takes the blood pressure and pulse rate of the client and asks the client to rate the level of pain on the pain scale. The nurse then notifies the primary healthcare provider. Which standard of practice does the nurse perform?
Assessment
A primary healthcare provider notes that all conventional treatment procedures have proved to be ineffective in managing a client's disorder. The primary healthcare provider decides to try an experimental treatment. The nurse ensures that the client has understood the implications of the new treatment plan thoroughly and then signs the client's consent form as a witness. Which basic healthcare ethic does the nurse follow in this situation?
Autonomy
A nurse notices bruising on a 2-year-old patient's head, arms, abdomen, & legs; Mother describes the patient's frequent falls; What is the best nursing action for the nurse to take?
Contact a child abuse hotline.
Which role does a nurse play when helping clients to identify and clarify health problems and to choose appropriate courses of action to solve those problems?
Counselor
After your assessment and notifying the HC provider a nurse should always...
Document that you notified provider, their response, your follow up and patient response
If a patient states they do not understand the procedure they are consenting to the nurse should
Notify healthcare provider or nursing supervisor
What necessary information should the nurse remember regarding assisted suicide, according to American Nurses Association (ANA) (2008)?
Nurses' participation in assisted suicide may violate the code of ethics.
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?
P&P of facility employed at; NPA for state; regulation in TJC manual;& ANA standards of nursing practice
A nurse is sued for failure to monitor a patient appropriately after a procedure; Which of the following statements are correct about this lawsuit
Person filing has burden of proof; has to prove that a breach in standard of care has caused the injury
The nurse should understand the effects of internal and external variables to plan and deliver individualized care. Which variable is an example of an external variable?
Socioeconomic factors
Which act protects a person who is HIV positive?
The Americans with Disabilities Act (ADA)
What legal complications might a nurse face for using a restraint without a legal warrant on a client?
The nurse may be charged with false imprisonment.
According to Quality and Safety Education (QSEN), what is patient-centered care?
Understanding that the client is the source of control when providing care
When should a medical examiner decide whether a postmortem examination should be conducted?
When a client dies within 24 hours of admission to the hospital
A nurse is obtaining consent from an unemancipated minor to perform an abortion. When would the nurse consider the consent-giving process to be appropriately completed? Select all that apply.
When consent has been given specifically by a court. When self- consent has been granted by a court order. When consent has been obtained from at least one parent of the minor.
A person's agreement to allow something to happen such as surgery or an invasive diagnostic procedure, based on a full disclosure of risks, benefits, alternatives, and consequences of refusal is called
an informed consent
Confidential document that describes any patient accident while the person is on the premises of a health care agency is called
an occurrence (incident) report
Provides data investigation in an attempt to determine deviations from standards of care; corrective measures are needed to prevent recurrence & alert risk mgnt to potential claim situation is the purpose of
an occurrence (incident) report
Taking or selling controlled substances & Applying physical restraints without a written physician's order are violations that result in?
both criminal and administrative law sanctions against the nurse
Informed consent creates a legal duty for the health care provider to
disclose material facts in terms the patient is able to understand to make an informed choice
If HC provider confirms their orders and you believe it is still inappropriate you should
inform supervising nurse or follow chain of command
Identify what the nurse's responsibility is when he or she "floats" to another nursing unit
inform their supervisor of any lack of experience in caring for the type of patients on the unit & request an orientation to the unit
If nurses have to accept unreasonable assignments, they need to
make written protests to nursing administrators and keep a copy
Failure to use skill or learning that would be used under same or similar circumstances by members of the nursing profession defines
malpractice
The 2nd trimester a person can have abortion but the state protects
maternal health & enforces regulation on the procedure and facility