NUR 115

A nurse has been asked to serve as an expert witness in a malpractice case in which an infant died in the newborn nursery. Which questions should the nurse consider prior to accepting this job? Select all that apply.

"How much clinical experience do I have in the newborn nursery?" "How much education do I have about caring for newborns?" Explanation: The nurse who works on a case as an expert witness should have a solid education background and strong clinical experience comparable with those of the nurse defendant. Whether the nurse has worked in the hospital system, how the nurse would react if sued, and how the nurse would feel in similar situations should not be considerations as an expert witness.

A nurse has been named in a malpractice lawsuit. Prior to taking the nurse's deposition, the attorney explains that the case will be governed by common law. Which question by the nurse is indicated?

"Will this case be precedent setting?" Explanation: Most law involving malpractice is common law. If a case is the first to set down a rule by its decision, a precedent will be set. Statutory law, such as state nurse practice acts, is enacted by the legislature. The findings of the case are binding in a common law case. The law establishing a board of health is known as administrative law.

The health care provider prescribes cold therapy every 4 hours for a client after foot surgery. The nurse places the ice pack directly on the client's skin and returns 60 minutes later. After removal of the ice pack, the skin is pale and cold to the touch. The client develops frostbite and begins a lawsuit for malpractice. When reviewing the case, the nurse attorney recognizes which most important statement about the malpractice suit?

All elements are in place to hold the nurse liable. Explanation: All four elements are met: The nurse had a duty. The duty was breached. It is easy to find causation (an ice pack directly on skin for 60 minutes), and harm (development of frostbite) was done. The client is not responsible since the lack of sensation may have occurred early and it was the nurse's responsibility to ensure safety.

The nurse recognizes that liability requires specific elements that must be established to prove that malpractice or negligence has occurred. Identify the specific elements. Select all that apply.

Causation Damages Duty Breach of duty Explanation: Elements of liability are duty, breach of duty, causation, and damages. Breach of confidentiality is a type of invasion of privacy and a violation of HIPAA.

A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify?

Directive leadership Explanation: Directive (also known as autocratic or authoritarian) leadership describes a leader who makes all the decisions and tells followers what to do. Democratic, or participative, leadership style and shared governance involve sharing the decision-making process and activities with others who have an interest. Institutional governance is governance by the institution.

A nurse is leaving a primary health care system to practice in a tertiary health care system. Which area of nursing would the nurse most likely be entering in this new job?

Hospice care nursing Explanation: The U.S. Department of Health and Human Services Division of Nursing has analyzed current nursing practice and education in relation to population health care needs. Levels of health care are categorized as primary, secondary, and tertiary. Most current resources, services, nursing practice, and nursing education exist within the category of secondary health care: emergency care, acute and critical care (including community clinic nursing), diagnosis, and treatment. The population's needs, however, fall mostly within the categories of primary health care (health promotion, education, protection, and screening) and tertiary health care (rehabilitation, long-term care, support services, and hospice care).

The nurse attorney provides an educational session to the nursing staff on acts of negligence. Which responses by the staff would indicate to the attorney that the staff can accurately identify acts of negligence? Select all that apply.

"I can be charged with negligence if I apply a heating pad to the client's skin and the client suffers a superficial or first-degree burn." "I can be charged with negligence if I notify the health care practitioner about a change in a client's status but do not follow up or document. Explanation: Negligence occurs when a nurse fails to provide care that another nurse with the same educational background would perform. Applying heat and burning the client's skin is not an act another prudent nurse would do. The nurse must act as the client's advocate by following up and documenting when a health care provider does not respond to a change in the client's condition. When a nurse follows correct policies for administering medications, follows the standards of care, and uses equipment in the correct manner, this eliminates the risk of practicing in a negligent manner.

Which statement(s) by a nurse to a charge nurse indicates that the nurse requires further training? Select all that apply.

"When I sign the consent form as a witness, I am saying that the person knows all the risks and benefits of the procedure." "I must make sure I give the client all necessary information about the procedure before I have the client sign the consent form." "When a client is having surgery, it is my responsibility to get the consent." Explanation: The person performing the procedure is responsible for providing all information about the procedure and obtaining informed consent. If the client has questions about the consent, the nurse may answer them. The nurse's signature indicates that the consent was signed and the nurse witnessed the client's signature. If there is an immediate threat to life or health, consent is not needed.

Nurses may commit both intentional and unintentional torts when practicing within the profession. What intentional torts may occur in nursing practice? Select all that apply.

A nurse threatens to hit an older client who has dementia and is screaming. A nurse seeks employment in a hospital after falsifying credentials on a resume. A nurse places a client who is a fall risk in restraints without an order from the health care provider. A nurse makes disparaging remarks to the staff about a client who has a sexually transmitted infection (STI). Explanation: Torts may be intentional or unintentional acts of wrongdoing. Some of the intentional torts for which nurses may be held liable include assault and battery. Examples of intentional torts would include a nurse threatening to hit an older client who has dementia and who is wailing; a nurse seeking employment in a hospital after falsifying credentials on a resume; a nurse placing a client who is a fall risk in restraints without the proper order; a nurse making disparaging remarks to the staff about a client who has a sexually transmitted infection. A nurse forgetting to put the side rail up on a crib would be an example of an unintentional tort, as would a nurse not reporting a change in client condition in a timely manner.

The nurse manager is using voluntary standards as a guideline for developing policies on the unit. What voluntary standards are available for the nurse to use? Select all that apply.

American Nurses Association Standards of Practice Professional standards for certification of individual nurses in general practice Process of certification Explanation: Voluntary standards in nursing would include the American Nurses Association (ANA) Standards of Practice, the process of certification, and professional standards for certification of individual nurses in general practice. State nurse practice acts are not an example of voluntary standards in nursing. Rules and regulations of nursing are not examples of voluntary standards in nursing.

Which are torts rather than crimes? Select all that apply.

Assault Defamation of character Negligence Explanation: Torts are intentional or unintentional acts of wrongdoing. Some of the intentional torts for which nurses may be held liable include assault and battery, defamation of character, negligence, invasion of privacy, false imprisonment, and fraud. Manslaughter and robbery are crimes.

A nurse threatens to restrain a verbally abusive client if the abuse continues. Which legal tort has the nurse committed?

Assault Explanation: Assault is threatening to touch a person, such as by applying restraints, without consent. Sharing a client's confidential information without consent is an invasion of privacy. When a person performs an act that a reasonable person would not do under the same circumstance, it is negligence. Defamation of character occurs when one makes statements that damage another person's reputation.

Which services are within the scope of practice of a hospital-based social worker? Select all that apply.

Assisting clients and families in dealing with the social, emotional, and environmental factors that affect their well-being Making referrals to appropriate community resources Providing assistance with securing medical devices and supplies Assisting with discharge planning Explanation: Hospital-based social workers generally do not provide direct, in-hospital psychological counseling. All other services indicated are within the scope of practice of a hospital-based social worker.

An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor?

Battery Explanation: The UAP is engaging in battery, which is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to (or held by) that other person. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that harm the other party's reputation.

The nurse is working at a facility that is applying for Magnet® Recognition. The nurse knows that compared with other hospitals, Magnet® hospitals have which direct effect on client care?

Better patient outcomes Explanation: Magnet® hospitals have better patient outcomes than facilities without the recognition. Magnet® hospitals have higher nurse retention and job satisfaction scores, but these do not have a direct effect on client care. Magnet® hospitals have shorter, not longer, patient stays.

A client has been in the emergency department for 3 hours for treatment of a migraine headache. Care has been delayed due to a multiple fatality car accident. The client gets up to go to the bathroom unattended, faints, and suffers a subdural hematoma. The family threatens to sue for malpractice. Which element of malpractice will be the most difficult for the attorney to prove?

Causation Explanation: Typically, causation is the most difficult component of malpractice to prove. Causation asks the question, "Did the nurse's actions directly cause the damages?" Duty is typically outlined in standards of care, breach of duty can be proved by documentation of the visit, and damages are clearly evident.

A client has asked that a nurse witness the signing of the client's will. What should the nurse do prior to witnessing this signature? Select all that apply.

Check to see whether state laws allow the nurse to witness this signature. Assess the client's state of mind. Review the client's medical record. Talk to the client about why the client is signing the will now. Explanation: Rules regulating wills vary from state to state. The nurse should be sure that the client is of sound mind and not under the influence of mind-altering drugs. There is no requirement that beneficiaries leave the room. The nurse should know why the client is signing the will now to assess for possible coercion.

The growth in home health care is largely attributed to which factor?

Early discharge of clients from the hospital setting Explanation: Home health care is one of the most rapidly growing areas of the health care system. The prospective payment system of reimbursement encourages early discharge from the hospital and has created a new, acutely ill population that needs skilled nursing care at home. Though some nurses may desire to work in the community and hospitals may have a shortage of nurses, these are not the primary factor related to the increase in home health care. It is not that hospitals cannot care for an increasing number of clients so much as it is that they will not be reimbursed by payers for costs associated with longer client stays; thus, they are motivated to discharge clients earlier even though clients are often not yet ready to provide all of their own needed care, leading to the need for and prevalence of home health care.

A nurse has applied soft wrist restraints to a client following endotracheal intubation. Documentation of which information is essential when using restraints on a client? Select all that apply.

Findings from patient assessment, performed every 2 hours Foley catheter draining clear yellow urine 0.9 normal saline infusing intravenously at 100 mL/hr Explanation: When restraints are applied, charting must indicate regular client assessment findings; provision or administration of fluids and nutrition; bowel and bladder elimination; and attempts to release the client from the restraints for a trial period. Additional order completion and presence of family in the room are not required documentation for client restraint.

A nurse is reviewing the different types of health care delivery services available in the community. Which method would the nurse identify as having the primary care goal of reducing costs by preventing illness?

Health maintenance organization (HMO) Explanation: Health maintenance organizations (HMOs) are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. Their primary care goal is to reduce costs by preventing illness. Preferred provider organizations provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. Accountable care organizations offer incentives to provide integrated, well-coordinated care. Community health centers ensure that everyone who needs care has access regardless of the ability to pay.

A nurse is providing care to an older adult client. The client has been alert and independent with ambulation but now is exhibiting some confusion along with being unsteady when getting out of bed and walking. The nurse fails to report and document this change in status. No safety measures are taken and the client falls while getting out of bed to use the bathroom and fractures a hip. The client is experiencing significant pain from the fractured hip and requires surgery to repair the fracture. The nurse is sued for malpractice. Which action reflects the element of causation in this case?

Lack of safety measures implemented with status change Explanation: Causation is reflected by the nurse's failure to implement appropriate safety measures due to the change in the client's status. This failure causes the client to fall while attempting to get out of bed, resulting in a fractured hip. Duty is reflected by the responsibility of nurses to accurately assess clients, report changes in status, and implement measures to address changes in status. Breach of duty is reflected by (a) the failure to note and report that an older adult client previously assessed as alert and independent in ambulation is now exhibiting periods of confusion and unsteadiness when walking; and (b) by failure to execute and document use of appropriate safety measures (e.g., assisted ambulation). Damages are reflected in the result—that is, the fractured hip, pain, and need for surgery.

A nurse suspects that a client is a prostitute. The nurse documents this suspicion in the medical record and includes it in report to the oncoming shift. The nurse also mentions the suspicion to the nurse's sister saying, "I had a client named Susan in room 126 today who I think is a prostitute." Which violations has this nurse committed? Select all that apply.

Libel HIPAA Slander Explanation: Slander is the spoken defamation of character (e.g., including in the change-of-shift report); libel is written defamation (e.g., including in the client record). HIPAA rules are violated when a client's personal information is disclosed (e.g., informing one's sister). The use of the client's room number and name make the client's presence in the facility discoverable. The nurse did not threaten the client (assault) or physically touch the client (battery).

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?

Medicare Explanation: The federal government implemented a system of prospective payment in 1983 for people enrolled in Medicare. A prospective payment system uses financial incentives to decrease total health care charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group, which is a classification system used to group clients with similar diagnoses. Medicaid provides health care through funds obtained from federal, state, and local sources. In capitation strategy, a preset fee per member is paid to a health care provider, regardless of whether the member requires services. AmeriCare provides health care services

A new graduate wants to be knowledgeable about state-mandated rules to better practice within the scope of nursing. What are the best resources for this nurse to research? Select all that apply.

Nurse practice acts Nursing educational requirements Composition and disciplinary authority of board of nursing Explanation: Examples of state-mandated rules would include nurse practice acts, nursing educational requirements, and composition and disciplinary authority of boards of nursing. Delegation trees, medication administration, and Medicare and Medicaid provision for reimbursement of nursing services are not examples of state-mandated rules.

A nurse is part of a group named in a malpractice lawsuit. The plaintiff is suing for general damages. Which items would be addressed? Select all that apply.

Pain Suffering Disfigurement Disability Explanation: For a plaintiff to prevail in a malpractice suit, the plaintiff must have sustained damages. The purpose of the suit is to compensate for these damages. General damages include pain and suffering, disfigurement, and disability. Special damages are for losses and expenses related to the injury, such as medical expenses and lost wages.

A nurse is discharging a client who was admitted for observation following a motor vehicle accident. The client is a single parent who is living in a new community. What service would be an appropriate referral for this client?

Parish nursing Explanation: Parish nursing is an expanding area of specialty nursing practice that emphasizes holistic health care, health promotion, and disease prevention activities. It combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Hospice care is appropriate for an individual with an advanced chronic illness who has a life expectancy of 6 months or less. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older clients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. A medical home is an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated client-centered care.

An occupational nurse is working with patients at a construction site. According to Maslow's Hierarchy of Needs, what dimension of care should the nurse make the highest priority in working with these clients?

Physiologic Explanation: Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy is a useful framework that can be applied to the various nursing models for assessment of a client's strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for clients at a worksite.

The state government has decided to decrease funding for the Medicaid program. Which component of care will this most impact?

Political and economic considerations Explanation: Medicaid cuts by the state government will influence the political, economic, and social realities of the profession.

What nursing function would be most commonly found in an ambulatory care facility?

Providing direct client care Explanation: Ambulatory care centers and clinics (agencies that deliver outpatient medical care) may be located in hospitals, may be a freestanding service provided by a group of health care providers who work together, or may be managed by an advanced practice registered nurse. Although a nurse may serve as an administrator or manager in such a facility, the nursing function most commonly found in this setting is providing direct client care. Educating individuals or groups would be a nursing function more commonly found in a primary care facility. Assessing the home environment would be a nursing function more commonly found in home health care.

A client has been having yearly Pap smears and yearly mammograms for more than 10 years. According to Lewin, this client is in which stage of the change process related to having annual Pap smears and mammograms?

Refreezing Explanation: Refreezing is the long-term solidification of the new pattern of behavior. Unfreezing is the recognition of the need for a change. Moving is initiating the change. Prizing and choosing are not stages in the change process.

A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care?

Relief from physical, mental, and spiritual distress Explanation: The chief focus of palliative care is relief or management from physical, mental, and spiritual distress. The goal of palliative care is to prevent and relieve suffering by early assessment and treatment of pain and other physical problems (such as difficulty breathing, nausea, fatigue, and problems with sleeping). Like hospice care, palliative care is provided by an interdisciplinary team. Physical rehabilitation and occupational therapy would be the goal of home care, moving the client from the functional level at discharge from the hospital to a higher level of functioning, closer to the level prior to the hospitalization. Provision of a dignified death experience would be the goal of hospice.

A nurse is preparing a presentation for a group of staff nurses about the rules affecting nursing practice and the parties involved. When describing the role of different sources for the rules, which issue would the nurse identify as being addressed specifically by state legislation? Select all that apply.

Scope of practice Educational requirements of nurses Explanation: State legislation is involved with issues such as scope of practice and educational requirements for nursing. Position statements related to medication administration and unprofessional conduct are issues addressed by the Board of Nursing. Clinical procedures are associated with rules established by the specific health care institution.

Nurse practice acts are examples of which type of laws?

Statutory laws Explanation: Nurse practice acts are statutory laws. Statutory laws must be in keeping with both the federal constitution and the state constitution. Constitutional law refers to rights carved out in the federal and state constitutions. The majority of this body of law has developed from state and federal supreme court rulings, which interpret their respective constitutions and ensure that the laws passed by the legislature do not violate constitutional limits. Administrative law is the body of law that governs the activities of administrative agencies of government. Common law is the body of English law as adopted and modified separately by the different states of the U.S. and by the federal government and is in contrast with statutory law.

A local college is having a career-day seminar for student nurses. Booths from various agencies and facilities have been set up. One of the students approaches the booth of a home care agency and asks the nurse there about what is required to become a home care nurse. Which of the following would the nurse incorporate into the response?

Strong clinical decision-making skills Explanation: A nurse working in home care needs advanced knowledge and skills in general nursing practice with an emphasis on community health and acute medical-surgical nursing. The home care nurse also needs high-level assessment, critical thinking, and decision-making skills in a setting where other health care professionals are not available to validate observations, conclusions, and decisions. Home care nurses provide "high-tech, high-touch" care to people with acute health care needs. A master's degree is not necessary. Clinical nurse specialists practice within a specific or specialized area of care and are ideal case managers, because they have the educational background and clinical expertise to organize and coordinate services and resources to meet patients' health care needs cost-effectively and efficiently.

A client is being prepared for an elective surgical procedure and the consent form has not been signed. Who should the nurse have obtain consent for the procedure?

The health care provider performing the surgical procedure Explanation: The nurse should inform the surgeon the consent has not been signed. Obtaining informed consent is the responsibility of the person who will be performing the diagnostic or treatment procedure or the research study. In this particular case, the surgeon, the client, and a witness, all need to sign the consent form. The nurse's roles are to confirm that a signed consent form is present in the client's chart and to answer any client questions about the consent.

The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the baby while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the baby again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing?

The new mother attempts to breastfeed the baby again using the new techniques and is successful. Explanation: Refreezing involves making a change operational, or a part of one's everyday life. The mother feeding the baby using new techniques is an example of refreezing. The nurse recognizing that a new mother is having difficulty breastfeeding is an example of unfreezing, in which the need for a change is recognized. The nurse educating the mother on ways to ensure proper latching and demonstrating various positions in which to hold the baby while feeding are examples of moving, in which change is initiated after a careful process of planning.

A nurse enters a client's room and finds that the client is lying on the floor. The nurse makes the client comfortable on the bed and completes an examination. She informs the physician and the nursing supervisor about this incident and also completes an incident report. Which action by the nurse indicates correct knowledge of handling an incident report?

The nurse documents a complete description of the happenings in the client's records. Explanation: An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. It is kept separate from the medical record. The incident report is a legal document and making a copy of it is not advisable. It should not be placed in the client's records; however, the nurse can mention the incident in the client's records without mentioning the incident report.

A nurse is writing a letter to a U.S. congressman to support the promotion of health care issues. Which guidelines would ensure a properly written letter? Select all that apply.

The nurse should state the purpose of the letter briefly and clearly in the first paragraph. The nurse should name the city and state where the nurse lives and votes. The nurse should restate exactly what the legislator should do at the end of the letter. Explanation: Writing a letter to a U.S. congressman should be in the format of a formal letter, stating the nurse's concerns in a way that best relays this information. The formal letter should state the purpose of the letter briefly and clearly in the first paragraph, state the city and state where the nurse lives and votes, and restate exactly what the legislator should do at the end of the letter. The nurse should cite specific examples from the workplace to support the position. The letter should be kept to one page. The letter should be addressed to one legislator only, not a group of individuals.

The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task?

The stability of the patient's condition, potential for harm, and complexity of the activity Explanation: RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activity), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs.

An inner-city hospital is seeing a declining client census. The nurse managers begin to strategically plan to determine ways to increase their client population. In the implementation of these strategies, they also evaluate their success and failure and renew their plan. This activity is:

problem solving. Explanation: Management involves getting a job done or accomplishing a goal. The process they use is similar to the problem-solving process, which is based on the scientific or research method. The nurses are not making directive initiatives. Although this work is a continuing process, this description is too vague. Nurses cannot control patient outcomes; they can only hope to improve them by making changes that may or may not work.

What is one of the most significant trends in health care today?

shift from hospitals to community-based care Explanation: The shift to community-based care is related to the public's desire to participate more actively in health care decisions, issues, and choices.