NURS: Ch 7 NCLEX
During the orientation to the hospital, the staff development educator discusses unit and institutional-based policies. What is the source of the practice rules that result in unit and institutional-based policies? a) Healthcare institution b) Federal legislation c) State legislation d) Board of nursing
a) Healthcare institution The healthcare institution determines the unit and institutional policies. These policies may vary from institution to institution. Such policies may include clinical procedures, policies specific to the institution, and personnel and employment policies.
If you wanted to find a list of the violations that can result in disciplinary actions against a nurse, you should read which of the following? a) Nurse Practice Act b) Code of Ethics for Nurses c) Nurses' Bill of Rights d) American Journal of Nursing
a) Nurse Practice Act Each stated has a Nurse Practice Act that protects the public by broadly defining the legal scope of nursing practice. Practicing beyond those limits makes you vulnerable to charges of violating the state Nurse Practice Act. Nurse Practice Acts list the violations that can result in disciplinary actions against a nurse and also serve to exclude untrained or unlicensed people from practicing nursing.
Nurse Practice Acts are examples of which type of laws? a) statutory laws b) common law c) constitutional laws d) administrative laws
a) statutory laws Nurse Practice Acts are statutory laws. Statutory laws must be in keeping with both the federal constitution and the state constitution.
Which of the following clinical events constitute areas of potential liability for the nurses involved? Select all that apply. a) An elderly patient develops skin breakdown on his coccyx because he was turned infrequently. b) A patient with no known cardiac history suffers an unwitnessed cardiac arrest and dies. c) An anemic patient experiences a febrile reaction to a transfusion of packed red blood cells. d) A patient experiences a seizure after a missed dose of his scheduled anticonvulsant. e) A confused patient experiences a fall because her bedrails were left in a lowered position.
a) An elderly patient develops skin breakdown on his coccyx because he was turned infrequently. d) A patient experiences a seizure after a missed dose of his scheduled anticonvulsant. e) A confused patient experiences a fall because her bedrails were left in a lowered position. Liability exists when the elements of duty, breach of duty, causation, and damages exist. Failure to turn an immobile patient, missing a dose of medication, and leaving a vulnerable patient's bedrails lowered all constitute breaches of nurses' duties that result in damages. Not every untoward event is evidence of liability; however, febrile blood reactions or unexpected cardiac arrests may occur without any inappropriate causation by care providers.
During a clinical placement on a subacute, geriatric medicine unit, a student nurse fed a stroke patient some beef broth despite the fact that the patient's diet was restricted to thickened fluids. As a result, the patient aspirated and developed pneumonia. Which of the following statements underlies the student's potential liability in this situation? a) The same standards of care that apply to a registered nurse apply to the student. b) The patient's primary nurse is liable for failing to ensure that delegated care was appropriate. c) The student and the nursing instructor share liability for this lapse in care. d) The student's potential liability is likely negated by the insurance carried by the school of nursing.
a) The same standards of care that apply to a registered nurse apply to the student. Despite the fact that their knowledge and skills are still under development, nursing students are held to the same standards of care as registered nurses. Consequently, primary liability does not lie with the student's instructor or the patient's primary nurse. Insurance may be carried by the school of nursing, but this does not negate the student's legal responsibility to provide care at a high standard.
A nurse exits the room of a confused patient without raising the side rails on the bed. The failure to raise the side rails would be which of the following elements of liability related to malpractice? a) breach of duty b) damages c) causation d) duty
a) breach of duty Breach of duty is failing to meet the standard of care, and in this case, it was the failure to execute and document the use of appropriate safety measures. Causation is the failure to use appropriate safety measures that results in injury to the patient. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-patient relationship. Damages are the actual harm or injury resulting to the patient.
A malpractice case involving an incident in the operating room has entered litigation. A scrub nurse has been asked to present her firsthand knowledge of the incident based upon recollection of the incident and documentation in the patient record. The nurse's role in this malpractice case is: a) nurse as a fact witness. b) nurse as the plaintiff. c) nurse as the defendant. d) nurse as an expert witness.
a) nurse as a fact witness. The nurse will act as a fact witness. Fact witnesses, who are placed under oath, must base their testimony on only firsthand knowledge of the incident and not on assumptions. The nurse will be asked if the testimony is based on independent recollection of the incident or on documentation in the patient's record. The nurse as defendant will work closely with an attorney while preparing the defense. The nurse as an expert witness will explain to the judge and jury what happened based upon the patient's record and offer an opinion about whether the nursing care met acceptable standards.
A patient states that his recent fall was caused by the fact that his scheduled antihypertensives were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the patient. Which of the following measure should the nurses prioritize when anticipating that legal action may follow? a) Enlist support from nursing and nonnursing colleagues from the unit. b) Document the patient's claims and the events surrounding the alleged incident. c) Consult with practice advisors from the state board of nursing. d) Liaise with the hospital's legal department as soon as possible.
b) Document the patient's claims and the events surrounding the alleged incident. It is imperative for nurses to carefully and accurately document assessment findings and the nursing care that they provide, a fact that is especially salient when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.
After reporting to work for a night shift, Nurse L. learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute patients in addition to his or her regular patient assignment. Which of the following statements is true of Nurse L. when working in understaffed circumstances? a) Nurse L. must document that float staff, nurses on overtime, and part-time staff were contacted in an effort to fill the gaps in care. b) Nurse L. will be legally held to the same standards of care as when staffing levels are normal. c) Nurse L. is legally obliged to refuse to provide care when understaffing creates the potential for unsafe conditions. d) Understaffing constitutes an extenuating circumstance that creates a temporarily lower expectation for care for Nurse L.
b) Nurse L. will be legally held to the same standards of care as when staffing levels are normal. The claim of being overworked does not constitute a legal defense, and both the potential for liability and standards of care remain unchanged despite and increased patient assignment. While it is prudent to make all realistic attempts to fill the gaps in staffing, documenting these efforts does not change Nurse L.'s legal position. A nurse has the right to refuse an unsafe patient assignment but the nurse is not legally obliged to withhold care.
A friend tells you not to even think about carrying your own insurance because "you'll be a magnet for attorneys trying to make a buck." When you seek the advice of the American Nurses Association, you are likely to read which of the following reasons for purchasing a personal professional liability insurance policy? (1) Protection of the nurse's best interests (2) Limitations of employer's coverage (3) Care or advice given outside of work (4) Protection of the institution's best interests a) (1) b) (1) and (2) c) (1), (2), (3) d) All of the above
c) (1) Protection of the nurse's best interests (2) Limitations of employer's coverage (3) Care or advice given outside of work The ANA (1990) lists these for purchasing a personal professional liability insurance policy.
Which of the following clinical events is addressed by the provisions of the Health Insurance Portability and Accountability Act (HIPAA)? a) A patient with suicidal ideation is admitted for treatment despite being adamantly opposed to the admission. b) A patient develops a stage II pressure ulcer after several consecutive shifts where the hospital was short of safe staffing levels. c) A patient believes that the healthcare team is withholding information about her diagnosis and wishes to read her medical chart. d) A patient develops a nosocomial infection after sharing a room with another patient who had vancomycin-resistant enterococcus (VRE).
c) A patient believes that the healthcare team is withholding information about her diagnosis and wishes to read her medical chart. HIPAA defines a number of rights that patients possess within the domains of privacy and disclosure. Among these is the right that patients have to see and copy their health record. HIPAA does not address issues of possible negligence or unsafe care, such as the consequences of staffing shortages or lapses in infection control procedures. Patients who are deemed a genuine threat to themselves or to others may legally be admitted for care against their will.
A patient's morning blood work indicates a significant decline in his hemoglobin and hematocrit, prompting the primary care provider to order a blood transfusion. As a component of the informed consent process, the potential risks and benefits have been explained to the patient. How should the patient's comprehension of this information be determined? a) Supplement the spoken teaching with written materials. b) Ask the patient if he understands the risks and benefits of transfusion. c) Ask the patient to explain the risks and benefits in his own words. d) Provide an opportunity for the patient to ask any questions about the procedure.
c) Ask the patient to explain the risks and benefits in his own words. When determining a patient's comprehension of information, it is insufficient to simply ask if he or she understands. Rather, the patient should be asked to paraphrase or repeat the information that was provided. Supplementing teaching with written materials may enhance the patient's comprehension, but this does not determine whether or not the teaching was understood. Encouraging the patient to ask questions is an important aspect of teaching, but the absence of questions should not be construed as comprehension.
Which of the following aspects of nursing would be most likely defined by legislation at a state level? a) The process that nurses must follow when handling and administering medications. b) The criteria that patients must meet in order to qualify for Medicare or Medicaid. c) The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs). d) The criteria that a nurse must consider when delegating tasks to unlicensed care providers.
c) The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs). The scope of practice defines the parameters within which nurses provide care and is established by state legislation, most commonly in the form of a Nurse Practice Act. The criteria and due process for delegation in the clinical setting is addressed by a stated board of nursing. Qualification criteria for programs such as Medicare and Medicaid are established by federal legislation while the process for safe and appropriate medication administration is defined and monitored by a stated board of nursing.
Which process evaluates and recognizes educational programs as having met certain standards? a) licensure b) credentialing c) accreditation d) certification
c) accreditation Accreditation is the process by which an educational program is evaluated and recognized as having met certain standards. Credentialing refers to ways in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants the license to do so. 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.
A registered nurse enters a patient's room and observes the nursing assistant pushing a patient down on the bed. The patient starts crying and informs the nursing assistant that he needs to go to the bathroom. The nursing assistant holds the patient down and tells him he was just in the bathroom. The nurse observing this incident is aware that the nursing assistant's action is an example of which of the following? a) fraud b) defamation of character c) battery d) assault
c) battery The nursing assistant 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 diminishes the other party's reputation.
Having recently completed a specialty nursing program in neonatal care, a nurse is now preparing to leave her current position on a medical unit and begin providing care in the hospital's neonatal intensive care unit (NICU). The nurse has completed which of the following processes of credentialing? a) accreditation b) licensure c) certification d) validation
c) certification The process of certification involves the attainment and validation of specialized nursing knowledge and skills. Certification is often necessary in order to ensure that the nursing care that is provided in specialized and high-acuity settings is safe and appropriate. Accreditation is the process by which an educational program, rather than an individual nurse, identifies that standards are being met. The process of licensure involves the determination that a nurse meets minimum requirements to practice, but not necessarily the specialized knowledge that is necessary for some care settings.Validation is not a specific aspect of the process of credentialing.
The results of a patient's most recent computed tomography (CT) scan indicate that his renal tumor has most likely metastasized to his liver and lungs. The healthcare team has scheduled a family meeting in order to discuss these findings with the patient and his family. Because a vacant meeting room is unavailable at short notice, the family meeting will take place shortly in the patient's room, which is shared by two other patients. This may constitute a direct violation of which of the following? a) the hospital's policies and procedures b) the hospital's risk management program c) the Health Insurance Portability and Accountability Act (HIPAA) d) the state's Nurse Practice Act
c) the Health Insurance Portability and Accountability Act (HIPAA) HIPAA guarantees patients' rights to privacy, and discussion of this patient's health status in a venue where others may overhear the proceedings is likely a contravention of HIPAA. Nurse Practice Acts focus primarily on issues related to scope of practice and professional discipline rather than the ethics of privacy. The hospital's policies and procedures may not directly address invasion of privacy and a risk management program exists primarily to reduce malpractice claims rather than ensure privacy.
Which of the following parties is responsible for obtaining informed consent from a patient? a) the patient's family or significant other b) the patient's nurse c) the person performing the procedure, study, or treatment d) the nursing supervisor
c) the person performing the procedure, study, or treatment Obtaining informed consent is the responsibility of the person who will be performing the diagnostic or treatment procedure or the research study. The nurse's roles are to confirm that a signed consent form is present in the patient's chart and to answer any patient questions about the consent.
A fellow student asks you about your legal liability when you do your clinical practice. Which of the following are true? (1) Student nurses are responsible for their own acts of negligence if these result in patient injury. (2) Student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. (3) 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. (4) Nursing instructors may share a student's responsibility for damages in the event of patient injury if the instructor failed to provide reasonable and prudent clinical supervision. a) (1) and (3) b) (2) and (4) c) (1), (2), (3) d) All of the above
d) All of the answers are true.
If you harm a patient by administering a medication (wrong drug, wrong dose, etc.) ordered by a physician, which of the following is true? a) You are not responsible, since you were merely following the doctor's orders. b) Only you are responsible, since you actually administered the medication. c) Only the physician is responsible, since he or she actually ordered the drug. d) Both you and the physician are responsible for your respective actions.
d) Both you and the physician are responsible for your respective actions. Nurses are legally responsible for carrying out the orders of the physician in charge of a patient unless an order would lead a reasonable person to anticipate injury if it were carried out. If the nurse should have anticipated injury and did not, both the prescribing physician and the administering nurse are responsible for the harms to which they contributed.
Injuries related to lifting or transferring patients occur in the healthcare setting and may be considered a work-related injury. Which law was intended to reduce work-related injuries and illnesses? a) The Health Care Quality Improvement Act of 1986 b) Americans with Disabilities Act of 1990 c) Title VII of the Civil Rights Act of 1964 d) The Occupational Safety and Health Act of 1970
d) The Occupational Safety and Health Act of 1970 The Occupational Safety and Health Act of 1970 set legal standards in the United States in an effort to ensure safe and healthful working conditions for men and women. The Health Care Quality Improvement Act of 1986 was enacted to encourage healthcare practitioners to identify and discipline practitioners who engage in unprofessional conduct and to restrict the ability of incompetent practitioners to move from state to state without disclosure of the practitioner's previous performance. Title VII of the Civil Rights Act of 1964 protects employees from discrimination. The Americans with Disabilities Act of 1990 prohibits discrimination against disabled people and requires covered entities to reasonably accommodate individuals who are protected by the Act.
A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license? a) The National League for Nursing b) The Supreme Court c) The employing healthcare institution d) The State Board of Nurse Examiners
d) The State Board of Nurse Examiners The State Board of Nurse Examiners in the United States may revoke or suspend a nurse's license or registration for drug or alcohol abuse, which is the most common reason.
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which of the following guidelines is true regarding a nurse's role is witnessing a testator's signature? a) Witnesses do not need to observe the signing of the will and can sign it at a later time. b) A beneficiary to a will is allowed to act as a witness. c) A single witness is sufficient for a will. d) Witnesses to a signature do not need to read the will.
d) Witnesses to a signature do not need to read the will. Witnesses to the signature on a will do not need to read it, but they should be sure the document being signed is a will and not some other document. Witnesses should watch the testator sign the will, and they should sign in the presence of each other. A beneficiary to a will is not allowed to act as a witness in most states. Two or three witnesses are most commonly required on a will.
When a state attorney decides to charge a nurse with manslaughter for allegedly administering a lethal medication order, this is an example of what type of law? a) public law b) private law c) civil law d) criminal law
d) criminal law Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs.
During the admission assessment of 40-year-old female patient with a suspected mandibular fracture, the patient discloses to the nurse that her injury came as a result of her husband hitting her. Which of the following actions should the nurse prioritize when responding to this disclosure? a) Informing the patient of her right to keep this information private b) performing an assessment to confirm the patient's statement c) ensuring the patient's statement is confirmed by another nurse d) reporting the abuse to the appropriate authorities
d) reporting the abuse to the appropriate authorities Nurses have a legal and ethical obligation to report cases of abuse. It would be inappropriate and likely unethical to require a third party witness to the statement or to withhold action pending assessment results. The nurse's obligation to report abuse legally supersedes the patient's right to privacy.
