2873 Healthcare Law
A pt who has tested positive for HIV tells the nurse, "I feel helpless. My boss fired me b/c I'm HIV positive." Which is the best response by the nurse? "Don't worry. You're protected by Good Samaritan laws." "Don't lose hope. Take this as an opportunity to spend time with your family." "I understand your feelings, but I think you should concentrate on your health now." "You should approach a lawyer. You're protected by the Americans with Disabilities Act."
"You should approach a lawyer. You're protected by the Americans with Disabilities Act."
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? 1. Call the nursing supervisor to discuss the situation 2. Discuss the problem with a colleague 3. Leave the nursing unit and go home 4. Say nothing and begin your work
1. Call the nursing supervisor to discuss the situation Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.
What should a nurse understand about healthcare proxies or a durable power of attorney for healthcare? A proxy is a legal document that prohibits the purchase or sale of organs. A proxy is a legal document that ensures the client has the right to refuse medical treatment. A proxy is a legal document that designates a person or persons to make health care decisions on behalf of the client. A proxy is a legal document that directs treatment in accordance with the client's wishes in case of a terminal illness or condition.
A proxy is a legal document that designates a person or persons to make health care decisions on behalf of the client.
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 Negligence Malpractice False Imprisonment
Battery Assault False Imprisonment Intentional torts include battery, assault, and false imprisonment. Unintentional torts include negligence and malpractice.
Authority of State Boards of Nursing
Establishing requirements to obtain and maintain nursing license Issues nursing licenses determines scope of practice setting and enforcing minimum criteria for nursing education programs •Three functions mirror federal and state governments -Executive: Administers nurse practice act -Legislative: Adopts necessary rules to implement act -Judicial: Authority to discipline a licensee or deny licensure
Legal Ramifications social media
Improper use of social media can violate state and federal laws violations can result in civil and criminal penalties, including fines and jail time personal liability
A student nurse is gossiping with colleagues about a patient's many romantic relationships. The registered nurse warns the student nurse about talking about the patient's personal life in a public place. The nurse's warning is intended to prevent which error? Assault Libel Invasion of privacy Defamation of character
Invasion of privacy
Section 4723.28 ORC
Lists 32 actions that can result in Board Sanctions Identifies those sanctions sets out processes to be used when taking action if it isn't in 4723.28-Board cannot take action board has jurisdiction over only its licensees action is never taken in secret - due process must be provided fraud, misrepresentation, or deception can result in disciplinary action
A nursing student has learned about advance directives for healthcare. Which documents should the student classify as advance directives? Select all that apply. Living wills Informed consent Health care proxies Witnesses' depositions Durable powers of attorney for health care
Living wills Health care proxies Durable powers of attorney for health care
A client dies in the hospital 2 hours after being admitted. Who has the authority to decide if a post-mortem should be conducted? Surviving spouse Nursing manager Medical examiner Primary healthcare provider
Medical examiner If a client dies within 24 hours of being admitted to the hospital, the medical examiner has the right to decide whether a post-mortem should be conducted. If the client's death does not need to be reviewed by the medical examiner and the client has not requested an autopsy in writing, the surviving spouse may request a post-mortem. The nursing manager and the primary healthcare provider are not authorized to make decisions regarding a post-mortem.
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. Nursing students are not accountable if a client is harmed. Nursing students should never be assigned any tasks they are unprepared for. Nursing students are employees of the hospital and may act as witnesses to consent forms. Nursing students can work as nursing assistants or nurse's aides when not attending classes. Nursing students should notify the nursing supervisor in case they are delegated tasks they are not prepared for.
Nursing students should never be assigned any tasks they are unprepared for. Nursing students can work as nursing assistants or nurse's aides when not attending classes. Nursing students should notify the nursing supervisor in case they are delegated tasks they are not prepared for.
Confidence: Nailed It Stats 24. What does a nurse understand by the term regulatory law as applied to nursing practice? Regulatory law provides fair and equitable treatment when civil wrongs or violations occur. Regulatory law describes and defines the legal boundaries of the nursing practice within each state. Regulatory law reflects the decisions made by administrative bodies such as the State Boards of Nursing. Regulatory law results from judicial decisions made in courts based on the judgments of individual legal cases
Regulatory law reflects the decisions made by administrative bodies such as the State Boards of Nursing.
Patient Self-Determination Act of 1991
Requires health care institutions to provide written information to clients concerning the clients' rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.
federal laws
Social Security Act of 1965 Patient Self-Determination Act of 1991 Health Insurance Portability and Accountability Act of 1996 Patient Protection and Affordable Care Act of 2010 Controlled Substance Act
purpose of law and legislation
The *primary purpose is to protect the patient and the nurse* Laws and legislation *define the scope of acceptable practice and protect individual rights* Nurses who are aware of their rights and duties in legal matters are better able to protect themselves against liability or loss of professional licensure
What does the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 state? The act states that employees can change jobs without losing health insurance coverage. The act states that the hospital should not discharge or transfer a client if an emergency condition exists. The act states that the hospital protects a person who is HIV positive but does not have acquired immunodeficiency syndrome (AIDS). The act states that health care institutions should provide written information to clients concerning their rights under state law to make decisions.
The act states that the hospital should not discharge or transfer a client if an emergency condition exists.
A 16-year-old single mother of a 1-year-old infant and the infant's grandmother bring the baby to the emergency department and report that the infant accidentally fell down the stairs. The nurse knows that a consent form for treatment should be signed. Who has the responsibility for signing the consent? The mother, despite her age No one, because this is an emergency The grandmother, because she is a relative Family court, because the mother is a minor
The mother, despite her age The client is an emancipated minor, meaning that she has adult status. In most states the age of majority is 18 years; however, parents younger than 18 years are considered emancipated minors and may sign consents for themselves and their children. Consent always is needed when a parent is present and capable of providing it. The grandmother does not have the legal right to give consent. Family court is unnecessary.
The nurse is evaluating the need for the use of restraints when managing a patient with delirium. Which conditions must be met before the nurse may use restraints? Select all that apply. The patient is improving. The patient refuses to undergo a necessary procedure. The safety of the patient is at risk. There is a written order from a health care provider. Less restrictive patient interventions have failed.
The safety of the patient is at risk. There is a written order from a health care provider. Less restrictive patient interventions have failed.
intentional tort
assault, battery, false imprisonment, fraud
Causation
would the injury have not occurred "but for" the defendant's actions?
Maintaining RN Licensure
2 yr license period Renewal fee $65 Continuing Education - 24/renewal period One hour of CE must relate to Ohio Nursing Law
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 emancipated minor Any parent for the adult's unemancipated minor A brother or sister of an adult's minor brother or sister As a grandparent for a minor grandchild under normal circumstances
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
State Board of Nursing
Appointed board within each state charged with responsibility to administer the nurse practice act of that state. each state has its own; run by nurses and consumers appointed by the governor's board responsible for enforcing the Nurse Practice Act
A pt who has developed a pulmonary embolism after abdominal surgery is immediately transferred to another hospital. Which law has been broken in this case? Mental Health Parity Act Americans Disability Act Patient Self-Determination Act Emergency Medical Treatment and Active Labor Act
Emergency Medical Treatment and Active Labor Act
What is the priority nursing intervention before a client undergoes amniocentesis? Starting an intravenous infusion of normal saline Performing a vaginal and rectal examination Ensuring that informed consent has been obtained from the client Informing the client that the procedure may precipitate an infection
Ensuring that informed consent has been obtained from the client
State Laws
Licensing of professionals—scope of practice -Credentialing -Discipline Licensing of health care institutions Laws relating to public health and disease prevention and control (mandatory reporting laws) -Communicable disease -Abuse Consent Advanced directives Physician-assisted suicide
What action should the nurse take if abuse of a 10-year-old child is suspected? Report the suspicion to local authorities. Elicit more information from the parents. Refer the parents to a group therapy meeting. Notify the healthcare provider of the suspicion
Report the suspicion to local authorities. A nurse is mandated by law to report suspected child abuse.
health care law
The collection of laws that have a direct impact on the delivery of health care or on the relationships among those in the business of health care or between the providers and the recipients of health care.
Tort Law
most common type of civil action encountered by nurses goal = money damages includes NEGLIGENCE aka malpractive and professional negligence
In which situations is the nurse allowed to use physical restraints? SATA the pt is extremely irritated the pt has suicidal ideation the HCP has given a written order the pt is potentially dangerous to other pts the pt's family members have asked to restrain the pt
the HCP has given a written order the pt is potentially dangerous to other pts
The nurse is sued for failure to monitor a pt appropriately after a procedure. Which statements are correct about this lawsuit? SATA the nurse represents the plaintiff the defendant must prove injury, damage, or loss. the person filing the lawsuit has the burden of proof the plaintiff must prove that a breach in the prevailing standard of care caused an injury. the nurse is a witness
the person filing the lawsuit has the burden of proof the plaintiff must prove that a breach in the prevailing standard of care caused an injury. The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage. Thus, the plaintiff has the burden of proof. The nurse is the defendant, not a witness.
A nurse is working with an unlicensed assistive personnel (UAP) in caring for a group of clients. Which statement by the UAP indicates a correct understanding of the UAP's role? "I will turn off clients' IVs that have infiltrated." "I will take clients' vital signs after their procedures are over." "I will use unit written materials to teach clients before surgery." "I will help by giving medications to clients who are slow in taking pills."
"I will take clients' vital signs after their procedures are over." Monitoring vital signs after procedures is within the scope of a UAP's role. Registered professional nurses or licensed practical nurses, not UAPs, should perform turning off clients' intravenous (IV) infusions that have infiltrated. Using unit written materials to teach clients before surgery should be performed by registered professional nurses or licensed practical nurses, not UAPs. Helping by giving medications to clients who are slow in taking pills should be performed by registered professional nurses or licensed practical nurses, not UAPs.
A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? Select all that apply. "I cry all the time; I'm just so sad." "Since I retired I've been so depressed." "I'd like to end it all with sleeping pills." "The voices say I should kill all prostitutes." "My boss makes me so angry—he's always picking on me."
"I'd like to end it all with sleeping pills." "The voices say I should kill all prostitutes." The statement about ending it all is a suicide threat; it is a direct expression of intent without action. Likewise, the threat to harm others must be heeded. Confiding feelings of sadness or depression does not indicate that the client plans to self-harm or harm others. The statement about the boss reflects the client's feelings of anger and the cause but does not indicate a threat to self or others.
A 17-year-old mother is to sign the consent for her son's myringotomy. What should the nurse say to the mother about this procedure? "This procedure may not help." "Tell me what you know about this procedure." "Your son will need to have this done again when he's older." "One of your parents must also sign this because you're too young."
"Tell me what you know about this procedure."
Following an accident at a job site, a patient's employer contacts the hospital and asks the nurse about the patient's condition to determine the patient's likelihood of returning to work in the future. Which is the best response by the nurse to the employer? "You need to speak to the primary healthcare provider." "We can send the patient's medical records for your reference." "The patient is doing well and will definitely be able to return to work." "You will have to get the patient's permission to receive any related information."
"You will have to get the patient's permission to receive any related information."
A nurse is caring for a pt who recently had coronary bypass surgery and now is on the post-op unite. Which are legal sources of standards of care that the nurse uses to deliver safe health care? SATA 1. Information provided by the head nurse 2. Policies and procedures of the employing hospital 3. State Nurse Practice Act 4. Regulations identified in The Joint Commission manual 5. The American Nurses Association standards of nursing practice
2. Policies and procedures of the employing hospital 3. State Nurse Practice Act 4. Regulations identified in The Joint Commission manual 5. The American Nurses Association standards of nursing practice
A nurse stops to help in an emergency at at the scene of an accident. The injured party files a suit and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? 1. The nurse's auto insurance 2. The nurse's homeowner's insurance 3. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence. 4. The Patient Care Partnership, which may grant immunity from suit if the injured party contends.
3. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence. The Good Samaritan law holds the health care provider immune from liability as long as he or she functions within the scope of his or her expertise.
The nurse attends to a trauma patient who has been transferred from the intensive care unit (ICU). The nurse finds out that the ICU nurse provided a detailed explanation on the patient's condition to the family without consent from the patient. The ICU nurse also gave the patient a steroid shot even though the patient refused the medication. Which torts would the ICU nurse be guilty of? Select all that apply. Malpractice Battery Invasion of privacy Negligence Defamation of character
Battery Invasion of privacy Battery is any intentional touching without consent. Giving a steroid injection to a patient after the patient has rejected an invasive procedure is considered battery. Malpractice occurs when health care delivered falls below a standard of care expected. The patient's privacy has been invaded when the healthcare provider informs the patient's family of the patient's present medical condition without consent. Negligence is conduct that falls below a standard of care. Defamation of character is the publication of false statements that damage a person's reputation.
The nurse is caring for a patient who is extremely irritable and agitated. The nurse first transfers the patient forcefully to an isolated room to avoid disturbing other patients in the ward. The nurse then sedates the patient by giving a morphine injection. Which torts has the nurse committed? Select all that apply. Assault Battery False imprisonment Invasion of privacy Defamation of character
Battery False imprisonment
Charges Issued
Board members get details - identity of licensee not known Vote on whether to issue Notice of Opportunity - contains all charges Board believes it can prove Once charge, info becomes public
The nurse is learning about legal implications in nursing practice. Which statements are true about the various sources of law? SATA Civil laws protect the rights of individuals in the society. Common law presents decisions made by administrative bodies. Criminal laws protect society by providing punishment for crimes. Criminal laws are passed to protect society from nursing negligence. Regulatory law reflects decisions made by administrative bodies when they pass rules
Civil laws protect the rights of individuals in the society. Criminal laws protect society by providing punishment for crimes Regulatory law reflects decisions made by administrative bodies when they pass rules
A nurse notes that the health care unit keeps a listing of the pt names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks w/ the nurse manager b/c this action is a violation of which act? HIPAA PSDA PPACA Emergency Medical Treatment and Active Labor Act
HIPAA The Privacy Rule of the HIPAA requires that patient information be protected from unnecessary publication.
HIPAA as a privacy standard
HIPAA - 1996 reinforces protection of electronically transmitted information requires all health care providers to ensure pt's privacy and confidentiality
Hearing/Consent Agreement
Hearing - hearing officer - Board committee court reporter produces transcript consent agreement - charged individual agrees to enter into an agreement in lieu of a hearing - charges are set out - sanctions agreed upon presented to the Board for ratification not valid until Board has voted
A nonviolent client on the psychiatric unit suddenly refuses to take the prescribed antipsychotic medication. What should the nurse do? Honor the client's decision and document the behavior and all interventions. Use an authoritarian approach to induce the client to take the prescribed medication. Call the primary healthcare provider and request that the client be discharged against medical advice. Start proceedings to have the client declared incompetent and seek a court order permitting medication.
Honor the client's decision and document the behavior and all interventions.
A nurse administers intravenous (IV) therapy to the wrong client. What possible legal complications might the nurse face in such situation? Assault Battery Malpractice False imprisonment
Malpractice If a nurse administers IV therapy to a wrong client, the nurse may face the charge of malpractice. Assault is any action that places the client or the nurse in fear of a harmful or offensive contact w/out consent. Battery is any intentional touching w/out consent. False imprisonment occurs w/ unjustified restraint of a person w/out legal warrant.
A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy? Inform the patient's spouse about the disease. Do not inform the patient or the family members about the disease. Obtain permission from the patient to inform the patient's spouse about the disease. Obtain informed consent from the spouse to reveal the illness to the patient.
Obtain permission from the patient to inform the patient's spouse about the disease.
What is the professional nurse's legal responsibility regarding child abuse? Honor the request of the parents not to report the suspected abuse. Report any suspected abuse to local law enforcement authorities. Return the child to the legal parent even if he or she is suspected of abuse. Provide the parents with a copy of the child's medical record
Report any suspected abuse to local law enforcement authorities. Nurses and primary healthcare providers are legally responsible for reporting suspected or actual abuse
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 when less restrictive interventions are not successful. Restraints can be used when all other alternatives have been tried and exhausted. Restraints can be used only to ensure the physical safety of the resident or other residents. Restraints can be used anytime without a written order from the healthcare provider
Restraints can be used anytime without a written order from the healthcare provider Restraints can be used only on the written order of a healthcare provider. Restraints can be used when less restrictive interventions are not successful. Restraints may be used after all available alternatives have been tried and exhausted. Restraints can be used only to ensure the physical safety of the resident or other residents.
What should the nurse do to avoid malpractice and the resulting professional negligence? SATA Strictly follow the given standards of care regularly update current nursing knowledge properly document all assessments and interventions avoid explaining medical procedures to pts complete health documentation at the end of the shift
Strictly follow the given standards of care regularly update current nursing knowledge properly document all assessments and interventions Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other healthcare team members and to avoid negligence.
Refusing to follow the prescribed treatment regimen, a client plans to leave the hospital against medical advice. What is it important for the nurse to inform the client of? That the client is acting irresponsibly That this action violates the hospital policy That the client must obtain a new primary healthcare provider for future medical needs That the client must accept full responsibility for possible undesirable outcomes
That the client must accept full responsibility for possible undesirable outcomes
Which act protects a person who is HIV positive? The National Organ Transplant Act The Americans with Disabilities Act (ADA) The Patient Self-Determination Act (PSDA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Americans with Disabilities Act (ADA)
A 1-week-old infant has been in the pediatric unit for 18 hours after placement of a spica cast. The nurse obtains a respiratory rate slower than 24 breaths/min; no other changes are noted. Because the infant is apparently well, the nurse does not report or document the slow respiratory rate. Several hours later the infant experiences severe respiratory distress, and emergency care is necessary. What should be considered if legal action is taken? Most infants' respirations are slow when they are uncomfortable. The respirations of young infants are irregular, so a drop in rate is unimportant. Vital signs that are outside the expected parameters are significant and should be documented. The respiratory tracts of young infants are underdeveloped, and the respiratory rate is not significant.
Vital signs that are outside the expected parameters are significant and should be documented.
A surgeon obtains pt consent for an appendectomy. While operating, the surgeon also removes the pt's gall bladder. This mistake could be classified as which type of tort? assault battery false imprisonment defamation of character
battery Torts are intentional or unintentional mistakes that are infringements of civil law. Removing the gall bladder without consent may be considered battery because the surgeon's actions go beyond the scope of the patient's original consent, which was only for the appendectomy. Assault involves the intentional threat of bodily harm, but there is no indication the surgeon meant to harm this patient by removing the gall bladder. Forcing the patient to stay in the hospital even if the patient is unwilling would indicate false imprisonment. Making false, damaging statements about a patient would indicate defamation of character.
A nursing student is listing the points that need to be remembered about the loss of a client's medical records. Which point listed by the nursing student is accurate? "Loss of medical records may lead to libel charges." "The registered nurse should maintain accurate nursing records." "There is an assumption that the care provided to the client was negligent." "The healthcare facility needs to demonstrate why the medical records were lost."
"There is an assumption that the care provided to the client was negligent." In case a client's medical record is lost, there is an assumption that the care provided to the client was negligent. Loss of medical records may lead to a malpractice claim. The entire institution is responsible for maintaining medical records. Primary healthcare providers need to demonstrate why the medical records were lost.
When witnessing a patient giving informed consent prior to undergoing surgery, which actions should the nurse perform? Select all that apply. If the patient refuses to sign the consent, leave the situation as it is. Confirm that the patient has understood the information about the surgery. Inform the healthcare provider if the patient refuses to undergo the surgery. Sign the consent form as a witness, once the patient voluntarily gives consent. Ask a nursing student to witness the informed consent if the nurse is busy.
Confirm that the patient has understood the information about the surgery. Inform the healthcare provider if the patient refuses to undergo the surgery. Sign the consent form as a witness, once the patient voluntarily gives consent.
Major causes of Negligence
- failure to follow standards of care - failure to use equipment in a responsible manner - failure to communicate - failure to document - failure to assess and monitor - failure to act as a patient advocate
Patient Self-Determination Act of 1991 responsibilities of healthcare personnel
Under PSDA a pt's record needs to document whether or not the pt has signed an advance directive For living wills or durable powers of attorney for health care to be enforced, a pt must be declared legally incompetent or lack the capacity to make decisions regarding hi or her own health care treatment
Employer/employee liability
Vicarious liability Employer liable for the acts of its employee if the employee was acting as an agent of the employer and the actions resulted in injury within that scope of employment.
A nurse notes that an advance directive is on a pt's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow? a living will allows an appointed person to make health care decisions when the pt is in an incapacitated state a living will is invoked only when the pt has a terminal condition or is in a persistent vegetative state the pt cannot make changes in the advance directive once admitted to the hospital a durable POA for health care is invoked only when the pt has a terminal condition or is in a persistent vegetative state
a living will is invoked only when the pt has a terminal condition or is in a persistent vegetative state A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.
assault
an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact no actual contact is required for an assault to occur
battery
any intentional offensive touching w/out consent or lawful justification the contact can be harmful to the pt and cause an injury, or it merely can be offensive to the pt's personal dignity
Post Board Action
appeal through Franklin County Court of Common Pleas Info released to public Reported to practitioner data banks Federal government may bar Medicare reimbursement
Process of Board action
complaint investigation consultation - supervising member charges issued hearing/consent agreement board determination of sanction
Complaints
confidential all are investigated by Board staff prioritize investigations no "statue of limitations" complaint form on the www - anonymous - identity protected - immunity from liability if acting in good faith
confidentiality/privacy
confidentiality - the protection of private info gathered about a pt during the provision of health care services legal and ethical concern in nursing practice only info that is pertinent to a pt's treatment and welfare is disclosed
Informed consent
consent is required before treatment must be given voluntarily a competent adult a legal guardian or individual holding durable POA an emancipated or married minor parent of a minor child court order the pt must be given enough info to be the ultimate decision-maker
sources of law
constitutional law statutory law administrative law tort law common law contract law criminal law
A woman has sever life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of PRBCs to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? obtain a court order to give the blood coerce the husband into giving the blood call security and have the husband removed from the hospital more information is needed about the wife's preference and if the husband has her medical POA
more information is needed about the wife's preference and if the husband has her medical POA Adult patients such as those with specific religious objection are able to refuse treatment for personal religious reasons, but there need to be clear directions on who can make the decision.
Delegation
nurse's primary legal and ethical consideration is safe, effective care for pts professional nurses retain accountability for acts delegated to another person
Injury or Harm
physical harm combination - physical, mental, emotional, or financial harm
Reducing the Risk for Malpractice
practice in safe setting practice w/in the scope of the nurse practice act communicate meet the standard of care promote positive interpersonal relationships practice in a way that considers the impact on the others' feelings, safety, and rights observe agency policies and procedures always put pt's rights and welfare first be aware of relevant law and regulations
A client who had previously signed a consent form for a liver biopsy reconsiders and decides not to have the procedure. What is the nurse's best initial response? "Why did you sign the consent form originally?" "I can understand why you changed your mind." "Can you tell me your reasons for refusing the procedure?" "You must be afraid about something concerning the procedure."
"Can you tell me your reasons for refusing the procedure?" The response "Can you tell me your reasons for refusing the procedure?" attempts to explore why the client is refusing the procedure; the question promotes communication. The response "Why did you sign the consent form originally?" is accusatory; the client has the right to withdraw consent at any time. The response "I can understand why you changed your mind" is a conclusion without appropriate data; it may also increase the client's anxiety level. "You must be afraid about something concerning the procedure" is a conclusion without appropriate data; it also puts the client on the defensive.
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." "The United Network for Organ Sharing (UNOS) protects the donor's estate from liability for injury or damage." "The United Network for Organ Sharing (UNOS) gives priority to international clients who need organs on an urgent basis." "The United Network for Organ Sharing (UNOS) provides civil and criminal immunity to the hospital and the primary healthcare provider."
"The United Network for Organ Sharing (UNOS) has a contract with the federal government." The United Network for Organ Sharing (UNOS) has a contract with the federal government. The National Organ Transplant Act of 1984 protects the donor's estate from liability for injury or damage. The United Network for Organ Sharing gives priority to clients in their geographical area who need organs on an urgent basis. The National Organ Transplant Act of 1984 provides civil and criminal immunity to the hospital and the healthcare provider.
The patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patient's experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply). 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to follow the six rights of medication administration 4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition
1. Failure to document a change in assessment data 5. Failure to notify a health care provider about a change in the patient's condition The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.
A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) 1. The nurse does not need any representation. 2. The patient must prove injury, damage, or loss occurred. 3. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4. The patient must prove that a breach in the prevailing standard of care caused an injury. 5. The burden of proof is always the responsibility of the nurse.
2. The patient must prove injury, damage, or loss occurred. 3. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4. The patient must prove that a breach in the prevailing standard of care caused an injury. The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage.
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patient's medical diagnoses on the message board. Later in the day, the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPPA)? [23] 1. Discussing the patient conditions in the nursing report room at the change of shift 2. Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
3. Posting medical information about the patient on a message board in the patient's room Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by people who are not involved in the patient's treatment.
Establishing Liability 4 elements
Duty Breach of Duty Causation Injury or Harm
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 priority nursing action? 1. Give the family the record 2. Discuss the issues that concern the family with them 3. Call the nursing supervisor 4. Determine from the medical record if the family has been granted permission by the patient to access his or her medical information
4. Determine from the medical record if the family has been granted permission by the patient to access his or her medical information Family members do not have the right to private personal health information without the consent of the patient. Confidentiality protects private patient information once it has been disclosed in health care settings.
A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPPA) 2. Americans with Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA)
4. Emergency Medical Treatment and Active Labor Act (EMTALA) The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.
The nurse is caring for a 6-year-old child with hypovolemic shock. The child is a Jehovah's Witnesses. The child needs an immediate blood transfusion, but the child's parents refuse to provide consent. Which would be the most appropriate action? Administer blood to the child. Administer intravenous fluids. Provide oral hydration and nutrition. Seek court order for blood transfusion
Administer blood to the child. Jehovah's Witnesses is a cultural and religious group that refuses blood transfusions based on their religious beliefs. According to the Durable Power of Attorney for Health Care (DPAHC) document, the court will grant an order allowing hospitals and healthcare providers to treat children of Christian Scientists or Jehovah's Witnesses who have denied consent for treatment of their minor children. Therefore, to save the life of the child it is most appropriate for the health care provider or nurse to administer blood to the child. Refusing a blood transfusion in the case of hypovolemic shock would most likely result in the death of the child. Administering only intravenous fluids may not help, because the child is in hypovolemic shock. Oral hydration and nutrition will not be sufficient to resuscitate a child who has had severe blood loss. The court will allow the healthcare providers to resuscitate the child; thus the medical personnel need not seek or wait for court orders.
The nurse is speaking to a patient who has been diagnosed with human immunodeficiency virus (HIV). The patient could lose his current job if information about the disease is revealed. Which law should the nurse discuss with the patient? Mental Health Parity Act Americans with Disabilities Act Uniform Anatomical Gift Act Patient Self-Determination Act
Americans with Disabilities Act
Investigation
Board has burden of proof subpoena powers conducted by well-trained staff - most are RNs Nurse may receive letter from Board asking for details regarding the allegations
A visitor from a room adjacent to a client asks the nurse what disease the client has. The nurse responds, "I will not discuss any client's illness with you. Are you concerned about it?" This response is based on the nurse's knowledge that to discuss a client's condition with someone not directly involved with that client is an example of what? Libel Negligence Breach of confidentiality Defamation of character
Breach of confidentiality The release of information to an unauthorized person or gossiping about a client's activities constitutes a breach of confidentiality and an invasion of privacy. Libel occurs when a person writes false statements about another that may injure the individual's reputation. Negligence is a careless act of omission or commission that results in injury to another. Defamation of character is the publication of false statements that injure a person's reputation.
A psychiatric nurse is hired to work in the psychiatric emergency department of a large teaching hospital. While reviewing the manuals, the nurse reads, "People with mental health emergencies shall be triaged within 5 minutes of entering the emergency department." What does the nurse consider this statement to represent? Hospital policy Standard of care Hospital procedure Mental Health Bill of Rights
Hospital policy
Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? SATA I am thinking of joining the health committee at my church I need to read newspapers, watch news broadcasts, and search the internet for information related to health I will join nursing committees at the hospital after I have completed orientations and better understand the issues affecting nursing Nurses do not have very much voice in legislation in DC, b/c of the nursing shortage I will go back to school as soon as I finish orientation
I am thinking of joining the health committee at my church I need to read newspapers, watch news broadcasts, and search the internet for information related to health I will join nursing committees at the hospital after I have completed orientations and better understand the issues affecting nursing Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees to be involved in decision making. Nurses have a powerful voice in the legislature.
The nurse is learning about nursing malpractice. Which statements should the nurse consider as good nursing practice? Select all that apply. Nursing notes can be illegible as long as the nurse can read them. Nursing notes should be maintained properly. Nursing records should be properly preserved. Institutions should maintain complete nursing records. Only basic duties should be recorded in nursing records.
Nursing notes should be maintained properly. Nursing records should be properly preserved. Institutions should maintain complete nursing records.
A patient who is hospitalized with chronic illness is depressed and demands to go home. The nurse applies a physical restraint and administers medication to the patient. What does this nursing intervention indicate? The nurse is following Good Samaritan laws. The nurse may be charged with malpractice. The nurse is guilty of invading the patient's privacy. The nurse may be charged with false imprisonment.
The nurse may be charged with false imprisonment.
A woman arrives at the prenatal clinic stating that her pregnancy test is positive. She asks the nurse for information regarding an abortion. After verifying that the woman is at 8 weeks' gestation, the nurse counsels her that having an abortion is controversial and that many women have long-lasting feelings of guilt after an abortion. What is the nurse's legal responsibility? To share her own thoughts on abortion with the client To provide the client with correct, unbiased information To ask why the client wants information about abortion To notify the primary healthcare provider because this is beyond the scope of nursing practice
To provide the client with correct, unbiased information
A home health nurse notices significant bruising on a 2-yr-old pt's head, arms, abdomen, and legs. The pt's mother describes the pt's frequent falls. What is the best nursing action for the home health nurse to take? document her finding and treat the pt instruct the mother on safe handling of a 2-yr-ol contact the child abuse hotline discuss the story w/ a colleague
contact the child abuse hotline Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.
Board Sanctions
denial, suspension, revocation restrictions reprimand fines other - voluntary retirement - community service - CE
Duty
duty to exercise ordinary care to avoid harm - nurses have a professional duty to their pts - provide reasonable care to all assigned pts - the standard of care for nurses is the degree of care that would be exercised by a "reasonably prudent nurse" acting under the same or similar circumstances
The occupational nurse is speaking to a pt who has started a new job after working for a company for 6 mos. The pt is worried about losing health insurance. Which advice should the nurse give to the pt? you should no have left the job don't worry you will not lose insurance coverage you should apply for your new health plan as soon as possible I am not able to help you. Please consult with the health law advocate
you should apply for your new health plan as soon as possible According to the Health Insurance Portability and Accountability Act (HIPAA), employees can change jobs without losing health coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group coverage. In this scenario, the patient has worked for only 6 months. Therefore, the patient will lose health insurance coverage on taking a new job. The nurse should advise the patient to apply for a new health plan in the new company as soon as possible. The nurse should not judge the patient's decision to leave the job. Taking a new job is the patient's decision, which the nurse should respect. The group coverage from the previous job would be lost, because the patient has worked for fewer than 6 months. The nurse should know about all healthcare laws, so asking the patient to consult a healthcare advocate is an inappropriate nursing behavior.
Breach of Duty
fall below the standard of care something was done that should not have been done OR nothing was done when something should have been done
A nursing student is recalling the order of priority for giving consent to perform an autopsy in cases where a medical examiner review is not needed. Which person receives the highest priority for giving consent? Surviving child Surviving parent Surviving spouse The client in writing before death
The client in writing before death If a medical examiner's review is not necessary, the highest priority is given to the client. The client may provide the consent in writing before death. If the client or the surviving spouse is unable to give consent for the autopsy, a surviving child may be requested to give consent. The surviving parent may give consent for an autopsy if the client, the surviving spouse, and the surviving child are unable to do so. In case the client has not provided written consent before death, the nurse may obtain consent from the surviving spouse.
The nurse is working the night shift in an emergency room. The nurse receives a patient who is violent toward the staff. The patient is uncooperative and hysterical. The nurse decides to use restraints on this patient. Which are indications for using restraints? Select all that apply. There is a written order from the healthcare provider. The patient is hysterical. All other less restrictive interventions are unsuccessful. The patient may harm other patients. The nurse and three other nurses agree on restraining.
There is a written order from the healthcare provider. All other less restrictive interventions are unsuccessful. The patient may harm other patients.
Consultation
supervising member for disciplinary matters how to proceed - need for additional evidence - close the case - placement in alternative program - pursue charges w/ full Board
constitutional law
the interpretation and implementation of the U.S. Constitution highest source of law in US gives authority to the other sources of law constitutional rights - due process, equal protection
A nurse providing care in a hospital witnesses a client's spouse shaking the client vigorously because the client has had an episode of incontinence. Because of the suspicion of physical abuse, legally the nurse should discuss the concerns with which party? The client The client's spouse The client's primary healthcare provider Adult Protective Services
Adult Protective Services The nurse has a legal responsibility to report suspicions of abuse to the appropriate agency, which in this instance is Adult Protective Services. The client will not be able to understand the discussion. It is not the nurse's responsibility to directly challenge the spouse's behavior in this situation; the nurse may act as a client advocate by interrupting the spouse's behavior and providing immediate physical and emotional care. The nurse should then report suspicions of abuse to Adult Protective Services. Although the nurse may report suspicions about the spouse's behavior to the healthcare provider, the law requires that Adult Protective Services be notified.
The nurse attends to a patient who sustained injuries when crossing the street. The patient was hit by a car that failed to stop at a stop sign. The patient was rushed to the emergency department and then to surgery to repair injuries. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The healthcare provider informs the nurse that patient confidentiality should be strictly maintained. What should the nurse interpret from this? Select all that apply. The nurse should respect that the patient has the right to keep personal information from being disclosed. The nurse should avoid discussing the patient's medical reports in public areas with other healthcare professionals. The nurse should not disclose information about a procedure to the patient. The nurse must protect any private information about the patient, once it has been disclosed in healthcare settings. Message boards where daily nursing care information is posted in the patient's room cannot contain information revealing the patient's medical condition.
The nurse should avoid discussing the patient's medical reports in public areas with other healthcare professionals. The nurse must protect any private information about the patient, once it has been disclosed in healthcare settings. Message boards where daily nursing care information is posted in the patient's room cannot contain information revealing the patient's medical condition.
The nurse has failed to obtain informed consent before performing a procedure on a patient. Which type of torts result from this nursing action? Select all that apply. 1 Assault 2 Battery 3 Negligence 4 False imprisonment 5 Libel
battery negligence Negligence is performing an action that falls below a standard of care. Failure to obtain informed consent is an act of negligence. Assault refers to an action that places a person within harmful or offensive contact without consent. Battery is any intentional touching without consent. Because the nurse has failed to obtain informed consent, doing any intervention on the patient would be considered as battery. False imprisonment is the unjustified restraint of a person without legal warrant. Failure to obtain informed consent would not result in assault or false imprisonment. Libel is written defamation of character.
A nurse is planning care for a pt going to surgery. Who is responsible for informing the pt about the surgery along w/ possible risks, complications, and benefits? family member surgeon nurse nurse manager
surgeon The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.
Which of the following actions, if performed by the RN, would result in both criminal and administrative law sanctions against the nurse? SATA taking or selling controlled substances refusing to provide health care info to the pt's child reporting suspected abuse and neglect of children applying physical restraints w/out a written physician's order completing an occurrence report on the unit
taking or selling controlled substances applying physical restraints w/out a written physician's order The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a health care provider on the basis of The Joint Commission and Medicare guidelines.
Which situation does not cover nurses who respond to a mass casualty incident (MCI) for malpractice or negligent lawsuits under the Good Samaritan Act? terrorist act neighborhood fire roadside car accident high school sporting event
terrorist act When terrorist acts occur, nurses are often required to go to an assigned site to offer aid. When this occurs, the nurse is not covered from malpractice or negligent lawsuits. Nurses who respond to injuries that occur in a neighborhood fire, roadside car accident, or a high school sporting event are covered under the Good Samaritan Act.
nurse may refuse assignment when -
the nurse lacks the knowledge or skill to provide competent care care exceeding the Nurse Practice Act is expected health of the nurse or her unborn child is directly threatened by the type of assignment orientation to the unit has not been completed and safety is @ risk the nurse clearly states and documents a conscientious objection on the bases of moral, ethical, or religious grounds the nurse's clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the pt
The nurse has been charged for committing a misdemeanor. Which action will be taken against the nurse? the nurse will be given a warning the nurse will be asked to pay a fine the nurse will be suspended from duty the nurse will be imprisoned for more than 1 yr
the nurse will be asked to pay a fine A misdemeanor is a crime that has a penalty of a fine or imprisonment of less than 1 year. Therefore, the nurse will be asked to pay a fine. The nurse has committed a crime so a warning is an inadequate legal action. A felony is a serious crime that has a penalty of imprisonment for more than 1 year or suspension from duty. The nurse's action is not a felony and does not call for penalty of imprisonment for more than 1 year.
Informed consent contract law
the person(s) giving consent must fully comprehend: - the procedure to be performed - the risks involved - expected or desired outcomes - expected complications or side effects that may occur as a result of treatment - alternative treatments that are available
A group of nurses makes a list of pts who require organ transplantation. Which pt would be given priority for organ transplantation? the pt who is most critically ill the pt who is a very young age the pt who will pay more for the intervention the pt who lives in close proximity to the healthcare center
the pt who is most critically ill The patient who is most critically ill or is unstable would be given priority, because receiving the organ transplant can save the patient's life. Young patients would not be given priority for receiving an organ transplant, because they are relatively stable. Being partial toward the patient who is willing to pay more for the intervention is unethical and biased. Giving preference for an organ transplant to a patient who lives in close proximity is inappropriate, because other patients may require it more based on their health condition.
An 8-yr-old girls is brought to the ED w/ severe abdominal pain. The nurse has to get consent before medical treatment can be started. The parents of the child are divorced, and the mother has custody. The pt is accompanied by her mother, father, and elder sister, who is 19 yrs old. Who should sign the consent form for the pt? the pt's father the pt's sister the pt the pt's mother
the pt's mother When the patient is a minor, consent is given by parents or guardians. In this case, the parents are divorced, so the consent is given by the parent who has custody of the child, the mother.