Chapter 7 PrepU Fundamentals
A nurse is caring for a client following endotracheal intubation. Before applying soft wrist restraints to prevent the client from pulling out the endotracheal tube, what is the most appropriate action of the nurse?
Obtain a medical order. Explanation: Nurses must obtain a medical order before each and every instance in which they use restraints. Due to the severity of the client illness requiring endotracheal intubation, the client may not be able to provide a written consent. The client does not need to be sedated unless medically necessary, and although it is appropriate to notify the family, this is not the priority.
A nurse is overheard in the hospital cafeteria making false comments about a client. The nurse is guilty of:
slander. Explanation: Slander is oral defamation of character. Libel is written defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent. Invasion of privacy involves a breach of keeping client information confidential.
A nurse hired to work in an ambulatory setting attends new employee orientation. The nurse never worked in ambulatory before and is concerned about the Scope and Standards of Practice for Professional Ambulatory Care Nursing. Which response by the nurse educator would further explain the Scope and Standards of Practice for Professional Care Nursing to the new nurse?
"The Scope and Standards of Practice for Professional Ambulatory Care Nursing deals with the professional obligations of a nurse working in the ambulatory setting." Explanation: The Scope and Standards of Practice for Professional Ambulatory Care Nursing are the standards of care for nurses working in the ambulatory arena. It does not take precedent over the facility's policies and procedures, but must be worked in conjunction with the policies and procedures. It is not used for assessing nurses. NCLEX determines if a nurse is minimally competent to practice as a nurse.
The client being admitted to the oncology unit conveys his wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in his best interest to obtain which document?
A living will Explanation: A living will is an advance directive that specifies the type of medical treatment clients do or do not want to receive should they be unable to speak for themselves in a terminal or permanently unconscious condition.
Nurses practicing in a critical care unit must acquire specialized skills and knowledge to provide care to the critically ill client. These nurses can validate this specialty competence through what process?
Certification Explanation: Certification validates specialty knowledge, experience, and clinical judgment. A nurse in a critical care unit having specialized skills and knowledge to provide care would be an example of certification. Licensure is a specialized form of credentialing based on laws passed by a state legislature. Licensure endorses entry-level competence. Legal accreditation is granted to educational programs by state agencies endorsing the approval of the program's design and mission to meet the needs of state requirements. Litigation is not a method for validation.
A client states that his recent fall was caused by the fact that his scheduled antihypertensive medications were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow?
Document the client's claims and the events surrounding the alleged incident. Explanation: 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.
A nurse enters the client's room and finds the client lying on the floor experiencing a seizure. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report?
To evaluate quality care and potential risks for injury to the client Explanation: An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. Incident reports determine how to prevent hazardous situations and serve as a reference in case of future litigation. Accurate and detailed documentation often helps to prove that the nurse acted reasonably or appropriately in the circumstances. It may not always serve as a method of determining the nurse's fault in the incident. The document does not evaluate the immediate care provided to the client but states the actions taken.
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?
Certification Explanation: 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 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.
A postanesthesia nurse is reporting about a client to the intensive care unit nurse in the elevator. There are staff members and visitors in the elevator. The postanasthesia nurse is doing what?
breaching the client's confidentiality Explanation: The principle of confidentiality requires that information about a client be kept private. Discussing clients outside the clinical setting, telling friends or family about clients, or even discussing clients in the elevator with other workers violates client confidentiality and must be avoided.
A client being discharged from the hospital asks the nurse, "When I go visit my family out of state, should I take my living will with me, or do I need a new one for that state?" What is the most appropriate response made by the nurse?
"Take it with you. It is recognized universally in the United States." Explanation: A separate or different advance directive is not needed for each state, so it can be used in any state and does not matter where it was created. A living will is recognized in each state as valid so a client should be advised to take it with them as they travel out of state. The other responses are incorrect or inappropriate given this scenario.
Which process evaluates and recognizes educational programs as having met certain standards?
Accreditation Explanation: 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 that person 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.
The nursing faculty is lecturing on unintentional and intentional torts. The faculty asks a nursing student to provide an example of an unintentional tort. Which example would indicate the student has a clear understanding of torts?
A nurse gives a medication and client has an adverse reaction. Explanation: Unintentional tort occurs when the nurse did not intend harm, but harm occurred (administration of medication and client has an adverse reaction). The other three responses are intentional torts.
Which scenario is an example of certification?
A nurse who demonstrates advanced expertise in a content area of nursing through special testing Explanation: Certification is a voluntary process whereby a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the NLN Commission for Nursing Education Accreditation and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit health care agencies.
A nurse is named as a defendant in a malpractice lawsuit. Which action would be recommended for this nurse?
Do not volunteer any information on the witness stand. Explanation: The nurse on the witness stand should be polite, but not volunteer any information. The nurse should only answer the questions asked. The other answers are not examples of what a nurse should do in a malpractice lawsuit.
The nurse educator is presenting a lecture on the Occupational Safety and Health Act. Which situation, if identified by the nursing staff, would indicate to the educator that the staff understands the Occupational Safety and Health Act?
Helps reduce workforce injuries and illness in the workplace Explanation: The Occupational Safety and Health Act of 1970 helps to reduce injuries and illness in the workplace. The National Practitioner Data Bank is a clearinghouse for health care practitioners who engage in unprofessional conduct and prevents them from moving from state to state. Nurses are obligated to report abuse because of the nurse-client relationship; it is not a requirement of the Occupational Safety and Health Act. The Americans with Disabilities Act protects people with communicable diseases and those recovering from drug or alcohol addiction.
An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which offense has the nurse committed?
Invasion of privacy Explanation: The nurse has committed the tort of invasion of privacy. Personal names and identities are concealed or obliterated in case studies or research work. Invasion of privacy is a type of intentional tort. Defamation is an act in which untrue information harms a person's reputation, and is therefore not applicable here. Negligence is the harm that results because a person did not act reasonably.
An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which offense has the nurse committed?
Invasion of privacy Explanation: The nurse has committed the tort of invasion of privacy. Personal names and identities are concealed or obliterated in case studies or research work. Invasion of privacy is a type of intentional tort. Defamation is an act in which untrue information harms a person's reputation, and is therefore not applicable here. Negligence is the harm that results because a person did not act reasonably.
The health care provider prescribes orders for a client with newly diagnosed uncontrolled seizure activity. When reviewing the prescriptions, the nurse correctly identifies that which prescription, if followed, puts him at risk for negligence charges?
Restrain all four extremities Explanation: The nurse is obligated to carry out the health care provider's orders unless it is unclear or incorrect. The client with seizures must be protected from harm. Restraints restrict the client's movement and can cause harm. Diazepam, oxygen, and frequent neurologic assessments are correct interventions for a client with uncontrolled seizure activity.
A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged?
Slander Explanation: The nurse can be charged with slander, which is a verbal attack on a person's character. Libel pertains to damaging written statements read by others. Both libel and slander are considered defamation of character—an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. Negligence and malpractice pertain to actions which are committed or omitted, thereby causing physical harm to a client.
A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which statement is true regarding the Good Samaritan law?
The Good Samaritan law will provide legal immunity to the nurse. Explanation: The Good Samaritan laws provide legal immunity to passersby who provide emergency first aid to victims of accidents. Therefore, the law is applicable to the nurse as well; moreover, the nurse did not accept any compensation for the service provided. The law is equally applicable to everyone, but does not provide absolute exemption from prosecution in cases of negligence. Paramedics, ambulance personnel, physicians, and nurses who stop to provide assistance are still held to a higher standard of care because they have training above and beyond that of average laypeople. In cases of gross negligence, health care workers may be charged with a criminal offense.
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?
The State Board of Nurse Examiners Explanation: 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. The employing health care institution may have submitted the paperwork regarding the allegation of the issue but does not suspend or revoke the nurse's license. The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. The Supreme Court is the highest judicial court in a country or state. The Surpreme Court does not rule on nurse's license.
A client is unhappy with the health care provided to him. He approaches the nurse and informs her that he is leaving the facility. The client has not been discharged by the physician. The nurse finds that the client has dressed and is ready to go. What would the nurse's action be in this situation?
The nurse should call the nursing supervisor and inform her about the situation. Explanation: The nurse should call the nursing supervisor and inform her about the situation. The client should be made to sign the document stating that he is responsible for his own actions. The nurse cannot keep the client restrained because that would be false imprisonment. Likewise, the nurse cannot overlook the incident because there is a responsibility for client care. Additionally, the nurse cannot warn the client that he will not be allowed to come back to the hospital because it is the client's right to access health care whenever required.
A nurse observes another nurse place an unused dose of narcotics in their pocket. If caught, the nurse could be charged with which type of crime?
felony Explanation: A felony is a serious criminal offense, and includes actions such as stealing narcotics, murder, falsifying medical records, and insurance fraud. A misdemeanor is a minor criminal offense; a tort is a lawsuit in which a plaintiff charges that a defendant committed a deliberately aggressive act. Negligence is harm that results because a person did not act reasonably.
Which statement made by the nurse providing care to a group of clients indicates that the nurse requires further education regarding negligence?
"I don't need to assess distal pulses on a client after a femoral arteriography." Explanation: Distal pulses should be checked immediately after a femoral arteriography; therefore, the nurse is negligent for checking three hours after the procedure. Fresh fruit may contain bacteria and further compromise a client with neutropenia. The Allen test confirms that there is proper circulation to the hand before drawing an ABG. The nurse checks breath sounds at least every 8 hours for adventitious sounds that may indicate aspiration.
The nurse educator is presenting an in-service on nursing and malpractice. Which statements made by the nursing staff would indicate to the educator that further teaching is required? Select all that apply.
"If I make a mistake, I will not tell anyone." "I will have the supervisor fill out the incident report when I make an error." Explanation: Errors and mistakes should be reported and incident reports filled out. The incident report should be filled out by the person responsible for the error. Documentation should be accurate, factual, complete, and timely. Nurses are accountable for any designated task. The nursing plan is part of the client's permanent record.
A nurse caring for an older adult client following a total abdominal hysterectomy documents administration of morphine 4 mg intravenously for pain of 8 on 1-10 scale, bed in the lowest position, bed alarm on, side rails up times two, and call light in reach. After the nurse leaves the room, the client gets out of bed and falls. In which order should the nurse proceed?
Assess the client for injury. Assist the client back into bed. Notify the physician. Document the incident. Complete an incident report. Explanation: Following a fall, the nurse should assess the client before moving the client. If the client can be moved, safely return the client to bed and make sure the client is secure per safety procedures. The nurse should then notify the physician. The nurse should document the incident and interventions or treatments provided. Finally, an incident report should be completed.
When the nurse inserts an ordered urinary catheter into the client's urethra after the client has refused the procedure, and then the client suffers an injury, the client may sue the nurse for which type of tort?
Battery Explanation: Battery is the actual carrying out of such a threat (unlawful touching of a person's body). A nurse may be sued for battery if there is failure to obtain consent for a procedure.
A nurse exits the room of a confused client without raising the side rails on the bed. The failure to raise the side rails would constitute which element of liability related to malpractice?
Breach of duty Explanation: 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, which results in injury to the client. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Damages refers to the actual harm or injury that the client incurs.
A nurse fails to administer a medication that prevents seizures, and the client has a seizure. The nurse is in violation of the Nurse Practice Act. What type of law is the nurse in violation of?
Civil Explanation: Malpractice cases are generally civil litigation cases that involve nurses.
When the nurse informs a client's employer of his autoimmune deficiency disease, the nurse is committing the tort of:
Invasion of privacy Explanation: Nurses have access to information recorded in the medical record, information shared or observed through care or interactions with friends and family, and through access to the client's body. A loss of privacy occurs if others inappropriately use their access to a person.
A client informs the nurse that he wants to discontinue his treatment and go home. Later, the nurse finds the client dressed to leave. Which action should the nurse take in this situation?
Let the client go after signing a document stating he is going against medical advice. Explanation: If a client wishes to go before his medical treatment is finished, he should sign a document indicating personal responsibility for leaving against medical advice. The nurse should not restrain the client, as it would make the nurse liable for legal action. The nurse may call the physician and get the discharge paper signed, but this is not appropriate. The nurse cannot warn the client that he will be denied health care in future, because it is his right to access the health care facility whenever he needs.
A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit?
Malpractice Explanation: The facility and nurse could be charged with malpractice, which is failing to perform (or performing) an act that causes harm to a client. Administering the medication intravenously instead of orally as prescribed has caused harm to a client. Negligence is failing to perform care for a client. When a person threatens to touch a client without consent, it is assault, whereas battery is carrying out the implied threat (assault).
A client newly diagnosed with congestive heart failure has a prescription for digoxin. The nurse counts the heart rate before administration of the medication and obtains a heart rate of 51 beats per minute. Which action by the nurse demonstrates adherence to the standards of nursing care?
Nurse withheld the medication and notified the health care practitioner. Explanation: Nurses are responsible for following the standards of care for their particular work area. A reasonably prudent nurse would withhold the medication and notify the health care practitioner. All other options put the client's safety at risk and would not be done by a reasonably prudent nurse.
The health care facility is involved in litigation by four clients. When reviewing the cases, which legal case would the nurse attorney identify to best describe malpractice?
The nurse administers amoxicillin to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. Explanation: All elements of liability are in place for the scenario involving a nurse administering amoxicillin to a client with documented allergies to penicillin: the nurse had a duty, but breached it when giving the medication. There also was causation (amoxicillin) and harm (seizures and respiratory arrest). The nurse is negligent when applying an ice pack without an order. The nurse used proper mechanics, so the client fall is an accident even though harm occurred. Giving the wrong medication could be cause for malpractice, but there was no harm.
A nurse comes across a screaming child in the park. The child was hit by a baseball bat, resulting in a swollen and reddened left arm. Any attempt to move the child's left arm results in the child screaming intensely. The nurse used two baseball bats to make a splint, which she applied to the child's left arm. The child is transported to the hospital and later develops compartmental syndrome of the left arm. The nurse requests a meeting with the nurse attorney to discuss the possibility of being involved in a lawsuit by the child's family. After a review of the events, which important information will the attorney share with the nurse concerning the case?
The nurse is protected by the Good Samaritan Act, which states the nurse may give emergency care using good judgment. Explanation: The nurse is protected by the Good Samaritan Act, which states the health practitioner may give emergency care in a prudent manner using good judgment. The nurse used two sturdy objects to immobilize the child's arm; therefore, she was not grossly negligent. A prudent nurse would have done the same. The Good Samaritan Act states the health care practitioner is not obligated to assist; however, it protects the practitioner if she decides to render emergency care.
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 he or she 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 letter should be kept to one page. The letter should be addressed to one legislator only, not a group of individuals.
After reporting to work for a night shift, the nurse 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 clients, in addition to her regular client assignment. Which statement is true for this nurse when working in understaffed circumstances?
The nurse will be legally held to the same standards of care as when staffing levels are normal. Explanation: The claim of being overworked does not constitute a legal defense, and both the potential for liability and standards of care remain unchanged despite an increased client assignment. While it is prudent to make all realistic attempts to fill the gaps in staffing, documenting these efforts does not change the nurse's legal position. A nurse has the right to refuse an unsafe client assignment but the nurse is not legally obliged to withhold care.
A student nurse is assisting an older adult client to ambulate following hip replacement surgery when the client falls and reinjures the hip. Who is potentially responsible for the injury to this client?
The student nurse, the nurse instructor, and the hospital Explanation: As a student nurse, you are responsible for your own acts, including any negligence that may result in client injury. A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. The status of students enrolled in college and university programs is less clear, as is the liability of the educational institution in which they are enrolled and the health care agency offering a site for clinical practice. Nursing instructors may share responsibility for damages in the event of client injury if an assignment called for clinical skills beyond a student's competency, or the instructor failed to provide reasonable and prudent clinical supervision.
A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which legal term describes the case?
Tort Explanation: A tort is a litigation in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. The lack of action on the nurse's part truly indicates unintentional tort. A misdemeanor or felony would be an offense under criminal law, and neither is applicable in this case. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.
The nurse educator provides an educational session to the nursing staff on protection of a client's privacy. Which circumstances, identified by the staff, would indicate to the educator that the teaching was effective? Select all that apply.
With the client's permission, the nurse explained the client's diagnosis to the client's spouse. The nurse removed the client from the emergency department waiting room into a private area to collect assessment data. Explanation: To prevent invasion of privacy, all client information is considered confidential and private; this includes name and all identifiers (e.g., social security number, address, date of birth). With the client's permission, information can be shared with a spouse. A client should be taken to a private, soundproof area to collect data. Unnecessary exposure of a client's body, taking pictures of a client, and questioning a client's social life when it does not affect care planning are examples of invasion of privacy.
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which guideline is true regarding a nurse's role is witnessing a testator's signature?
Witnesses to a signature do not need to read the will. Explanation: 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.
A legal document that states a client's health-related wishes — such as a preference for pain management if the client becomes terminally ill — and also allows the client's daughter to direct his care, is a(an):
advance directive. Explanation: Clients communicate their wishes to health care providers by verbally participating in health care decision making and by employing written documents called advance directives.
A student is preparing to graduate from nursing school and understands that professional regulations and laws that govern nursing practice are in place. These regulations and laws are in place for which reason?
to protect the safety of the public Explanation: Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.
