Chapter 7 PrepU N204
The nurse is assigned to various clients on a medical unit. Which statement(s) made to a client by the nurse constitutes assault? Select all that apply. A. "I will withhold your cell phone until you pay full attention to these discharge instructions." B. "I am going to insert a catheter in you, if you do not get up to go to the bathroom." C. "Give me your hand to hold, I can see you are upset by the bad news." D. "Hold still for these stitches; otherwise, I am going to have to hold you down." E. "Let me help you get your shirt off, so I can listen to your lungs."
B. "I am going to insert a catheter in you, if you do not get up to go to the bathroom." D. "Hold still for these stitches; otherwise, I am going to have to hold you down."
A nurse suspects that a client is a prostitute. The nurse documents this suspicion in the medical record and includes it in report to the oncoming shift. The nurse also mentions the suspicion to the nurse's sister saying, "I had a client named Susan in room 126 today who I think is a prostitute." Which violations has this nurse committed? Select all that apply. Libel Assault HIPAA Slander Battery
Libel Slander is the spoken defamation of character; libel is written defamation. HIPAA rules are violated when a client's personal information is disclosed. The use of the client's room number and name make her presence in the facility discoverable. The nurse did not threaten the client (assault) or physically touch the client (battery).
What governing body has the authority to revoke or suspend a nurse's license?
The State Board of Nurse Examiners
A nurse enters a client's room and finds that the client is lying on the floor. The nurse makes the client comfortable on the bed and completes an examination. She informs the physician and the nursing supervisor about this incident and also completes an incident report. Which action by the nurse indicates correct knowledge of handling an incident report? The nurse documents a complete description of the happenings in the client's records. The nurse makes a copy of the incident report and places it in the client's records. The nurse makes a copy of the incident report to give to the physician. The nurse mentions in the client's report that an incident report was completed.
The nurse documents a complete description of the happenings in the client's records. A. An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. It is kept separate from the medical record. The incident report is a legal document and making a copy of it is not advisable. It should not be placed in the client's records; however, the nurse can mention the incident in the client's records without mentioning the incident report.
A client requests that the nurse allow the client 15 minutes two times a day for prayer during hospitalization. What value does this represent? A. Foundation value B. Focused value C. Free value D. Future value
A. Foundation value A habitual act is indicative of a foundation value.
A nurse is overheard in the hospital cafeteria making false, derogatory comments about a client. The nurse is guilty of: A. slander. B. libel. C. invasion of privacy. D. assault.
A. slander.
A nurse is called to a deposition for a malpractice charge that has resulted in the death of a client. As the chart is reviewed, the prosecuting attorney questions the nurse about several defaming comments written in the medical record about the client. What charges can be filed against the nurse due to these comments? A. Malpractice B. Slander C. Libel D. Negligence
C. Libel Libel is damaging statements written and read by others. Because defaming comments were written in the chart, libel charges could be appropriate. Malpractice is negligence in performing or failing to perform expected duties of one's profession. Slander is oral defamation of character. Negligence is performing an action a reasonable person would not perform or failing to perform an action that a reasonable person would perform, resulting in harm to another.
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? A. The student nurse B. The nurse instructor C. The hospital D. The student nurse, the nurse instructor, and the hospital
D. The student nurse, the nurse instructor, and the hospital 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 nursing student administers an overdose of a narcotic to a client and the client arrests. When discussing the incident with nursing faculty, which statements made by the student indicate the need for further teaching? Select all that apply. A. "I realize that I am held to the same standards as a registered nurse." B. "I have also put the nursing faculty at risk with my action." C. "I am glad I am a student because nursing faculty will be blamed, not me." D. "I should have informed you that I felt unprepared for my assignment." E. "I cannot be held liable because this is only my second time at this facility."
C. "I am glad I am a student because nursing faculty will be blamed, not me." E. "I cannot be held liable because this is only my second time at this facility."
Nurses complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report? A. To document everyday occurrences B. To document the need for disciplinary action C. To improve quality of care D. To initiate litigation
C. To improve quality of care The primary reason to fill out an incident report is to improve the quality of care. Incident reports are not designed to be a means for disciplinary action. Incident reports are designed to identify actual or potential risks that can be addressed to improve quality of care. Incident reports are not intended to initiate litigation or document everyday occurrences.
An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor? A. Battery B. Assault C. Fraud D. Defamation of character
A. Battery The UAP is engaging in battery, which is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to (or held by) that other person. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that harm the other party's reputation.
Which statement best conveys the concept of ethical agency? A. Ethical practice requires a skill set that must be conscientiously learned and nurtured. B. Individuals who enter the nursing profession often innately possess ethical characteristics. C. Ethical practice is best learned and fostered by surrounding oneself with people who exhibit ethical character. D. A nurse's understanding and execution of ethical practice is primarily a result of increased years of experience.
A. Ethical practice requires a skill set that must be conscientiously learned and nurtured. Ethical agency must be cultivated in the same way that nurses cultivate the ability to do the scientifically right thing in response to a physiologic alteration. It is inaccurate to assume that it will passively develop from the presence of other ethical practitioners, or from years of experience. It is not an innate characteristic of personality.
A new graduate wants to be knowledgable about state-mandated rules to better practice within the scope of nursing. What are the best resources for this nurse to research? Select all that apply. A. Nurse practice acts B. Medicare and Medicaid provisions for reimbursement of nursing services C. Nursing educational requirements D. Delegation trees E. Composition and disciplinary authority of board of nursing F. Medication administration
A. Nurse practice acts C. Nursing educational requirements E. Composition and disciplinary authority of board of nursing Examples of state-mandated rules would include nurse practice acts, nursing educational requirements, and composition and disciplinary authority of boards of nursing. Delegation trees, medication administration, and Medicare and Medicaid provision for reimbursement of nursing services are not examples of state-mandated rules.
Nurse practice acts are examples of which type of laws? A. Statutory laws B. Constitutional laws C. Administrative laws D. Common 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. Constitutional law refers to rights carved out in the federal and state constitutions. The majority of this body of law has developed from state and federal supreme court rulings, which interpret their respective constitutions and ensure that the laws passed by the legislature do not violate constitutional limits. Administrative law is the body of law that governs the activities of administrative agencies of government. Common law is the body of English law as adopted and modified separately by the different states of the U.S. and by the federal government and is in contrast with statutory law.
A client is being prepared for an elective surgical procedure and the consent form has not been signed. Who should the nurse have obtain consent for the procedure? A. The health care provider performing the surgical procedure B. The client's family or significant other C. The perioperative nurse D. The nursing supervisor
A. The health care provider performing the surgical procedure The nurse should inform the surgeon the consent has not been signed. Obtaining informed consent is the responsibility of the person who will be performing the diagnostic or treatment procedure or the research study. In this particular case, the surgeon, the client, and a witness, all need to sign the consent form. The nurse's roles are to confirm that a signed consent form is present in the client's chart and to answer any client questions about the consent.
Nurses are occasionally asked to witness a testator's (person who makes the will) signing of a will. Which guideline is true regarding a nurse's role in witnessing a testator's signature? A. Witnesses to a signature do not need to read the will. B. Witnesses do not need to observe the signing of the will and can sign it at a later time. C. A beneficiary to a will is allowed to act as a witness. D. A single witness is sufficient for a will.
A. 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 it 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.
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.Health care institution B.Federal legislation C.State legislation D.Board of nursing
A.Health care institution The health care 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. Unit and institutional-based policies are not derived from federal legislation, state legislation, or the board of nursing.
The client being admitted to the oncology unit conveys wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in the client's best interest to obtain which document? A. A will B. A living will C. Proof of health care power of attorney D. A proxy directive
B. A living will 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 otherwise unconscious condition. A will is a legal document detailing how to dispose of one's assets and belongings upon death. Proof of health care power of attorney and a proxy directive are documents identifying another person to legally make health care decisions for the client. In this case the client is stating the client's own decisions in advance of potential incapacitation.
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? A. Negligence B. Malpractice C. Assault D. Battery
B. Malpractice 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 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? A. To determine the nurse's fault in the incident B. To evaluate the quality of care provided and assess the potential risks for injury to the client C. To provide information to local, state, and federal agencies D. To evaluate the immediate care provided by the nurse to the client
B. To evaluate the quality of care provided and assess the potential risks for injury to the client 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.
Socialization into the nursing profession may have the most significant effect on: A. roles. B. values. C. documentation. D. planning.
B. values Socialization into a culture refers not only to the adoption of practices, such as documentation and planning, and ways of relating to one another (roles) but to the very beliefs that one holds to be most important (values). Because values guide one's practices and roles, the most significant effect of socialization into nursing would be its effect on values.
A nurse has been named in a malpractice lawsuit. Prior to taking the nurse's deposition, the attorney explains that the case will be governed by common law. Which question by the nurse is indicated? A. "Why is this not a statutory case?" B. "Does that mean the findings of the case are not binding?" C. "Will this case be precedent setting?" D. "Will the board of health be involved?"
C. "Will this case be precedent setting?" Most law involving malpractice is common law. If a case is the first to set down a rule by its decision, a precedent will be set. Statutory law, such as state nurse practice acts, is enacted by the legislature. The findings of the case are binding in a common law case. The law establishing a board of health is known as administrative law.
A nurse is providing care to an older adult client. The client has been alert and independent with ambulation but now is exhibiting some confusion along with being unsteady when getting out of bed and walking. The nurse fails to report and document this change in status. No safety measures are taken and the client falls while getting out of bed to use the bathroom and fractures a hip. The client is experiencing significant pain from the fractured hip and requires surgery to repair the fracture. The nurse is sued for malpractice. Which action reflects the element of causation in this case? A. Responsibility to report changes in status B. Failure to document and report the change C. Lack of safety measures implemented with status change D. Fractured hip, pain, and need for surgery
C. Lack of safety measures implemented with status change Causation is reflected by the nurse's failure to implement appropriate safety measures due to the change in the client's status. This failure causes the client to fall while attempting to get out of bed, resulting in a fractured hip. Duty is reflected by the responsibility of nurses to accurately assess clients, report changes in status, and implement measures to address changes in status. Breach of duty is reflected by (a) the failure to note and report that an older adult client previously assessed as alert and independent in ambulation is now exhibiting periods of confusion and unsteadiness when walking; and (b) by failure to execute and document use of appropriate safety measures (e.g., assisted ambulation). Damages are reflected in the result—that is, the fractured hip, pain, and need for surgery.
A client is scheduled for a colonoscopy. The nurse realizes immediately after administering medications to induce conscious sedation that the client has not signed the informed consent. If the nurse has the client sign the informed consent at this point, which element of informed consent would be violated? A. Disclosure B. Comprehension C. Competence D. Voluntariness
Competence The client under conscious sedation would not be considered competent to make a decision to undergo an invasive procedure such as a colonoscopy. Disclosure ensures that the following information has been given to the client: the nature of the treatment, possible alternative treatments, and potential risks and benefits of the treatment. Comprehension is met when the client demonstrates understanding by describing in the client's own words to what he is consenting. The client's consent must be given voluntarily.
A client states that the client's recent fall was caused by his scheduled antihypertensive medications being 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? A. Document the client's claims and the events surrounding the alleged incident. B. Consult with the hospital's legal department as soon as possible. C. Consult with practice advisors from the state board of nursing. D. Enlist support from nursing and non nursing colleagues from the unit.
Document the client'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, especially when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.
