Fundamentals of Nursing Ch. 4

An older adult fell at home and fractured a hip, which requires surgical repair. After admittance to the emergency department, the client was given sedation for pain before a surgical permit was signed. What should be done to obtain consent? 1. The physician should have the clients wife sign the consent form. 2. The physician should wait until the effects of the medication wear off and have the client sign the form. 3. Because the client has been medicated, the nurse should thoroughly explain the consent form to the client. 4. This would be considered an emergency situation and consent would be implied.

Correct Answer: 1 Rationale 1: A client who is confused, disoriented, or sedated is not considered functionally competent and a legal guardian or representative can provide or refuse consent for the client. In this case, because the client was given medication that sedated him, the wife would be appropriate for giving consent for the surgical procedure. Rationale 2: Waiting until the effects of the medication wear off would not be in the best interest of the client. Rationale 3: Thorough explanation may or may not matter in this case because the client is considered functionally incompetent. Besides, it is the physicians responsibility to obtain informed consent. Rationale 4: Implied consent may be used in a medical emergency, but in this case, there is an appropriate option available.

The high school graduate desiring to attend nursing school reviews the schools for accreditation. Which regulatory bodys actions is the student analyzing? 1. State board of nursing 2. NLNAC 3. CCNE 4. ANA

Correct Answer: 1 Rationale 1: All states require that all schools of nursing in the state are approved/accredited by the state board of nursing. Rationale 2: Some but not all states require that programs be both state approved and accredited by a national accrediting agency such as NLNAC. Rationale 3: Some but not all states require that programs be both state approved and accredited by a national accrediting agency such as CCNE. Rationale 4: Voluntary accreditation is not required by all states and is a means of informing the public and prospective students that the nursing program has met certain criteria. The ANA (American Nurses Association) is nursings professional organization.

A nurse on the unit notices that a co-worker exhibits a pattern of behavior suggestive of drug abuse. What should the nurse do? 1. Report the situation to the unit charge nurse. 2. Send an anonymous letter to the director of nursing. 3. Let other co-workers know about the situation. 4. Report the situation, then let management take care of it.

Correct Answer: 1 Rationale 1: As a mandatory reporter, the nurse is required to report situations where co-workers are suspected of impairment, which includes alcohol/drug abuse as well as mental illness. The nurse should report the matter starting at the lowest possible level in the agency hierarchy. In this case, the charge nurse would be appropriate. Rationale 2: The nurse should take responsibility for the report by being open about it, not making an anonymous report to the higher level of management. Rationale 3: The nurse should obtain support from at least one other trustworthy person before filing the report. This doesnt mean telling the whole unit, which could be detrimental to both the nurse reporting the incident and the co-worker. Rationale 4: After the report is made, the nurse should see the problem through, not assume that management will take care of the situation.

The admitting nurse explains the process of signing forms to allow for the clients insurance company to be billed for services. If the insurance fails to pay for services, the client is responsible for payment. Which type of law did the nurse explain to the client? 1. Contract law 2. Tort law 3. Statutory law 4. Administrative law

Correct Answer: 1 Rationale 1: Contract law involves the enforcement of agreements among private individuals or the payment of compensation for failure to fulfill the agreements. Signing a form prior to receipt of health care services makes the client responsible for cost, regardless of insurance payment. Rationale 2: Tort law defines and enforces duties and rights among private individuals that are not based on contractual agreements. Rationale 3: Statutory laws are laws enacted by any legislative body. Rationale 4: Administrative laws give administrative agencies the authority to create rules and regulations to enforce statutory laws.

A client woke in the middle of the night, confused and unaware of the surroundings. Although the call light was within reach, the client got out of bed unassisted, tripped on the bedside chair, and fell. Which element of malpractice should the clients attorney realize is missing in this case? 1. Foreseeability 2. Damages 3. Injury 4. Duty

Correct Answer: 1 Rationale 1: Foreseeability is the link between the nurses act and the injury suffered. The call light was within reach, but the client did not use it and got out of bed unassisted. Nighttime confusion occurs with some clients, but unless the nurse had knowledge or awareness that this would happen, there was no link between the nurses action and the clients fall. Rationale 2: Damages may well be present, but these probably are not due to any action or inaction on the nurses part. Rationale 3: Injury may well be present, but this probably is not due to any action or inaction on the nurses part. Rationale 4: Duty was addressed this case because the call light was within reach

When providing client care the nurse demonstrates practices that are designed to provide legal protections from liability. Which actions is the nurse demonstrating? Standard Text: Select all that apply. 1. Checking the clients name band prior to the administration of a preoperative medication 2. Asking for help when moving a comatose client because the client can not be safely handled by one nurse 3. Attending an in-service on the appropriate use of a new piece of equipment used in the facility 4. Delegating only those tasks that he or she cant personally perform 5. Reviewing the five rights of medication administration when the client states, This doesn't look like my usual pill

Correct Answer: 1, 2, 3, 5 Rationale 1: Legal protection for nurses is best assured by always checking the identity of the client to make sure it is the right client. Rationale 2: Legal protection for nurses is best assured by asking for assistance and/or supervision in situations in which the nurse feels inadequately prepared. Rationale 3: Legal protection for nurses is best assured by maintaining clinical competence. Rationale 4: Delegation is a nursing responsibility that is designed to help provide quality and timely nursing care, but that is not its sole focus. Rationale 5: Legal protection for nurses is best assured by checking any order that a client questions.

The nurse manager is concerned that a staff nurses care demonstrates gross negligence. What actions did the manager use to make this determination? Standard Text: Select all that apply. 1. Removed a clients central line 2. Reconnected contaminated intravenous tubing to a client 3. Accessed the computerized documentation system with a password 4. Walked a client with a blood pressure of 70/58 mm Hg to the bathroom 5. Delegated nasotracheal suctioning for a client to unlicensed assistive personnel

Correct Answer: 1, 2, 4, 5 Rationale 1: Gross negligence involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk for harm. Removing a clients central line would be gross negligence. Rationale 2: Gross negligence involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk for harm. Reconnecting contaminated intravenous tubing would be gross negligence. Rationale 3: Accessing the computer documentation system with a password demonstrates compliance with HIPAA. Rationale 4: Gross negligence involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk for harm. Walking a patient with an unsafe blood pressure is gross negligence. Rationale 5: Gross negligence involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put others at risk for harm. Inappropriately delegating a skill is gross negligence.

The clinical nursing instructor determines that a nursing student understands the legal responsibilities to clients when providing care. What did the instructor observe to come to this conclusion? Standard Text: Select all that apply. 1. Prepared to discuss the clients medical diagnosis in pre-conference 2. Overheard stating, My care is held to the same standards as that of the unit nurses 3. Offers to stay with the client who is about to experience a painful diagnostic procedure 4. Addresses the staff and clients respectfully and by their full names 5. Asks for help with a dressing change involving techniques he or she has not yet performed alone

Correct Answer: 1, 2, 5 Rationale 1: Nursing students are held to the same standards as licensed nurses, and therefore need to make sure that they are prepared to provide the necessary care to assigned clients. Rationale 2: Nursing students are held to the same standards as licenses nursed, and therefore need to make sure that they are prepared to provide the necessary care to assigned clients. Rationale 3: Although offering to stay with a client during a painful procedure shows compassion, it is not a behavior representative of legal responsibility. Rationale 4: Although showing respect for staff and clients demonstrates professionalism, it is not a behavior that is representative of legal responsibility. Rationale 5: It is important that nursing students ask for help or supervision in situations for which they feel inadequately prepared.

While working a scheduled shift the nurse focuses on actions to protect the privacy of a client with local notoriety. What actions should the nurse take at this time? Standard Text: Select all that apply. 1. Secure the clients medical record. 2. Review the clients care with the media. 3. Remove the clients name from the door. 4. Permit family to view the clients record. 5. Fax the clients lab values with a cover sheet.

Correct Answer: 1, 3, 5 Rationale 1: Actions to ensure the clients privacy include securing the medical record. Rationale 2: Sharing the clients care with the media violates the clients privacy. Rationale 3: Actions to ensure the clients privacy include removing the clients name from the door. Rationale 4: Permitting family to view the clients record violates the clients privacy. Rationale 5: Actions to ensure the clients privacy include faxing information with a cover sheet.

The nurse manager learns that vital signs delegated to unlicensed assistive personnel (UAP) were not recorded accurately. With which care provider should the manager discuss this finding? 1. The UAP 2. The nurse 3. Both the UAP and the nurse 4. The team leader

Correct Answer: 2 Rationale 1: Although taking vital signs was an appropriate task to delegate to the UAP, the responsibility of the action in this case, the inaction, as the vitals were recorded in accurately is not fully assumed by the UAP. Rationale 2: Although taking vital signs was an appropriate task to delegate to the UAP, the responsibility of the action in this case, the inaction, as the vitals were recorded in accurately remains with the nurse. Rationale 3: Although taking vital signs was an appropriate task to delegate to the UAP, the full responsibility of the action in this case, the inaction, as the vitals were recorded in accurately is not shared by both the UAP and the nurse. Rationale 4: Delegating this task was not the responsibility of the team leader and thus he or she has no responsibility for this action.

A nurse is caring for a client in the emergency department (ED) who was brought in by her adult child for vague, flu-like symptoms. While helping the client to change into a gown, the nurse notices numerous bruises on the clients back and arms. When questioned, the client is distracted and ambiguous with her answers. Which action should the nurse take? 1. Report the situation to law enforcement. 2. Report the situation to social services. 3. Question the adult child who brought the client to the ED. 4. File a written report in the clients chart.

Correct Answer: 2 Rationale 1: In this case, social services should be notified. Law enforcement would be notified if the results of social services investigation warrant it. Rationale 2: Nurses are considered mandated reporters. As a result, they must report any situation when an injury is present and appears to be the result of abuse, neglect, or exploitation. The situation described may or may not be one of abuse or neglect, but the nurse is required to report it to the proper authorities. In this case, social services should be notified. Rationale 3: Questioning the clients adult child is appropriate, but the incident needs to be reported regardless of the questioning. Rationale 4: Documentation in the chart is extremely important, but this would be part of the nurses notes, not a separate written report.

The nurse is notified about new state practice act regulations. Which type of law should the nurse expect to implement and enforce the nurse practice act regulations? 1. Statutory law 2. Administrative law 3. Common law 4. Public law

Correct Answer: 2 Rationale 1: Statutory laws are laws enacted by any legislative body. Rationale 2: Administrative agencies are given authority to create rules and regulations to enforce statutory law when the state legislature passes a statute. State boards of nursing write rules and regulations to implement and enforce a nurse practice act, which was created through statutory law but is enforced by administrative law. Rationale 3: Common law refers to laws evolved from court decisions. Rationale 4: Public law refers to the body of law that deals with relationships between individuals and the government and governmental agencies.

An adult client who cannot read needs surgery and is competent to make his own decisions. What is the best action that the nurse should take? 1. Tell the client in the nurses own words what the surgical procedure involves. 2. Read the consent form to the client and have the client state understanding. 3. Make sure the physician explains the procedure to the client. 4. Have a family member who can read sign the consent form.

Correct Answer: 2 Rationale 1: Telling the client in words other than what is on the consent form is not appropriate, as some meaning and information may be lost in the transfer. Rationale 2: If a client cannot read, the consent form must be read to the client and the client must state understanding before the form is signed. Rationale 3: The physician should explain the procedure to the client, regardless of the clients literacy. Rationale 4: Because the client is a competent adult, he must be the one giving consent. Illiteracy does not make one incompetent.

A nurse who has been a longtime employee of a hospital, providing bedside care to clients, was seriously injured and is paralyzed from the shoulders down, with limited use of the upper arms. Through rehabilitation, the nurse is able to mobilize with a wheelchair and has no cognitive or psychological deficits. The nurse wants to return to the same position held prior to the injury. Under the guidelines of the ADA, what should the hospital do? 1. The hospital is required to accommodate the nurse. 2. The hospital must find another job for the nurse. 3. The hospital should claim undue hardship to accommodate this nurse. 4. The hospital terminate the nurses employment.

Correct Answer: 3

The nurse forgets to put the call light within the clients reach and then leaves the room. The client reaches for it and falls out of bed. With what should the nurse expect to be charged? 1. Assault 2. Battery 3. Negligence 4. Criminal intent

Correct Answer: 3 Rationale 1: Assault is the threat to touch another person unjustifiably. Rationale 2: Battery is the willful touching of a person that may cause harm. Rationale 3: Negligence is an example of a tort law. Negligence occurs when something is accidental and harm results, as in this case. Another example of negligence would be if surgical instruments or bandages are accidentally left in a client during surgery. Rationale 4: Criminal intent implies preplanned actions that are illegal.

A client scheduled for surgery has signed the consent form but refuses to have a Foley catheter placed, saying Thats not part of the surgery. What should the nurse do? 1. Explain that this is part of the surgical prep and continue with the procedure. 2. Explain that the client has already signed the consent, and place the catheter. 3. Respect the clients wishes and document accordingly. 4. Offer to call the physician.

Correct Answer: 3 Rationale 1: Battery exists when there is not consent, even if the client was not asked. In this case, the client has the right to refuse other treatment surrounding pre- and post-op care. Rationale 2: Battery exists when there is not consent, even if the client was not asked. In this case, the client has the right to refuse other treatment surrounding pre- and post-op care. Rationale 3: Consent is required before procedures are performed. Depending on the invasiveness of the procedure, a written consent may be required. The client signed a consent form for surgery, and the refusal for placement of a catheter should be respected. The nurse should document the incident and not continue with the procedure. Rationale 4: Calling the physician is not inappropriate.

A client is suing the hospital for malpractice. Before the case goes to court, the attorney meets with staff and reads the medical record. The nurse realizes that the attorney is performing which activity? 1. Burden of proof 2. Complaint 3. Discovery 4. Civil action

Correct Answer: 3 Rationale 1: Burden of proof falls to the plaintiff and is the duty to prove wrongdoing. Rationale 2: A complaint is a document filed by a person (plaintiff) who claims that his or her legal rights have been infringed on by one or more persons (defendants). Rationale 3: Discovery is an effort by both parties to obtain all the facts of the situation. It occurs before the trial. Rationale 4: A civil action is a legal action that deals with the relationships among individuals in society.

The nurse documents in a clients medical record: The client is a drug addict and is always asking for more medication than what is necessary. With what might the nurse be charged? 1. Defamation 2. Slander 3. Libel 4. Incompetence

Correct Answer: 3 Rationale 1: Defamation is verbal communication that is false or made with a careless disregard for the truth and that results in injury to the reputation of a person. Rationale 2: Slander is defamation by the spoken word. Rationale 3: Libel is defamation of character by means of print, writing, or pictures. Putting a statement such as this in the clients medical record is, first, making a diagnosis, which the nurse is not qualified to do, and, second, making an assumption about the clients need for medication, which is a personal attitude about how the client responds. Rationale 4: Incompetence relates to the ineffective or improper execution of nursing tasks.

A nurses co-worker makes a practice of telling offensive jokes or stories with a sexual undertone during the shift. Which action should the nurse take first? 1. Ignore the co-worker and walk away. 2. Report the incident to the nurse manager. 3. Tell the co-worker to stop the activity because the conduct is offensive. 4. Ask to be scheduled opposite this co-worker.

Correct Answer: 3 Rationale 1: Ignoring the situation is not addressing the situation in an assertive manner. Rationale 2: Reporting the incident to the nurse manager would be an appropriate second step if the behavior doesnt stop after the nurses approach. Rationale 3: Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the co-worker to stop, and why, is the first step in putting an end to the situation. Rationale 4: Asking to be scheduled opposite this person is not addressing the situation in an assertive manner

The client presents her hand when the nurse makes this statement: I need to start an IV so you can get your antibiotics. Which behavior did the client demonstrate? 1. Informed consent 2. Express consent 3. Implied consent 4. Compliance

Correct Answer: 3 Rationale 1: Informed consent is an agreement by a client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatment, and generally requires the clients signature (written consent) Rationale 2: Express consent may be either an oral or written agreement. In this case, there were neither spoken words nor a written consent form for the IV initiation. Rationale 3: Implied consent exists when the individuals nonverbal behavior indicates agreement. In this case, presenting the hand for IV initiation would be a nonverbal behavior indicating agreement with the treatment. Rationale 4: Compliance occurs when clients agree to follow the recommended treatment, usually by their own actions as in taking prescribed medications or following a prescribed diet.

Before applying for re-licensure, the nurse attends continuing education programs. Which action is the nurse performing to adhere to the state board of nursing expectation? 1. Licensure 2. Competency 3. Credentialing 4. Certification

Correct Answer: 3 Rationale 1: Licensure is the process of granting a legal permit to practice or engage in a profession, such as nursing. Rationale 2: Competency is a level of acceptable performance, and credentialing ensures this in licensure. Certification is also part of credentialing. It validates that an individual has met minimum standards of nursing competency in a specialty area. Rationale 3: Credentialing is the process of determining and maintaining competence in general nursing practice. It is one way to maintain the professional standards of practice and accountability for the members educational preparation. Rationale 4: Certification validates that an individual has met minimum standards of nursing competency in a specialty area.

A client is brought to the emergency department after being involved in a motor vehicle crash. Although the client is conscious, her condition is critical and will require emergency surgery. The client does not speak English. Which action should the nurse take? 1. Read the consent form and have the client sign it anyway. 2. Explain the form to the best of the nurses ability using pictures and gestures. 3. Have the hospital interpreter explain the procedure. 4. Proceed with surgery, as implied consent would be the case in this situation

Correct Answer: 3 Rationale 1: Reading the consent form to someone who doesnt understand the words is pointless. Rationale 2: There is a better option available than using pictures and gestures in the hope of explaining the procedure. Rationale 3: If the client does not speak the same language as the health professional who is providing the information, an interpreter must be present. Rationale 4: Implied consent indicates that the person understands what will be done.

A client being prepared for an invasive procedure questions some of the terminology in the consent form. Which response should the nurse make? 1. Just sign the form, and Ill make sure your physician talks to you before he begins the procedure. 2. I'll explain whatever you don't understand. 3. You should have asked your physician when he was in here. 4. I'll call your physician back in the room to answer your questions.

Correct Answer: 4 Obtaining informed consent for specific medical treatment is the responsibility of the person who is going to perform the procedure, in this case the physician. Informed consent suggests that the client has been given complete information, including benefits, risks, and alternatives if the treatment is not given. An element of informed consent is that the client must be given enough information to be the ultimate decision maker. If not, it is the physicians responsibility to make sure the clients understanding is clear. It is important that the person obtaining the consent (the physician in this case) answer the clients questions.

A client was given the wrong dose of medication and died. The case is being tried in court and similar cases are used by the court in comparison to arrive at a decision. Which doctrine should the nurses attorney explain is applied to this situation? 1. Common law 2. Public law 3. Administrative law 4. Stare decisis

Correct Answer: 4 Rationale 1: Common law is a type of law enacted by different entities. Rationale 2: Public law is a type of law enacted by different entities. Rationale 3: Administrative law is a type of law enacted by different entities. Rationale 4: Stare decisis, to stand by things decided, is a doctrine courts adhere to when arriving at a ruling in a particular case. The courts apply the same rules and principles applied in previous, similar cases.

A nurse who is opposed to abortion works in a hospital where abortions are performed. According to the Supreme Courts conscience clause, which action should the nurse take? 1. The nurse should not take action, because the nurse cannot interfere with a womans constitutional right to privacy. 2. The nurse should voluntarily terminate employment. 3. The nurse should counsel women before they have an abortion. 4. The nurse should refuse to participate in abortions.

Correct Answer: 4 Rationale 1: The nurse cannot interfere with a womans right to privacy, which includes control over her own body to the extent that she can abort her fetus. Rationale 2: The conscience clause states that nurses, as well as other health care personnel, have a right to refuse to participate in abortions. Rationale 3: Counseling a woman prior to an abortion would not be an appropriate action because the nurse has chosen to work in a hospital where these procedures are done. Rationale 4: In Roe v. Wade and Doe v. Bolton, the Supreme Court upheld that a womans right to privacy includes control over her own body to the extent that she can abort her fetus. Although the nurse cannot interfere with this, the conscience clause states that nurses, as well as other health care personnel, have a right to refuse to participate in abortions and hospitals have the right to deny admission to abortion clients.

The nurse carries out a medication order, incorrectly written by the physician and subsequently filled by the pharmacist. Who, in this situation, is legally liable for the action? 1. Physician 2. Pharmacist 3. Hospital 4. Nurse

Correct Answer: 4 Rationale 4: The responsibility for the nursing activity in this case, giving the medication belongs to the nurse. Liability is legal responsibility for ones action. Even though the physician wrote the order incorrectly and the pharmacist filled it, it was the nurse who carried it out, making that person ultimately responsible for the action.

The nurse is reviewing the Good Samaritan acts. For which situation should the nurse realize that these laws apply? 1. Giving CPR to a client brought to the emergency department, when the client later is found to have a Do Not Resuscitate order 2. Giving first aid to a child injured in a sporting event 3. Permitting a nursing student to try to insert an airway in an unconscious client 4. Leaving the scene of an emergency to call for help 5. Helping deliver the baby of a neighbor during a snowstorm

Correct Answer: 5