Zerwekh Chapter 20 Study Guide
The nurse has an adequate understanding of risk management when stating which of the following? (Select all that apply.)
"Risk management becomes involved when incidents occur." "Risk management becomes involved when untoward events occur." "Risk managers gather evidence surrounding the event." "Risk managers will interview those involved in an event."
In a legal suit, what element is necessary to prove a tort has been committed? a. Intent b. Assault c. Injury d. Malpractice
ANS C There are four elements that need to be present in a malpractice case, one of which is patient injury. The patient will have to prove that the specific nursing action caused injury or harm. The nurse, as a defendant, does not have a "burden of proof."
Which of the following statements by the nurse indicates understanding of legal actions? a. "A misdemeanor is a less serious crime resulting in a fine." b. "A felony is a less serious crime that can result in a fine." c. "Civil actions are serious and often result in prison time." d. "The defendant is the victim."
ANS: A A misdemeanor is a less serious crime resulting in a fine. A felony is a serious crime that often results in prison time. In court cases, the victim is the plaintiff.
Which of the following would be considered a criminal action? a. A nurse who steals narcotics from the hospital b. A nurse who gets into a verbal disagreement with a visitor c. A nurse who restrains a patient who is considered a threat to himself d. A nurse who refuses to allow a visitor onto the unit who appears intoxicated
ANS: A An example of a criminal action is the nurse who steals narcotics from the hospital. Verbal disagreements, restraining a patient who has the potential to harm themselves, and refusing visitors who appear intoxicated are not examples of a criminal action.
A student nurse is studying assault and battery. The student interprets assault and battery to include a. the nurse, without consent, touched the patient in an offensive, insulting, or injurious way. b. the nurse threatened to put the patient in restraints if they did not stay in bed. c. the nurse said the bill has to be paid before the patient can leave. d. the nurse failed to perform an act expected of a reasonable nurse.
ANS: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Permission to do this touching is usually implied when the patient seeks medical care. Using restraints or threatening to use them on competent patients to make them do what you want them to do against their wishes is an example of false imprisonment. Failure to perform an act expected of a reasonable, prudent nurse can constitute negligence.
A nurse tells a patient, "If you don't stop getting out of that chair, I'm going to put some restraints on you." What may this nurse be accused of? a. False imprisonment c. Invasion of privacy b. Defamation d. Malpractice
ANS: A Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Use of restraints may also be interpreted as false imprisonment. False imprisonment means making someone wrongfully believe that they cannot leave a place. It is often associated with assault and battery claims. Assault and battery are the legal terms applied to nonconsensual threat of touch (assault) or the actual touching (battery). Malpractice is the improper performance of professional duties, a failure to meet the standards of care that results in harm to another person. Defamation (libel and slander) refers to causing damage to someone else's reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander. Invasion of privacy applies to several behaviors, such as photographing a procedure and showing it without the patient's consent, going through a patient's belongings without consent, or talking about a patient's private life publicly.
Which of the following can result in a civil action against the nurse? a. Failure to monitor b. Enforcing strict compliance with contact precautions against the family's wishes c. Refusing to discuss the patient's medical history with the family per patient request d. Assisting the physician in a bedside procedure after obtaining informed consent
ANS: A Failure to monitor can result in a civil action against the nurse. Enforcing strict compliance with contact precautions against the family's wishes, refusing to discuss the patient's medical history with family per the patient's request, and assisting the physician in a bedside procedure after obtaining informed consent are not examples that could lead to civil action.
The nurse enters a patient's room to complete the discharge paperwork and finds the patient in tears. The patient reports that someone from the business office stated they could not leave the hospital until the bill was paid. What is the best nursing action? a. Comfort the patient and continue the preparations for discharge. b. Call the social worker for a financial evaluation. c. Call the family to arrange for the payment. d. Cancel the discharge plans and notify the physician of the situation.
ANS: A The best action is to comfort the patient and continue the discharge preparations. If the patient's claim is accurate, this could be false imprisonment (wrongfully making someone believe that they cannot leave a place). The nurse's best action is to comfort the patient and continue the discharge preparations. However, this should also be reported to the supervisor. Calling the social worker or the contacting the family is not appropriate.
A graduate nurse is preparing to start a first nursing job. What action would be the best legal safeguard for the graduate nurse to take? a. Competent practice c. A valid license b. A legal contract d. Following management policies
ANS: A The best legal safeguard is competent practice. Practicing within the parameters of the state's Nurse Practice Act, performing care based on established policies and procedures, and performing as a reasonable nurse are the best ways for a nurse to safeguard against legal action. It is important to maintain a current license and follow management policies; however, the best safeguard is being competent. A legal contract is not necessary for all situations and is not necessarily the best legal safeguard.
During a malpractice suit, how can the standard of "what the wise and prudent nurse would do" best be established? a. From the testimony of an expert nurse b. By consulting with nursing faculty regarding standards of care c. Conferring with a lawyer regarding malpractice parameters d. By consulting the standards of The Joint Commissions
ANS: A The most common way to establish the duty owed by a nurse is by the testimony of a registered nurse— usually, but not always, with training and background similar to the nurse being sued. This expert witness will then testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. The Joint Commission standards may reflect on hospital policies and procedures, not the nurse's practice. A lawyer provides legal advice but cannot attest to the standards of nursing practice that a nurse can. Faculty can be knowledgeable about standards of care, but the testimony of a nurse with similar training and background can determine what the wise and prudent nurse would have done.
A nurse places a heating pad on the lower leg of a patient with peripheral vascular disease. When the heating pad is removed, it is apparent that the patient has sustained partial-thickness burns to the area covered by the pad, and the nurse is sued for malpractice. Which statement is true? a. All elements are present to find the nurse liable for damages. b. Proximate cause cannot be established, so the nurse will not be found liable. c. The standard of care in such a situation cannot be established, so the nurse will not be found liable. d. No duty to the patient exists, so the nurse will not be held liable.
ANS: A The nurse had a duty, that duty was breached, the injury was foreseeable, and the patient suffered harm (partial-thickness burn). All four elements for a malpractice suit are present. The other options do not show that all elements are present and are therefore incorrect.
A nurse has just administered a medication when suddenly realizing that more medication was given than was ordered. Which action should the nurse take? a. Call the patient's physician and report the error. b. Say nothing about the medication error and continue to monitor the patient. c. Document the dose that was supposed to be given in the medical record. d. Document the amount given in the medical record but keep the error quiet.
ANS: A The nurse should call the physician and report the error after assessing the patient's condition. The nurse should never falsify a document in the medical record or keep the error to themself.
A nurse is giving a presentation on malpractice. Which statement indicates the nurse understands malpractice? a. "The elements of duty, breach of duty, and patient injury must be present for a malpractice claim." b. "Negligent nursing care and failure to follow standards must be present for a malpractice claim." c. "Failure to report, defamation, and discrimination must be present for a malpractice claim." d. "Error in judgment and invasion of privacy must be present for a malpractice claim."
ANS: A There are three elements that must be present for a malpractice claim: (1) You must have a duty—there must be a professional nurse-patient relationship. (2) You must have breached a duty that was foreseeable—you must have fallen below the standard of care. (3) Your breach of duty caused patient injury or damages. The other options do not indicate the nurse's understanding of malpractice.
The nurse understands "scope of nursing practice" when making which of the following statements? a. "The scope of nursing practice includes acts that permit some overlap between nursing and medicine." b. "The scope of nursing practice includes activities that are legally permissible for a nurse to perform in a particular state." c. "The scope of nursing practice are the specific duties the nurse owes to a patient." d. "The scope of nursing practice involves those activities for which a nurse can be held liable for malpractice."
ANS: B Defining the scope of nursing practice is part of the responsibility of the state board of nursing. This involves determining the specific activities for each level of nursing and who can perform what functions. The duty that a nurse owes to a patient is part of the professional nurse-patient relationship. Any nursing activity that is outside the scope of nursing practice can be grounds for malpractice or negligence.
What action might be taken on a nurse who commits an infraction of the Nurse Practice Act? a. The nurse is subject to discipline by a court of law. b. The nurse is subject to discipline by the state board of nursing. c. The nurse is subject to discipline by the local chapter of the state nurses association. d. The nurse is subject to discipline by the National League for Nursing.
ANS: B The Nurse Practice Act is regulated and enforced by the state board of nursing. State Nurse Practice Acts regulate nursing by controlling the scope of practice and determining the specific activities for each level of nursing. Some states control who may use the titles registered nurse (RN) and licensed practical nurse (LPN) or licensed vocational nurse (LVN). The Nurse Practice Act is regulated and enforced by the state board of nursing. The National League of Nursing is involved with nursing program accreditation. The local state nurses association does not provide discipline for infarctions to the Nurse Practice Act. Only if the infarction is of a criminal nature will the state board of nursing refer the case to the local court of law.
At the time of admission, a patient gave a history of allergy to penicillin that was duly noted in all critical areas of the patient's record. While giving medications, a nurse accidentally administered penicillin to this patient. The patient had a severe reaction but recovered. What is the implication of the nurse's action? a. The nurse cannot be sued for malpractice because the patient did not directly advise the nurse of the allergy. b. The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. c. The nurse who gave the medication can bring a countersuit against the nurse who took the history. d. There is no cause for concern because the action did not result in the patient's death.
ANS: B The nurse failed to act in a reasonable and prudent fashion and thus is liable for malpractice. The most common errors include failure to administer the right drug to the right patient, in the right amount, by the right route, at the right time, and with the right documentation. Claims involving medication errors are augmented when the nurse fails to record the medication administration properly, fails to recognize side effects or contraindications, or fails to know a patient's allergies. There is no justification for the nurse to bring about a countersuit for the nurse who took the medication history because it was clearly noted in all critical areas of the chart.
Which statement by the nurse indicates understanding of the nurse practice act? a. "The nurse practice act defends any action the nurse may take." b. "The nurse practice act defines the scope of practice for each level of licensure." c. "The nurse practice act details pay raises for each year of service to an organization." d. "The nurse practice act has language that grants nurses vacation time."
ANS: B The nurse practice act defines the scope of practice for each level of licensure. It is a type of state statutory law and can be obtained from the state board of nursing or online. It does not defend any action the nurse may take, detail pay raises, or discuss vacation time.
A nurse has relocated to another state and wants to find a full-time nursing job. What action should be taken first in order to provide care as a nurse? a. Begin applying for jobs at the local hospital. b. Contact the board of nursing in the nurse's new state to obtain licensure to practice. c. Begin practicing immediately, as the nurse is still licensed in the formerly lived in state. d. Begin practice on a part-time basis so that a new license is not needed.
ANS: B The nurse should contact the board of nursing in the state the nurse just moved to in order to determine what needs to be done to obtain licensure to practice in that state. The nurse should not begin practicing without an updated license even on a part-time basis. Each state may require a new license, and the nurse will not be covered by a license issued in another state unless the state is part of the nurse licensure compact. Either way, the nurse will need to contact the board of nursing first.
Which error in judgment would be the most serious for the nurse defendant in a legal case? a. Discussing the case with the plaintiff b. Tampering with the chart c. Hiding information from the plaintiff's attorney d. Being discourteous on the witness stand
ANS: B The patient's chart is a legal document. Changing or tampering with the chart would be in violation of the standards of practice, and the Nurse Practice Act and would not be considered "what a reasonable nurse would do." The nurse is expected to perform as a reasonable nurse would. If your actions are not those of a reasonable nurse and this causes someone to be injured, you can be sued. Being discourteous on the witness stand may not be professional. It is also not appropriate to discuss the case with the plaintiff or hide information; however, tampering with the chart is a more serious error in judgment.
A nurse wants to avoid malpractice claims. What action can be taken to greatly reduce the risk of a lawsuit? a. Reduce work status to part time. b. Implement fall precautions on an older adult patient. c. Leave clutter on the floor in patient rooms. d. Leave the patient's bed in the highest position.
ANS: B To protect themself from a malpractice claim, the nurse can implement fall precautions on an older adult patient. These include supervising the patient when getting out of bed, keeping the floor clear, and placing the bed in the lowest position. Reducing work status to part time would not guarantee that the nurse wouldn't be named in a lawsuit.
A nurse understands informed consent when making which of the following statements? a. "Informed consent is a binding agreement." b. "Informed consent involves filling out an incident report." c. "Informed consent occurs when the patient receives information about a procedure before giving consent." d. "Informed consent is a name for a written legal policy."
ANS: C Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for it to be done. Informed consent is not a binding agreement, an incident report, or a written legal policy.
The nurse has an adequate understanding of nurse practice acts when stating which of the following? a. "Nurse practice acts do not help guide nurses." b. "Nurse practice acts describe how to prepare for the NCLEX exam." c. "Nurse practice acts describe how and when to renew a nursing license." d. "Nurse practice acts provide a list of job openings."
ANS: C Nurse practice acts are great resources that provide information to nurses, including how and when to renew a nursing license. The nurse practice acts do not describe how to prepare for the NCLEX exam or provide a list of job openings.
A nurse is providing care to a 6-year-old child with a broken arm. The nurse notices multiple bruises. The child says, "my father got mad because I was bad, and he hit and broke my arm so that I would remember to be good." What is the best nursing action? a. Chart that the child is a victim of abuse. b. Do nothing because the nurse cannot prove the child was abused. c. Report the situation to the appropriate authorities. d. Ignore what the child said because little children often lie.
ANS: C States have many statutes that require health care providers to report certain incidences or occurrences. If the provider fails to report as required and a person is injured, there can be negligence per se. It important for nurses to be aware of the reporting statutes in the state in which they are practicing. In most states, it is the law to report evidence of child or adult abuse. It is not appropriate to chart a decision that the child is a victim of abuse but rather to accurately describe injuries and comments that are made. Nurses should listen to what the patient has to say—whether the patient is a child or adult.
What action must occur to prove a breach of duty? a. Liability testimony of physician b. Testimony from state board of nurses c. Expert testimony d. Testimony of coworkers
ANS: C The duty of a nurse is to act as a reasonable nurse would under the same or similar circumstances. An expert witness may testify as to what a reasonable nurse in the same or similar circumstances would be expected to do. Testimony from a physician, the state board of nursing, or coworkers does not establish a breach of duty. The state board of nursing provides the statues and laws that govern nursing practice.
In transcribing orders for a patient, the nurse finds a new order for aspirin, 500 mg, QID. The patient has a long history of gastrointestinal bleeding. What is the best nursing action? a. Give the medication. b. Withhold the medication and chart why it was not given. c. Call the physician and question the order in light of the patient's history. d. Ask if the patient is allergic to aspirin.
ANS: C The nurse should call the physician and question the medication order for aspirin based on the patient's history of gastrointestinal (GI) bleeding. Claims involving medication errors are augmented when the nurse fails to recognize side effects or contraindications or fails to know a patient's allergies. The nurse would withhold the medication until the physician is notified and the order clarified. Giving the medication could cause the patient to start bleeding. Although asking for allergies is an important nursing action, the important aspect in this situation in the medical history of GI bleeding.
During a life-threatening emergency, a nurse hurriedly gives the patient a medication by IV push. There is extravasation of medication. Later, necrosis and tissue sloughing take place. The nurse's behavior may be the basis for what action? a. Felony charge b. Misdemeanor charge c. Tort suit d. Defamation suit
ANS: C Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Civil, as opposed to criminal, actions are also called torts. Remember that civil actions occur when a plaintiff files a lawsuit to receive compensation for damages he or she suffered as a result of a perceived wrong. Unintentional torts are those that usually involve an inadvertent, unreasonable act that causes harm to someone. Defamation (libel and slander) refers to causing damage to someone else's reputation. If the means of transmitting the damaging information is written, it is called libel; if it is oral or spoken, it is called slander.
What is a significant action a nurse can take to prevent being named in malpractice suits? a. Refuse to care for suit-prone patients. b. Carry professional liability insurance. c. Maintain updated professional knowledge and skills. d. Check with a nursing supervisor before undertaking care.
ANS: C When you become a registered nurse, you will have a license to practice nursing. This license sets certain standards, which you must follow as a nurse in the state. Should you not live up to these standards, your state can take away your ability to practice as a nurse. The best way to maintain those standards to practice professionally is to stay updated on skills and knowledge. Refusing to care for patients does not prevent you from being named in other malpractice suits. Carrying professional liability insurance does not prevent a malpractice suit but may provide assistance and monies in paying out claims. Although it is important to check with a supervisor about questions concerning nursing care, it may not prevent you from being named if you perform a procedure or intervention incorrectly.
What would be the most effective way for a nurse to validate "informed consent?" a. Check the chart for a completed and signed consent form. b. Determine from the physician what was discussed with the patient. c. Ask the family whether the patient understands the procedure. d. Ask the patient what he or she understand regarding the procedure.
ANS: D Asking the patient (not the family unless the patient is a minor child) what he or she understands regarding the procedure is an effective way to validate informed consent. Informed consent in the health care setting is a process whereby a patient is informed of the risks, benefits, and alternatives of a certain procedure and then gives consent for the procedure to be done. The piece of paper is simply evidence that the informed consent process has been completed. Determining from the physician what was discussed does not guarantee that the patient understands what was explained.
Which definition, given by the nurse indicates understanding of malpractice? a. "Malpractice is a criminal act committed against society." b. "Malpractice means doing something a reasonable person or nurse would not do." c. "Malpractice is an intentional professional act of negligence." d. "Malpractice is a professional act or failure to act that leads to injury of a patient."
ANS: D Malpractice may be defined as doing something outside your scope of practice or something that is unsafe for the patient and could cause injury. A criminal act committed against society may be a felony or a misdemeanor. Negligence is the failure to act as an ordinary prudent person when such failure results in harm to another.
What is a correct statement regarding a nurse who acts beyond the scope of practice? a. Demonstrates what a good nurse he or she can be b. Provides enriched services to patients who would not otherwise receive them c. May make other nurses angry because of the increased expectations created d. May be disciplined by the board of nursing
ANS: D States may regulate nursing practice by controlling the scope of practice and determining the specific activities for each level of nursing. In most states, the Nurse Practice Act provides definitions and scope of practice for each level of nursing practice. The power of the board to discipline can have an adverse effect on the nurse's ability to practice. Practicing beyond the scope of practice does not demonstrate what a good nurse the person is and does not provide enriched services. Other nurses would not be angry at increased expectations but at the foolishness of the nurse practicing beyond the scope of practice.
A nurse is completing an incident report. The nurse demonstrates an adequate understanding of the report when refraining from putting which of the following on the form (Select all that apply.)
Conclusions about the incident Blame of others Judgment The nurse's opinion about what happened
Which actions take place in organizations to monitor quality improvement? (Select all that apply.)
Evaluation of what nurses are doing for patients Development of policies and procedures Employee evaluations Continuing education
A nurse is preparing to give an IM injection. This nurse has read several recent articles disputing the necessity of aspirating air when giving IM injections. Which action by the nurse is best? a) Look up the facility's policy on giving IM injections. b) Ask the charge nurse for advice on what to do. c) Do not aspirate, as this appears to be the best practice. d) Call the state board of nursing for their opinion.
a) Look up the facility's policy on giving IM injections. The nurse should look up and follow the facility's policy when giving IM injections. The charge nurse may or may not be a reliable source of information. The best action is to look up the policy. The nurse should not follow the recommendations in the article if they are contrary to policy; however, the nurse could refer this issue to the policy committee. The state board would likely refer the nurse to the institution's policies.
A nurse is in the process of confirming medications for a patient but is interrupted to take a call from a physician. Which action by the nurse is best? a) Start the medication confirmation process over. b) Finish confirming the medications and then give them. c) Delegate the confirmation process to another nurse. d) Hurry up and complete the medication administration.
a) Start the medication confirmation process over. The nurse should be very cautious when interrupted during a procedure. The most prudent thing for the nurse to do would be to start the process over again. Delegation may be necessary if the timing of the medications is critical and the phone call is going to take a long time and cannot wait. Beginning the process where it was left could lead to errors if the nurse is mistaken in where the process got interrupted. Hurrying increases the likelihood of making an error.
A nurse is caring for a postoperative patient whose orders include taking vital signs every 2 hours. The patient's baseline blood pressure was 142/86 mm Hg. After 2 hours, it is 112/60 mm Hg. Which action by the nurse is most appropriate? a) Take the patient's blood pressure again in 15 minutes. b) Call the physician, report the findings, and obtain new orders. c) Document the patient's blood pressure in the chart. d) Continue to take the vital signs every 2 hours as ordered.
a) Take the patient's blood pressure again in 15 minutes. Failure to monitor a patient appropriately and according to his or her status could lead to malpractice claims. This patient's blood pressure has changed significantly, so the nurse needs to increase the frequency of monitoring. Before calling the physician, the nurse should determine the patient's baseline blood pressure, which may make a call to the physician unnecessary. Documentation should be done, but more action is required.
A nurse has just finished turning a bed-fast patient who begins screaming at the nurse, yelling "How dare you move me! I'm going to sue you!" When discussing this issue with the unit manager, the manager should respond in which fashion? a) "We should call the hospital attorney for an opinion." b) "Did you harm the patient? If there is no harm, there is no suit." c) "Don't worry. This patient always says she's going to sue." d) "This patient can't sue you; you had consent to turn."
b) "Did you harm the patient? If there is no harm, there is no suit." There are four elements of malpractice required for a successful lawsuit: duty, breach of duty, causation, and harm. If the nurse did not harm the patient, the patient has no grounds to sue for malpractice. Stating that the patient always makes this claim and the nurse should not worry does not take into account the four elements. Even with consent, a breach in any of the four elements can lead to a lawsuit. The manager should understand them well enough to realize that a call to the attorney is not warranted.
A patient is insistent on leaving the emergency department against medical advice. The emergency room physician tells the nurse to call security and have them restrain the patient if necessary. Which action by the nurse is best? a) Call security and ask them to restrain the patient if needed. b) Tell the physician that this could be considered assault and battery. c) Document the physician's order before implementing it. d) Inform the physician that this could be considered false imprisonment.
b) Tell the physician that this could be considered assault and battery. Assault is the nonconsensual threat of touch, whereas actually touching the person against his or her will is battery. The nurse should inform the physician of these facts. You cannot restrain a competent adult unless clearly protecting the safety of others. Merely charting the order before implementing it does not absolve the nurse of legal duties to patients. False imprisonment is making a person feel as if he or she cannot leave a place; this is potentially a case of assault and battery.
