Ch. 23: Legal Implications in Nursing Practice
A patient who has tested positive for human immunodeficiency virus (HIV) tells the nurse, "I feel helpless. My boss fired me because I'm HIV positive." Which response by the nurse is best? "Don't worry. You're protected by Good Samaritan laws." "Don't lose hope. Take this as an opportunity to spend time with your family." "I understand your feelings, but I think you should concentrate on your health now." "You should approach a lawyer. You're protected by the Americans With Disabilities Act."
"You should approach a lawyer. You're protected by the Americans With Disabilities Act." Rationale The Americans With Disabilities Act (ADA) protects the rights of people with physical or mental disabilities as well as the rights of patients who have tested positive for HIV. Therefore, the nurse would recommend that the patient speak to a lawyer. Good Samaritan laws help protect health care professionals from charges of negligence in providing emergency care but do not provide protection for patients who are HIV positive. Asking the patient to take the opportunity to spend time with family is not appropriate because the patient may lose hope of fighting for rights. It is also not appropriate to recommend that the patient overlook this violation of rights and concentrate on health. p. 330
The nurse assesses a child in a psychiatric agency. The nurse finds that the child has suicidal thoughts. How would the nurse instruct the child's parents? "You should punish your child for saying such things." "Your child needs to be admitted to the agency immediately." "Don't worry; your child will become normal with medication." "You should carefully observe every movement your child makes at home."
"Your child needs to be admitted to the agency immediately." Rationale According to the Mental Health Parity Act (MHPA), patients having suicidal tendencies are to be admitted to mental health units for supervision. The nurse should instruct the parents that their child should be admitted to the agency because the child has suicidal tendencies. Punishing the child would not avoid suicidal behavior and may aggravate it. Having suicidal ideation is life threatening and requires close monitoring of the patient; medications would be of no use in this case. Letting the child go home despite knowing that the child has suicidal tendencies would violate the MHPA. pp. 330-331
An 8-year-old is brought to the emergency department with severe abdominal pain. The nurse has to get consent before medical treatment can begin. Which information should be provided before the patient's guardian gives consent? Select all that apply. One, some, or all responses may be correct. A complete explanation of the procedure or treatment Names and qualifications of the people performing the treatment The exact number of days required for complete cure and treatment A description of possible adverse effects or side effects of the treatment An explanation that once the guardian signs the consent, treatment must be given
- A complete explanation of the procedure or treatment - Names and qualifications of the people performing the treatment - A description of possible adverse effects or side effects of the treatment Rationale The patient or the patient's guardian should give consent only after receiving information about the procedure or treatment. The information should also include the names of the people who will be treating the patient and the possible side effects of the treatment or procedure. The nurse should also inform the guardian that she can later refuse treatment even if she initially signed consent. It is not practical for the nurse to anticipate the exact number of days required for a cure, and such information is not provided before the guardian gives consent. p. 333
A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging after a car accident. The health care provider prescribed two units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. Which action is the nurse's responsibility? Obtaining a court order to give the blood. Coercing the husband into giving the blood. Calling security and have the husband removed from the hospital. Abiding by the husband's wishes and informing the health care provider.
Abiding by the husband's wishes and informing the health care provider.
The nurse is caring for a 6-year-old child with hypovolemic shock. The child is a Jehovah's Witness and needs an immediate blood transfusion, but the child's parents refuse to provide consent. Which action would be most appropriate? Administer blood to the child. Administer intravenous fluids. Provide oral hydration and nutrition. Seek a court order for blood transfusion.
Administer blood to the child. Rationale Jehovah's Witness is a cultural and religious group that refuses blood transfusions based on their religious beliefs. According to the durable power of attorney for health care document, the court will grant an order allowing hospitals and health care providers to treat children of Christian Scientists or Jehovah's Witnesses who have denied consent for treatment of their minor children. Therefore, to save the life of the child, it is most appropriate for the health care provider or nurse to administer blood to the child. Refusing a blood transfusion in the case of hypovolemic shock would most likely result in the death of the child. Administering only intravenous fluids may not help because the child is in hypovolemic shock. Oral hydration and nutrition will not be sufficient to resuscitate a child who has had severe blood loss. The court will allow the health care providers to resuscitate the child; thus, the medical personnel need not seek or wait for a court order. p. 334
A nursing student is learning about the role of the State Board of Nursing. Which function is true of the State Board of Nursing? Select all that apply. One, some, or all responses may be correct. Provides for the rights of patients and protects employees Gives nursing home residents the right to be free of restraints Can suspend the license of the nurse who violates licensing provisions Licenses all registered nurses in the state in which they practice Has to follow due process before revoking or suspending a license
- Can suspend the license of the nurse who violates licensing provisions - Licenses all registered nurses in the state in which they practice - Has to follow due process before revoking or suspending a license Rationale The State Board of Nursing can suspend or revoke a license if the nurse's conduct violates provisions in the licensing statute. It is the governing body and issues licenses to all registered nurses in the state in which they practice. The State Board of Nursing has to follow due process before revoking or suspending a license; nurses must be notified of the charges against them and be given an opportunity to defend themselves in a hearing. The rights of patients and protection of employees were formulated under the Health Insurance Portability and Accountability Act of 1996. The right of residents of registered nursing homes to be free of restraints was granted by the Federal Nursing Home Reform Act (1987).
A student nurse who has not been trained to administer medications is assisting a registered nurse while caring for various patients in the general ward. Which intervention by the student nurse may result in a malpractice lawsuit? Collecting the vital signs of a patient Administering a subcutaneous injection Checking the body mass index of a patient Assisting the registered nurse with an enteral nutrition feeding
Administering a subcutaneous injection Rationale Student nurses should not perform tasks if they are unprepared because their actions can cause harm to patients. Administering a subcutaneous injection without proper preparation may lead to patient harm and expose the student nurse to a malpractice lawsuit. The student nurse can collect vital signs because this does not cause harm to the patient and is within the scope of practice for a student nurse. Checking the patient's body mass index is within the scope of practice for a student nurse. The student nurse can assist the registered nurse while providing enteral nutrition. Because this is done under the supervision of a licensed professional, the nurse will not face a malpractice lawsuit. p. 336
The nurse is learning about the legal implications in nursing practice. Which statement is true about the various sources of law? Select all that apply. One, some, or all responses may be correct. Civil laws protect the rights of individuals in the society. Common law presents decisions made by administrative bodies. Criminal laws protect society by providing punishment for crimes. Criminal laws are passed to protect society from nursing negligence. Regulatory law reflects decisions made by administrative bodies when they pass rules.
- Civil laws protect the rights of individuals in the society. - Criminal laws protect society by providing punishment for crimes. - Regulatory law reflects decisions made by administrative bodies when they pass rules. Rationale Civil laws protect the rights of individuals in the society and provide fair treatment in case of civil violations. Criminal laws protect society by providing punishment for crimes. These punishments are defined by municipal, state, and federal legislations. Regulatory laws are administrative laws and hence reflect decisions made by administrative bodies when they pass rules. Common law results from judicial decisions made in court when individual cases are decided. Civil laws are passed to protect society, such as in the case of nursing negligence. pp. 327-328
The night shift nurse is caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. Which action would the nurse take? Give the family the record. Give the patient the record. Allow the family to express concerns. Call the nursing supervisor.
Allow the family to express concerns. Rationale Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how best to address their concerns. The nurse should never give the family the medical record or allow the patient to see the medical record. Calling the health care provider would be useless because the provider cannot show the medical record to the family or the patient either, due to the Health Insurance Portability and Accountability Act of 1996. p. 329
The nurse is assessing a postsurgical patient who is in acute pain. The patient is not willing to change position for x-rays. The nurse tells the patient that a sedative injection will be administered if the patient does not cooperate for the procedure. Which tort is indicated? Assault Battery Invasion of privacy False imprisonment
Assault Rationale Assault places an apprehensive patient within harmful or offensive contact without consent. In this case, the nurse is threatening to give sedative injections if the patient does not cooperate with the procedure. This is an example of an assault on the patient. Battery is intentional touching without consent. Invasion of privacy refers to the unwanted intrusion into the private affairs of the patient. False imprisonment is an intentional tort in which a patient is restrained without a legal warrant.
When witnessing a patient giving informed consent prior to undergoing surgery, which action should the nurse perform? Select all that apply. One, some, or all responses may be correct. If the patient refuses to sign the consent, leave the situation as it is. Confirm that the patient has understood the information about the surgery. Inform the health care provider if the patient refuses to undergo the surgery. Sign the consent form as a witness once the patient voluntarily gives consent. Ask a nursing student to witness the informed consent if the nurse is busy.
- Confirm that the patient has understood the information about the surgery. - Inform the health care provider if the patient refuses to undergo the surgery. - Sign the consent form as a witness once the patient voluntarily gives consent. Rationale The patient needs to understand the surgical procedure and voluntarily give consent, so the nurse should enquire about the patient's understanding and answer any questions. If the patient refuses to undergo the surgery, the nurse should inform the health care provider, so any harmful consequences of refusal can be explained to the patient. The nurse's signature witnessing the consent means that the patient voluntarily gave consent, that the signature is authentic, and that the patient appears to be competent to give consent. If the patient refuses to sign the consent in spite of repeated explanations, this rejection should be documented, signed, and witnessed. Because of the legal nature of the document, a nursing student should not be asked to witness informed consent forms. p. 333
The nurse is caring for a surgical patient in the preoperative area. The nurse witnesses the patient's informed consent for the surgical procedure. Which statement is true regarding informed consent? Select all that apply. One, some, or all responses may be correct. It must be signed while the patient is free from mind-altering medications. It can be witnessed by the nurse or nursing student. It may be withdrawn at any time. It must be signed by patients age 16 and older. It is usually obtained by the health care provider and not the nurse.
- It must be signed while the patient is free from mind-altering medications. - It may be withdrawn at any time. - It is usually obtained by the health care provider and not the nurse. Rationale An informed consent must be signed while the patient is free from mind-altering medications and after the patient has received all information necessary to make an informed decision. In most situations, the health care provider, not the nurse, obtains informed consent because the nurse does not perform surgery or direct medical procedures. Signed consent must be witnessed by the nurse but never by a nursing student because of the legal nature of the document. Informed consent may be withdrawn at any time before the procedure and must be signed by patients age 18 and older. A parent or guardian's signature is required for minors. pp. 333-334
A nursing student is learning about the standards of care for nursing. Which action would the student take to maintain high nursing standards? Select all that apply. One, some, or all responses may be correct. Learn about the Nurse Practice Act in the state. Follow updates of laws and policies practiced. Read current nursing literature in specified practice areas. Avoid using procedures given by the employment agency. Understand current legal issues affecting nursing practice.
- Learn about the Nurse Practice Act in the state. - Follow updates of laws and policies practiced. - Read current nursing literature in specified practice areas. - Understand current legal issues affecting nursing practice. Rationale The Nurse Practice Act defines the scope of nursing practice, and all nurses should be aware of the particular laws in their respective states. Laws and policies can change with time, so keeping current with them is important. Reading current nursing literature in specified practice areas keeps the nurse up to date with the latest nursing knowledge; ignorance of such updates is not an acceptable excuse for malpractice. Understanding current legal issues affecting nursing practice is important; doing so helps the nurse practice in a fashion that avoids legal problems. Nurses should follow procedures given by the employment agency.
The nurse is learning about nursing malpractice. Which statement would the nurse consider as good nursing practice? Select all that apply. One, some, or all responses may be correct. Nursing notes can be illegible as long as the nurse can read them. Nursing notes should be maintained properly. Nursing records should be properly preserved. Institutions should maintain complete nursing records. Only basic duties should be recorded in nursing records.
- Nursing notes should be maintained properly. - Nursing records should be properly preserved. - Institutions should maintain complete nursing records. Rationale Nursing notes are important because they contain evidence needed to understand the care received by a patient. The notes should be legible to all people, not just the nurse. Similarly, complete nursing records should be properly preserved because they may be required to show what care was provided. Basic nursing duties as well as advanced nursing care should be recorded in the nursing records.
Which action would the nurse take to avoid malpractice and professional negligence? Select all that apply. One, some, or all responses may be correct. Strictly follow the given standards of care. Regularly update current nursing knowledge. Properly document all assessments and interventions. Avoid explaining medical procedures to patients. Complete health documentation at the end of the shift.
- Strictly follow the given standards of care. - Regularly update current nursing knowledge. - Properly document all assessments and interventions. Rationale As a rule, nurses should follow given standards of care to avoid malpractice. Regularly updating current nursing knowledge keeps nurses well informed of the latest medical knowledge and techniques and health care policies and laws. Properly documenting all assessments, interventions, and evaluations is necessary for future reference and communication with other health care team members. Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other health care team members and to avoid negligence.
A surgeon obtains patient consent for an appendectomy. While operating, the surgeon also removes the patient's gallbladder. This mistake could be classified as which type of tort? Assault Battery False imprisonment Defamation of character
Battery Rationale Torts are intentional or unintentional mistakes that are infringements of civil law. Removing the gallbladder without consent may be considered battery because the surgeon's actions go beyond the scope of the patient's original consent, which was only for the appendectomy. Assault involves the intentional threat of bodily harm, but there is no indication the surgeon meant to harm this patient by removing the gallbladder. Forcing the patient to stay in the hospital even if the patient is unwilling would indicate false imprisonment. Making false, damaging statements about a patient would indicate defamation of character. p. 337
The nurse is floated to work on a nursing unit where the assignment is beyond the nurse's capability. Which action would the nurse take? Call the nursing supervisor to discuss the situation. Discuss the problem with a colleague. Leave the nursing unit and go home. Say nothing and begin work.
Call the nursing supervisor to discuss the situation
The home health nurse notices significant bruising on a 2-year-old's head, arms, abdomen, and legs. The patient's mother describes the child's frequent falls. Which nursing action is best for the home health nurse to take? Document the findings and treat the child. Instruct the mother on safe handling of a 2-year-old child. Contact a child abuse hotline. Discuss this story with a colleague.
Contact a child abuse hotline. Rationale Nurses are mandated reporters of suspected child abuse. Significant bruising on a 2-year-old's head, arms, abdomen, and legs possibly indicates child abuse. It is not enough to document the findings, instruct the mother on safe handling of the child, or discuss the story with a colleague. pp. 334-335
A patient who has developed a pulmonary embolism after abdominal surgery is immediately transferred to another hospital. Which law has been broken in this case? Mental Health Parity Act (MHPA) Americans With Disabilities Act (ADA) Patient Self-Determination Act (PSDA) Emergency Medical Treatment and Active Labor Act (EMTALA)
Emergency Medical Treatment and Active Labor Act (EMTALA) Rationale According to the EMTALA, patients who have an emergency condition should not be discharged or referred to another hospital unless the condition stabilizes. Pulmonary embolism is a life-threatening condition and, according to this law, the patient should not be transferred to another hospital unless the condition is stabilized. According to the MHPA, health insurance companies should not place lifetime or annual limits on mental health coverage, and the coverage should be as generous as coverage for medical or surgical care. The ADA prevents discrimination against persons with disabilities and ensures equal opportunities in employment, state and local government services, public accommodations, commercial facilities, and transportation. According to the PSDA, health care institutions should provide written information to patients about their rights to make decisions regarding treatment.
A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care. Which law does this action most likely violate? Health Insurance Portability and Accountability Act of 1996 (HIPAA) Americans With Disabilities Act (ADA) Patient Self-Determination Act (PSDA) Emergency Medical Treatment and Active Labor Act (EMTALA)
Emergency Medical Treatment and Active Labor Act (EMTALA) Rationale The EMTALA requires that in an emergency situation the patient must be stabilized before a transfer is appropriate. HIPAA addresses privacy issues, the PSDA addresses a patient's right to refuse treatment and formulate advance directives, and the ADA deals with equal access for all individuals. p. 329
A patient is brought to the hospital after a motor vehicle accident. Which law makes it mandatory for the health care agency to provide emergency care to patients before transferring them to other hospitals? Good Samaritan laws Mental Health Parity Act (MHPA) Americans With Disabilities Act (ADA) Emergency Medical Treatment and Active Labor Act (EMTALA)
Emergency Medical Treatment and Active Labor Act (EMTALA) Rationale The EMTALA states that a patient who is brought to the emergency room of any hospital should be stabilized before being transferred. Good Samaritan laws protect people who provide help or first aid to victims with good intention. The MHPA forbids health plans from placing lifetime or annual limits on mental health coverage. The ADA protects the rights of people with physical or mental disabilities. p. 329
The nurse is caring for a patient who is in early stages of cardiac failure. The patient tells the health care provider and the nurse that he wishes to end his life without any suffering as soon as possible. Which would be the most appropriate action? Assist the patient in suicide as per his wish. Explain to the patient that his life can be extended. Ask the patient's family to make decisions regarding the patient's death. Ask the patient to wait for court orders regarding the decision.
Explain to the patient that his life can be extended. Rationale The patient does not have end-stage cardiac failure; thus, medical interventions would be of help for the patient to extend his life. Assisted suicide violates the Code of Ethics for nurses, is illegal in most states, and is not appropriate in a patient with a nonterminal disease. Because the patient could be managed by means of drugs and other medical interventions, there is no need for the patient's family to make decisions concerning the patient's death.
A terminally ill patient does not want to be resuscitated if complications arise. Which document would record the patient's wishes regarding treatment? Nurse's records Living will Health care proxies Durable powers of attorney
Living will Rationale A living will contains the decisions about medical procedures a patient would undergo or not undergo when terminally ill or in a vegetative state. The nurse's records are written documents maintained by the nurse about the daily care provided to the patient. Health care proxies or durable powers of attorney are legal documents that designate a person to make decisions on the patient's behalf. These documents are used when the patient is no longer capable of making decisions. p. 331
A patient is admitted to the emergency department with a head injury. The team decides that the patient requires an emergency surgery to stop internal hemorrhage, but the patient's family is not yet at the hospital to provide consent. Which action is most appropriate for the team to take in this situation? Perform the surgery without the informed consent. Provide nonsurgical interventions to stop the hemorrhage. Arrange for an order from the court to perform the surgery. Wait for the family members to arrive to get informed consent.
Perform the surgery without the informed consent. Rationale When the intervention is necessary to save the patient's life in an emergency, and there is no family member available to give consent, the emergency procedure can be performed. The surgery is performed assuming that the patient would have wished to be treated. Providing nonsurgical measures may not be therapeutic and beneficial for the patient. Arranging for a court order to perform the surgery may be time-consuming and may lead to the patient's death. Waiting for the family members to arrive and provide consent may complicate the patient's condition. p. 334
The nurse received a hand-off report from the night shift nurse at the change of shift in the conference room. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patients' rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which action violates the Health Insurance Portability and Accountability Act of 1996 (HIPAA)? Discussing patient conditions in the nursing report room at the change of shift Allowing nursing students to review patient charts before caring for patients to whom they are assigned Posting medical information about a patient on a message board in the patients' rooms Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
Posting medical information about a patient on a message board in the patients' rooms Rationale Posting the patient's medical condition on a message board in the patient's room is not necessary for treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatments, which violates HIPAA. The nurse can discuss patient conditions at change of shift, allow nursing students to review patient charts for whom they are assigned, and release patient information regarding terminal illness to family that the patient has given permission for information to be shared without violating HIPAA. p. 329
The nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the insurance of the nurse's employing institution does not cover the nurse. Which would probably cover the nurse in this situation? The nurse's automobile insurance The nurse's homeowners insurance The Good Samaritan laws, which grant immunity from suit if there is no gross negligence The Patient Care Partnership, which may grant immunity from suit if the injured party consents
The Good Samaritan laws, which grant immunity from suit if there is no gross negligence Rationale Good Samaritan laws hold health care providers immune from liability as long as they function within the scope of their expertise. Automobile and homeowners insurance would not cover the nurse in this situation. The Patient Care Partnership may grant immunity from suit if the injured party consents, which is not the case in this scenario. p. 334
A patient dies after receiving care from the nurse. In what circumstance would the nurse be legally protected by Good Samaritan laws? The nurse provides standard care in the hospital setting, but the patient cannot be saved because of the severe injury. The nurse provides emergency care outside the hospital, performing a procedure for which the nurse has been trained. The nurse performs an emergency procedure that is normally outside the nurse's scope of practice because no one else is available at the scene. The nurse does not provide care at the scene but puts the patient in a car heading to the hospital.
The nurse provides emergency care outside the hospital, performing a procedure for which the nurse has been trained. Rationale Good Samaritan laws protect health care professionals from charges of negligence in providing emergency care outside of the hospital setting, assuming the health care provider is qualified to provide the care. Good Samaritan laws do not protect the nurse within the hospital setting, where standard procedures can be followed. Good Samaritan laws may not protect the nurse if performing a procedure for which the nurse is not qualified or trained. The Emergency Medical Treatment and Active Labor Act emphasizes that in case an emergency arises, the patient should not be shifted but should receive immediate quality treatment. p. 334
A group of nurses makes a list of patients who require organ transplantation. Which patient would be given priority for organ transplantation? The patient who is most critically ill The patient who is a very young age The patient who will pay more for the intervention The patient who lives in close proximity to the health care center
The patient who is most critically ill
An 8-year-old girl is brought to the emergency department with severe abdominal pain. The nurse has to get consent before medical treatment can be started. The parents of the child are divorced, and the mother has custody. The patient is accompanied by her mother, father, and elder sister, who is 19 years old. Who should sign the consent form of the patient? The patient's father The patient's sister The patient herself The patient's mother
The patient's mother Rationale When the patient is a minor, consent is given by parents or guardians. In this case, the parents are divorced, so the consent is given by the parent who has custody of the child, the mother. p. 334
The nurse is studying the Emergency Medical Treatment and Active Labor Act (EMTALA). What is the meaning of the term patient dumping? Transferring a patient from a private to a public hospital on a patient's request Transferring a patient from a private to a public hospital after the patient is stabilized Transferring a patient from a private to a public hospital on consent of the health care provider Transferring a patient from a private to a public hospital without appropriate screening and stabilization
Transferring a patient from a private to a public hospital without appropriate screening and stabilization Rationale Patient dumping refers to transferring a patient from a private to a public hospital without appropriate screening and stabilization. The EMTALA was established to reduce the incidence of patient dumping. According to this act, patients can be transferred from a private to a public hospital on their own request, after being stabilized, or by consent of a health care provider. p. 329