Ch 7: Legal Dimensions of Nursing Practice PrepU
Which is not true regarding Nurse Practice Acts? a) They describe what medications nurses can prescribe. b) They vary among states. c) They were established to describe legitimate nursing function. d) They define the boundaries of the functions of a nurse.
They describe what medications nurses can prescribe. Explanation: Prescribing and dispensing medications are not legal practices for registered nurses, with the exception of nurses in advance practice roles.
Legal safeguards are in place in the nursing practice to protect the nurse from exposure to legal risks as well as to protect the client from harm. What are examples of legal safeguards for the nurse? Select all that apply. a) The nurse educates the client about The Patient Care Partnership. b) The nurse obtains informed consent from a client to perform a procedure. c) The nurse executes physician orders without questioning them. d) The nurse claims management is responsible for inadequate staffing leading to negligence. e) The nurse documents all client care in a timely manner. f) The physician is responsible for administration of a wrongly prescribed medication
• The nurse educates the client about The Patient Care Partnership. • The nurse obtains informed consent from a client to perform a procedure. • The nurse documents all client care in a timely manner. Explanation: Examples of legal safeguards for the nurse would include the nurse obtaining informed consent from a client, the nurse educating the client about The Patient Care Partnership, and the nurse documenting all client care in a timely manner. Legal safeguards for the nurse would not include the nurse executing physician orders without questioning them. Legal safeguards for the nurse would not include the nurse claiming management is responsible for inadequate staffing leading to negligence. Legal safeguards for the nurse would not include the physician being responsible for administration of a wrongly prescribed medication
A medical surgical client is in the radiology department. The client's cousin arrives on the medical surgical unit and asks to speak with the nurse caring for his cousin. The visitor asks the nurse to provide a brief outline of the client's illness. Which response, if given by the nurse, would demonstrate application of legal safeguard in her practice? a) "Do you have any identification proving you are related to the client?" b) "I cannot give you that information due to client confidentiality." c) "I will call the client and ask his permission." d) "I'm busy right now, but can talk later."
"I cannot give you that information due to client confidentiality." Explanation: Sharing a client's information without his or her consent is an invasion of privacy. The nurse cannot give out the information even if the client proves a relationship or at a later time without the client's consent. It is inappropriate to call the client to ask for permission.
The student nurse tells her family about a client with AIDS that she cared for in clinical yesterday. Which tort has the student committed? a) Assault b) Invasion of privacy c) Slander d) Fraud
Invasion of privacy Explanation: Invasion of privacy involves a breach of keeping client information confidential. Slander is oral defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent.
A client informs the nurse that he wants to discontinue his treatment and go home. Later, the nurse finds the client dressed to leave. Which action should the nurse take in this situation? a) Let the client go after signing a document stating he is going against medical advice. b) Call the physician and get his discharge paper signed. c) Restrain the client until his medical treatment is over. d) Warn the client that he may not be able to access health care again.
Let the client go after signing a document stating he is going against medical advice. Explanation: If a client wishes to go before his medical treatment is finished, he should sign a document indicating personal responsibility for leaving against medical advice. The nurse should not restrain the client, as it would make the nurse liable for legal action. The nurse may call the physician and get the discharge paper signed, but this is not appropriate. The nurse cannot warn the client that he will be denied health care in future, because it is his right to access the health care facility whenever he needs.
A nurse is caring for a client who has undergone coronary angioplasty. The cardiac monitor is showing abnormal ECG waves, indicating arterial fibrillation. The nurse does not recognize the importance of the sign; as a result, the client's condition deteriorates and the client has to be taken up for an emergency procedure. Which of the following describes the nurse's legal liability? a) Felony b) Tort c) Defamation d) Slander
Tort Explanation: A tort is a cause of action in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. A tort implies that a person breached his duty to another person. In this case, the nurse had a duty that was breached. A felony is a serious criminal offense, such as murder. Defamation is an act in which untrue information harms a person's reputation. Slander is a character attack uttered orally in the presence of others.
A nurse is working on a medical surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action made by the nurse is considered negligent if injury results from this action? a) calling the healthcare provider about abnormal lab results b) completing a physical assessment on a newly admitted client c) delegating all wound care and oral medication administration to the LPN/LVN d) asking the LPN/LVN to teach a new diabetic client how to administer insulin
asking the LPN/LVN to teach a new diabetic client how to administer insulin Explanation: Negligence is harm that results because a person did not act reasonably. As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular healthcare providers to perform (scope of practice), as well as the policy for the facility at which they are employed. Teaching is not in the current scope of practice for a LPN/LVN, and can be considered negligent. The other actions are within the scope of practice for registered nurses
A registered nurse enters a client's room and observes the unlicensed assistive personnel (UAP) pushing a client down on the bed. The client starts crying and informs the UAP that he needs to go to the bathroom. The UAP holds the client down and tells him he was just in the bathroom. The nurse observing this incident is aware that the UAP's action is an example of: a) assault. b) fraud. c) defamation of character. d) battery.
battery. Explanation: 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 harms the other party's reputation.
A nurse observes another nurse place an unused dose of narcotics in their pocket. If caught, the nurse could be charged with which type of crime? a) misdemeanor b) felony c) tort d) negligence
felony Explanation: A felony is a serious criminal offense, and includes actions such as stealing narcotics, murder, falsifying medical records, and insurance fraud. A misdemeanor is a minor criminal offense; a tort is a lawsuit in which a plaintiff charges that a defendant committed a deliberately aggressive act. Negligence is harm that results because a person did not act reasonably.
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) negligence c) libel d) slander
libel Explanation: Libel is damaging statements written and read by others. Since there were defaming comments written in the chart, libel charges could be appropriate. Malpractice, slander, and negligence are not charges in this scenario.
Which situation is an example of battery that the nurse may experience while performing her duties at the health care facility? a) telling the client that he cannot leave the hospital b) witnessing a procedure done on a client without his consent c) taking the client's photographs without consent d) performing a surgical procedure without getting consent
performing a surgical procedure without getting consent Explanation: Performing a surgical procedure without the client's consent is an example of battery. To protect health care workers from being charged with battery, adult clients are asked to sign a general permission for care and treatment during admission, and additional written consent forms for tests, procedures, or surgery. Telling the client not to leave the hospital is a false imprisonment. Taking the client's photographs without his permission and witnessing a procedure done on him without consent is violation of the client's privacy.
Professional regulations and laws that govern nursing practice are primarily in place for which reason? a) to limit the number of nurses in practice b) to ensure that practicing nurses are of good moral standing c) to protect the safety of the public d) to ensure that enough new nurses are always available
to protect the safety of the public Explanation: Governing bodies, professional regulations, and laws are in place to protect the public by ensuring that nurses are accountable for safe, competent, and ethical nursing practice. The other options do not describe accurately the role and responsibility of the governing bodies and the regulations and laws of nursing.
A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response? a) "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." b) "It is a document created by you and your attorney naming a benificiary to handle your estate if you become terminally ill." c) "It is an agreement that authorizes the hospital to make decisions on your behalf, if you become incapacitated." d) "I will contanct the hospital social worker to come and discuss the development of an advance directive with you."
"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." Explanation: An advance directive is a written statement identifying a competent person's preferences regarding which medical interventions to use in the event that the client can not make a decision for themselves concerning terminal care. The other responses are not correct.
Which of the following is an example of certification? a) A nurse who demonstrates advanced expertise in a content area of nursing through special testing. b) An education program that meets standards of the National League for Nursing. c) A graduate of a nursing education program who passes NCLEX-RN. d) A hospital meets the standards of the Joint Commission.
A nurse who demonstrates advanced expertise in a content area of nursing through special testing. Explanation: Certification is a voluntary process where a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the National League for Nursing Accrediting Commission and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit healthcare agencies
Injuries related to lifting or transferring patients occur in the health care setting and may be considered a work-related injury. Which law was intended to reduce work-related injuries and illnesses? a) The Occupational Safety and Health Act of 1970 b) The Health Care Quality Improvement Act of 1986 c) Title VII of the Civil Rights Act of 1964 d) Americans with Disabilities Act of 1990
The Occupational Safety and Health Act of 1970 Explanation: The Occupational Safety and Health Act of 1970 set legal standards in the United States in an effort to ensure safe and healthful working conditions for men and women. The Health Care Quality Improvement Act of 1986 was enacted to encourage health care practitioners to identify and discipline practitioners who engage in unprofessional conduct, and to restrict the ability of incompetent practitioners to move from state to state without disclosure of the practitioner's previous performance. Title VII of the Civil Rights Act of 1964 protects employees from discrimination. The Americans with Disabilities Act of 1990 prohibits discrimination against disabled people and requires covered entities to reasonably accommodate individuals who are protected by the Act.
A client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure? a) The nurse ensures that the client's family signs the consent form. b) The nurse informs the family about advance directives. c) The nurse informs the family about the living will. d) The nurse ensures that the client signs the consent form.
The nurse ensures that the client's family signs the consent form. Explanation: The nurse should ensure that the client's family signs the consent form. However, in some states and health care facilities, it is the physician who ensures that the client's family signs the consent form. The client cannot sign the consent form if he is not in an alert state or is unable to communicate. If the client is not in a condition to the sign the consent, a family member can sign the consent on his behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery.
A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the atenolol to 12.5 mg. However, since the physician is late for another visit, she requests that the nurse write down the order for her. What should be the appropriate nursing action in this situation? a) The nurse should ask the physician to come back and write the order. b) The nurse should remind the physician later to write the work order. c) The nurse should inform the client of the change in medication. d) The nurse should write the order and implement it.
The nurse should ask the physician to come back and write the order. Explanation: The nurse should ask the physician to come back and write down the order. Nurses are discouraged from following any verbal orders, except in an emergency. The nurse should never write an order on a physician's behalf because this is a wrong practice. The client should be informed about the change of medications, but this is not an appropriate action. The nurse should not leave the work for a later time, because the nurse may forget it.
Which nursing student would most likely be held liable for negligence? a) A nursing student administers medication to a resident, while working as an unlicensed assistive personnel (UAP) at a local nursing home. b) A nursing student reports that insulin was not administered to the client by the nurse on the previous shift. c) A nursing student completes an incident report after administering a medication to a client, who then experienced an adverse reaction to the medication. d) A nursing student performs a dressing change using sterile technique and documents the presence of necrotic tissue in the wound.
A nursing student administers medication to a resident, while working as an unlicensed assistive personnel (UAP) at a local nursing home. Explanation: The nursing student who administers medication to a resident, while working as an unlicensed assistive personnel (UAP) at a local nursing home, is performing a task outside the scope of the job responsibilities of a UAP. The other options demonstrate legally defensible actions by the nursing student
Which process evaluates and recognizes educational programs as having met certain standards? a) Credentialing b) Licensure c) Certification d) Accreditation
Accreditation Explanation: Accreditation is the process by which an educational program is evaluated and recognized as having met certain standards. Credentialing refers to ways in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants the license to do so. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area.
A student nurse is assisting an elderly patient to ambulate following hip replacement surgery, and the patient falls and reinjures the hip. Who is potentially responsible for the injury to this patient? a) The nurse instructor b) The student nurse c) The hospital d) All of the above
All of the above Explanation: As a student nurse, you are responsible for your own acts, including any negligence that may result in patient 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 patient injury if an assignment called for clinical skills beyond a student's competency or the instructor failed to provide reasonable and prudent clinical supervision.
A client informs the nurse that he is leaving the health care facility because he is not satisfied with the treatment. The nurse knows that the client's treatment is incomplete and further testing and evaluations are scheduled. Which action by the nurse would be most appropriate to prevent false imprisonment? a) Restrain the client to prevent him from leaving. b) Tell the client that he will not be able to get access again. c) Ask the client to sign a release without medical approval. d) Call the physician to speed up the discharge process.
Ask the client to sign a release without medical approval. Explanation: If a client wants to leave the health care facility, the nurse should ask him to sign a release stating that he left without medical approval. The nurse cannot restrain the client because it amounts to false imprisonment. Calling the physician is not an appropriate measure. Telling the client that he may not be able to access the health care facility again is an inappropriate response because health care is a right and the client can access it whenever necessary.
The nurse fails to contact the physician regarding a client who had an open-reduction internal fixation of the tibia and has experienced increasing leg pain (unrelieved by pain medication) for the past 4 hours. Which element of liability has been violated? a) Duty b) Damages c) Causation d) Breach of duty
Breach of duty Explanation: Failure to contact the physician and report the client's condition does not meet the expected standard of care and is a breach of duty. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Causation shows that the failure to meet the standard of care actually caused injury. Damages are the actual harm or injury to the client.
A client states that his recent fall was caused by the fact that his scheduled antihypertensive medications were mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow? a) Enlist support from nursing and non-nursing colleagues from the unit. b) Document the client's claims and the events surrounding the alleged incident. c) Consult with practice advisors from the state board of nursing. d) Consult with the hospital's legal department as soon as possible.
Document the client's claims and the events surrounding the alleged incident. Explanation: It is imperative for nurses to carefully and accurately document assessment findings and the nursing care that they provide, a fact that is especially salient when legal action is anticipated. This thorough and accurate assessment should precede consultation with the legal department, the state board of nursing, and colleagues.
A client has a prescription for amoxicillin (Amoxil) 500 mg P.O. (by mouth) every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops a pulmonary embolus, experiences respiratory distress, and is transferred to the intensive care unit. The client's family files a lawsuit against the facility and the nurse. While reviewing the case, which legal action has the nurse attorney identified that meets the criteria for the client's lawsuit? a) Assault b) Battery c) Malpractice d) Negligence
Malpractice Explanation: The facility and nurse could be charged with malpractice, which is failing to perform or performing an act that causes harm to a client. Administering the medication intravenously instead of orally as prescribed has caused harm to a client. Negligence is failing to perform care for a client. When a person threatens to touch a client without consent, it is assault, whereas battery is carrying out the implied threat (assault).
A client newly diagnosed with congestive heart failure has a prescription for digoxin (Lanoxin). The nurse counts the heart rate before administration of the medication and obtains a heart rate of 51 beats per minute. Which action by the nurse demonstrates adherence to the standards of nursing care? a) Nurse administered the medication and reassessed the client in 30 minutes b) Nurse withheld the medication, retook the heart rate, and gave it at a later time c) Nurse administered the medication after reviewing the client's serum potassium level d) Nurse withheld the medication and notified the health care practitioner
Nurse withheld the medication and notified the health care practitioner Explanation: Nurses are responsible for following the standards of care for their particular work area. A reasonably prudent nurse would withhold the medication and notify the health care practitioner. All other options put the client's safety at risk and would not be done by a reasonably prudent nurse.
During the admission assessment of a female client age 40 years with a suspected mandibular fracture, the client discloses to the nurse that her injury came as a result of her husband hitting her. Which action should the nurse prioritize when responding to this disclosure? a) Reporting the abuse to the appropriate authorities b) Informing the client of her right to keep this information private c) Performing an assessment to confirm the client's statement d) Ensuring the client's statement is confirmed by another nurse
Reporting the abuse to the appropriate authorities Explanation: Nurses have a legal and ethical obligation to report cases of abuse. It would be inappropriate and likely unethical to require a third party witness to the statement or to withhold action pending assessment results. The nurse's obligation to report abuse legally supersedes the client's right to privacy
A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which of the following statements is true regarding the Good Samaritan law? a) The Good Samaritan law is not applicable to health care workers. b) The Good Samaritan law will not protect the nurse because she did not accept compensation. c) The Good Samaritan law will provide absolute exemption from prosecution. d) The Good Samaritan law will provide legal immunity to the nurse.
The Good Samaritan law will provide legal immunity to the nurse. Explanation: The Good Samaritan laws provide legal immunity to passersby who provide emergency first aid to victims of accidents. Therefore, the law is applicable to the nurse as well; moreover, the nurse did not accept any compensation for the service provided. The law is equally applicable to everyone, but does not provide absolute exemption from prosecution in cases of negligence. Paramedics, ambulance personnel, physicians, and nurses who stop to provide assistance are still held to a higher standard of care because they have training above and beyond that of average laypeople. In cases of gross negligence, health care workers may be charged with a criminal offense.
A registered nurse has had her license suspended after being convicted of being impaired at work. What governing body has the authority to revoke or suspend a nurse's license? a) The National League for Nursing b) The Supreme Court c) The State Board of Nurse Examiners d) The employing health care institution
The State Board of Nurse Examiners Explanation: The State Board of Nurse Examiners in the United States may revoke or suspend a nurse's license or registration for drug or alcohol abuse.
When making client rounds, the charge nurse observes which action by a staff nurse that would constitute battery? a) The nurse tells the client she cannot leave the hospital because she is seriously ill. b) The staff nurse threatens to restrain the client if she did not take her medication. c) The elderly client refuses the intramuscular injection, but the staff nurse administered it. d) While bathing a client behind pulled curtains, two nurses are discussing a different client.
The elderly client refuses the intramuscular injection, but the staff nurse administered it. Explanation: If the client refuses a procedure or medication and the nurse proceeds with it, it is battery. Threatening a client is assault. Discussing another client within earshot of others is an invasion of privacy. Keeping a client against her wishes, regardless of her health status, is false imprisonment.
The health care facility is involved in litigation by four clients. When reviewing the cases, which legal case would the nurse attorney identify to best describe malpractice? a) The nurse administers amoxicillin (Amicar) to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. b) The nurse using proper mechanics assists a client to a locked bed. He slips and breaks his left femur. c) The nurse applies an ice pack to a client's lower back without an order and he feels better. d) The nurse administered the wrong medication to the client, who had one episode of vomiting 5 minutes after consuming the medication with no further adverse reactions.
The nurse administers amoxicillin (Amicar) to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest Explanation: All elements of liability are in place for administering amoxicillin to a client with documented allergies to penicillin: the nurse had a duty, but breached it when giving the medication. There also was causation (amoxicillin) and harm (seizures and respiratory arrest). The nurse is negligent when applying an ice pack without an order. The nurse used proper mechanics, so the client fall is an accident even though harm occurred. Giving the wrong medication could be cause for malpractice, but there was no harm
In some cases, the act of providing nursing care in unexpected situations is covered by the Good Samaritan laws. Which nursing actions would most likely be covered by these laws? a) negligent acts performed in an emergency situation b) emergency care for a choking victim in a restaurant c) any emergency care where consent is given d) medical advice given to a neighbor regarding her child's rash
emergency care for a choking victim in a restaurant Explanation: Good Samaritan laws are designed to protect health practitioners when they give aid to people in emergency situations, such as providing emergency care to a choking victim in a restaurant. The other examples listed are not situations covered by the Good Samaritan law.
After reporting to work for a night shift, the nurse learns that the unit will be understaffed because two RNs called out sick. As a result, each nurse on the unit will need to provide care for an additional four acute clients, in addition to her regular client assignment. Which statement is true for this nurse when working in understaffed circumstances? a) The nurse must document that float staff, nurses on overtime, and part-time staff were contacted in an effort to fill the gaps in care. b) Understaffing constitutes an extenuating circumstance that creates a temporarily lower expectation for care for the nurse. c) The nurse is legally obliged to refuse to provide care when understaffing creates the potential for unsafe conditions. d) The nurse will be legally held to the same standards of care as when staffing levels are normal.
he nurse will be legally held to the same standards of care as when staffing levels are normal. Explanation: The claim of being overworked does not constitute a legal defense, and both the potential for liability and standards of care remain unchanged despite an increased client assignment. While it is prudent to make all realistic attempts to fill the gaps in staffing, documenting these efforts does not change the nurse's legal position. A nurse has the right to refuse an unsafe client assignment but the nurse is not legally obliged to withhold care
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
to improve quality of care Explanation: 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 risks, either in the form of actual risks or potential risks, that can be identified and addressed to improve quality of care. Incident reports are not intended to initiate litigation or document everyday occurrences
