Chapter 2- Legal and Ethical Aspects of Nursing

Nursing Practice

-legal principles -established laws -moral standard -ethical principles

Nonmaleficence

The concept of do no harm

tort

Type of civil law that involves wrongs against a person or property

Nursing Liability

Breaches of standard care, practice, monitoring and communication

23. The nurse is caring for a patient who is scheduled for surgery. Before going to surgery, the nurse would make sure that the patient has been fully informed about the procedure to be done. What would the patient sign to acknowledge that he or she is making an intelligent decision? A. Patient's Bill of Rights B. Accountability statement C. Informed consent doctrine D. Confidentiality statement

C. Informed consent doctrine

Accountability

Willingness to take credit and blame for actions.

Abandonment of care

Wrongful termination of providing patient care

Deposition

a witness's testimony given under oath

liability

legal responsibility

Assault

threat or attempt to injure

Battery

unlawful touching of another person without consent

Minors under the age of 18

-marriage -court approved emancipation -living apart from parents or guardian for at least 60 days and independent of prenatal support -service in the armed forces -treatment for STD infections -drug or alcohol abuse -sexual assault -family planning

Breaches of Standard Care

-Derive from federal and state laws, rules, regulations, and codes -Failure to Practice, monitoring, communication -acts whose performance is required, permitted, or prohibited

Patient Rights

1. Access to health care without any prejudice 2. Treatment with respect and dignity at all times 3. Privacy and confidentiality 4. Personal safety 5. Complete information about one's own condition and treatment

2 primary categories law

1. Criminal 2. Civil

Ethical Principles

1. Respect for persons 2. Autonomy 3. Beneficence 4. Nonmaleficence 5. Justice

5. The LPN/LVN knows that one of the best defenses against a lawsuit is for a nurse to: A. Work only in a large hospital or nursing home B. Provide for every patient's needs a quickly as possible C. Promote a positive nurse-patient relationship D. Carry individual professional liability insurance

C. Promote a positive nurse-patient relationship

44. What fundamental principle must the nurse first observe when confronted with an ethical decision? A. Autonomy B. beneficence C. Respect for people D. Nonmaleficence

C. Respect for people The first fundamental principle is respect for people. Autonomy, beneficence, and nonmaleficence are not the first fundamental principle to observe when confronted with an ethical decision

Patient Self-Determination Act (PSDA)

A federal law that mandates that every individual has the right to make decisions regarding medical care, including the right to refuse treatment and the right-to-die

32. A nurse fails to irrigate a feeding tube as ordered, resulting in harm to the patient. This nurse could be found guilty of: A malpractice B. Harm to the patient C. Negligence D. Failure to follow the nurse practice act

A malpractice The nurse can be held liable for malpractice for acts of omission. Failure to meet a legal duty, thus causing harm to another, is malpractice. The nurse practice act has general guidelines that can support the charge of malpractice.

Libel

A written defamation of a person's character, reputation, business, or property rights.

27. Which factors put an older adult at risk for physical, emotional, and financial abuse? (Select all that apply.) A.Decrease in strength and mobility B.Increase in independence C.Isolation D.Declining mental ability E.Increased cardiac reserve

A, C, D

10. The LPN/LVN is reviewing the patient's medical record. The nurse notes the presence of an advance directive. The nurse recognizes that the purpose of this documentation is to: A. Help every person exercise the right to die with dignity B. Encourage a person to determine how he or she will die C. Allow a patient to exercise the right of autonomy D. Provide a means to prevent medical treatment

B. Encourage a person to determine how he or she will die

7.. LPN/LVNs have a code of professional and personal ethics to follow. The purpose of a code of ethics is to: A. Establish penalties for any unethical behavior B. Promote trustworthy, countable LPN/LVNs C. Make certain that all nurses are competent and always honest D. Give the nurse guidelines for ethical decision making

B. Promote trustworthy, countable LPN/LVNs

34. The nurse is preparing the patient for at Horace tesis. What must be completed before the procedure may be performed? A. Physical assessment B. Interview C. Informed consent D. Surgical checklist

C. Informed consent

14. The nurse gets a report, puts his patient assignment notebook in his pocket, and goes on break. His notebook has vary specific information about his patients and is missing from his pocket when he returns to the unit. The book is found later on the floor in the cafeteria by a visitor and is returned to the information desk. The nurse: A. May have breached the patient -self determination B. Is guilty of criminal misconduct C. Could be fired for malpractice D. Has violated the health insurance portability and accountability act of 1996 (HIPPA)

D. Has violated the health insurance portability and accountability act of 1996 (HIPPA)

25. A federal regulation that came into effect April 14, 2003, has impacted the health care field regarding privacy of a patient's health information. What is this regulation? A.Joint Commission on Accreditation of Healthcare Organizations B.Patient Self-Determination Act C.Patient's Bill of Rights D. Health Insurance Portability and Accountability Act

D. Health Insurance Portability and Accountability Act

47. Which is a nursing care error that violates the Health Insurance Probability and Accountability (HIPAA)? A. Administering a stronger dose of drug than was ordered B. Refusing to give a patient's daughter information over the phone C. Informing the patient's medical power of attorney of a medication change D. Leaving a copy of the patient's history and physical in the photocopier

D. Leaving a copy of the patient's history and physical in the photocopier

22. The LPN/LVN knows that building the nurse-patient relationship is important in providing patient care, and a legal relationship is being formed. If there is a breach in this relationship and harm to the patient has occurred, which legal action can the nurse be charged with? A. Assault B Negligence C.Slander D. Malpractice

D. Malpractice

1. What are the four elements required for a claim of malpractice? a. Duty, causation, damages, defense b. Liability, negligence, duty, damages c. Breach of duty, duty, liability, negligence d. Duty, breach of duty, causation, damages.

Duty, breach of duty, causation, damages

1. Which of the four elements of malpractice occurs when the jury or judge decides the punishment? a. Duty b. Breach of duty c. Causation d. Damages

d. Damages

liable

legally responsible

Malpractice

professional negligence Nursing responsibilities include actions taken and those omitted 4 key elements: 1. Duty: established relationship between patient and nurse 2. Breach: duty if failure to perform the duty in a reasonable, prudent manner 3. Harm: has occurred, this not have to be physical injury 4. The breach of duty was the proximate cause of the harm. The occurrence of the breach

Avoid a lawsuit

provide competent, compassionate care, communicate openly for therapeutic relationship, nurse- patient relationship must be based on trust

Slander

spoken defamation

56. Acts whose performance is required, permitted, or prohibited are defined by____________ of care.

standards Standards of care define acts whose performance is required, permitted, or prohibited.

Defamation

the action of damaging the good reputation of someone; slander or libel.

36. An older adult is admitted to the hospital with numerous bodily bruises, and the nurse suspects elder abuse. What is the best nursing action? A. Cover the bruises with bandages B. Take photographs of the bruises C. Ask the patient if anyone has hit her D. Report the bruises to the charge nurse

D. Report the bruises to the charge nurse

6. The nurse believes that all patients should be treated as individuals. The ethical principle that this belief reflects is: A. Autonomy B. Beneficence C. Nonmaleficence D. Respect for people

D. Respect for people

17. Social media use can have positive benefits including which outcomes? (Select all that apply) A. Networking between professionals B. Reduction in the amount of lateral violence between staff members C. Provides readily available education opportunities D. Access to mentoring answer E. Use of social media is an inexpensive answer

A. Networking between professionals C. Provides readily available education opportunities D. Access to mentoring answer

53. During lunch break, an emergency department (ED) nurse truthfully tells another nurse about the condition of a patient who came to the ED last night. What is the ED nurse guilty of ? (select all that apply) A. HIPPA violation B. Slander C. Libel D. Invasion of privacy E. Defamation

A, D.

54. A nurse failed to monitor a patient's respiratory status after medicating the patient with a narcotic analgesic. The patient's respiratory status worsened, requiring intubation. the patient's family claimed the nurse committed malpractice. What must be present for the nurse to beheld liable? (Select all that apply) a. A nurse-patient relationship exists. b. The nurse failed to perform in a reasonable manner. c. There was harm to the patient. d. The nurse was prudent in her performance. e. The nurse did not cause the patient harm. f. Duty does not exist.

A,B,C For the court to uphold the charge of malpractice, and to find the nurse liable, the following elements must be present: duty exists, there is a breach of duty, and harm must have occurred.

52. How can the medical record be used in litigation? (Select all that apply) A. Public record B. Proof of adherence to standards C. Evidence of omission of care D. Documentation of time lapses E. Evidence by only the plaintiff

A,B,C,D The information when used in court becomes a public record. The information can be used as proof of adherence to standards, omission of care, and documentation of time lapses. Both plaintiff and defendant can use the document.

33. Patients have expectations regarding the health care services they receive. To protect these expectations, which of the following has become law? A. American Hospital Association's Patient's Bill of Rights B. Self-Determination Act C. American Hospital Association's Standards of Care D. The Joint Commission's rights and responsibilities of patients

A. American Hospital Association's Patient's Bill of Rights

39. The nurse has strong moral convictions that abortions are wrong. When assigned to assist with an abortion, what is the most appropriate action for the nurse to take? A. Ask for another assignment B. Leave work C. Transfer to another floor D. Protest to the supervisor

A. Ask for another assignment

12. An alert adult patient has refused an intramuscular injection. The nurse waits until the patient is asleep and gives the injection anyway. The nurse could be charged with: A. Civil battery B. Malicious homicide C. Criminal assault D. Invasion of privacy

A. Civil battery

8. The patient admitted for surgery has a lump in her breast. The patient's daughter asks the LPN/LVN if her mother should have surgery. Which issue must be considered before responding? A. Confidentiality and invasion of privacy B. Informed consent, beneficence, and respect C. Respect for people and personal autonomy D. Nonmaleficence, justice, and liability

A. Confidentiality and invasion of privacy

13. The nurse loves photography and brings his camera to work at the nursing home. He takes a picture of one of his coworkers walking a patient. What best describes the actions take by the nurse? A. He violated the patient's right to privacy B. He failed to get proper medical clearance C. He performed an act of nursing malpractice D. He legally obtained a realistic picture

A. He violated the patient's right to privacy

50. A health care provider instructs the nurse to bladder train a patient. The nurse clamps the patient's indwelling urinary catheter but forgets to unclamped it. The patient develops a urinary tract infection. What do the nurse's actions' exemplify ? A. Malpractice B. Battery C. Assault D. Neglect of duty

A. Malpractice A nurse is liable for acts of commission (doing an act) and omission (not doing an act) performed in the course of their professional duty. A charge of malpractice is likely when a duty exists, there is a breach of that duty, and harm has occurred to the patient.

29. The nurse caring for a patient in the acute care setting assumes responsibility for a patient's care. What is this legally binding situation? A. Nurse-patient relationship B. Accountability C. Advocacy D. Standard fo care

A. Nurse-patient relationship When the nurse assumes responsibility for a patient's care, the nurse-patient relationship is formed. This is a legally binding "contract" for which the nurse must take responsibility. Accountability is being responsible for one's own actions. An advocate is one who defends or pleads a cause or issue on behalf of another. Standards of care define acts whose performance is required, permitted, or prohibited.

46. A nurse is considering purchasing malpractice insurance. What should the nurse be aware of regarding malpractice insurance provided by the hospital? A. Only offers protection while on duty B. Is limited in the amount of coverage C. Is difficult to renew D. Can be terminated at any time

A. Only offers protection while on duty Most institutional insurance only provides liability coverage if the nurse is on duty at that facility.

45. A nurse working on an acute care medical surgical unit is aware that his or her first duty is to the patient's health, safety, and well-being. Given this knowledge, which of the following is most necessary for the nurse to report? A unethical behavior of other staff members B. A worker who arrives late C. Favoritism shown by nursing administration D. Arguments among the staff

A. unethical behavior of other staff members A member of the nursing profession must report behavior that does not meet established standards. Unethical behavior involves failing to perform the duties of a competent caring nurse.

Negligence

Absence of due care , being careless Failure to act in a manner demonstrating the care and knowledge any prudent individual would. Medication errors Patient falls Use of restraints Equipment injuries

18. A nurse reported that she did a post on a social media site about her clinical experiences. The nurse reports she did not use the patient's name. Which information should be given to the nurse? (Select all that apply) A. "Names are the only identifiers that are a concern when considering patient privacy" B. "Any patient information that can aid in the identification of the patient's identity can be a problematic and a violation C. "As long as the information is erased there is not a problem" D. "Any distribution of information regarding the patient or clinical assignment is a violation of confidentiality " E. "Personal emails are lesser violations than posting on large websites"

B. "Any patient information that can aid in the identification of the patient's identity can be a problematic and a violation D. "Any distribution of information regarding the patient or clinical assignment is a violation of confidentiality "

48. Which of the following could cause a nurse to be cited for malpractice? A. Refusing to give 60mg of morphine as ordered B. Giving prochlorperazine (Compazine) to a patient allergic to phenothiazines C. Dragging an injured motorist off the highway and causing further injury D. Informing a visitor about a patient's condition

B. Giving prochlorperazine (Compazine) to a patient allergic to phenothiazines Standards of care dictate that a nurse must be aware of all the properties of drugs administered. Prochlorperazine (Compazine) is a phenothiazine. Providing confidential information or refusing to give an excessively large narcotic dose is not considered malpractice. Good Samaritan laws generally protect a person giving aid to an injured motorist.

20. What is the term for injury to a person or the person's property that gives rise to a basis for a legal action against the person who caused the damage? A. Assault B. Harm C. Malpractice D. Negligence

B. Harm Harm is the term for injury to a person or the person's property that gives rise to a basis for a legal action against the person who caused the damage. Assault is an intentional threat to cause bodily harm to another. It does not have to include actual bodily contact. Malpractice is the failure to meet a legal duty that results in harm to another. Negligence is the commission of an act or omission of an act that a reasonably prudent person would have done in a similar situation, leading to harm of another person.

11. The nurse knows that all patients have the right to nursing interventions regardless of their race, religion, or gender. The ethical principle that best describes this concept is: A. Nonmaleficence B. Justice C. Autonomy D. Beneficence

B. Justice

40. The new LPN/LVN is concerned regarding what should or should not be done for patients. What resource will be best provide this information? A. Nurse practice act B. Standards of care C. Scope of nursing practice D. Professional organization

B. Standards of care Standards of care define what should or should not be done for patients. The nurse practice act, scope of nursing practice, and professional organizations do not provide the best information as to what should or should not be done for patients

3. Th health care provider's order read "assist the patient with walking." The nurse allowed the patient to walk alone. The patient fell, fracturing the humerus. Which verdict is the most likely occurrence? A. The nurse will be found guilty of malpractice B. The nurse will be guilty of negligence C. The nurse will be charged with technical battery D. The nurse will not be found liable for any harm

B. The nurse will be guilty of negligence

15. The newly licensed nurse is assigned a patient who needs catheterization. The nurse has not performed the procedure before. What would be the best action for the nurse? A. Contact the nursing supervisor and explain the the procedure will need to be done by another nurse B.. Review the agency procedure for catheterization in the unit's resource area and see the assistance of another experienced nurse for help during the procedure C. Immediately advise the charge that someone else will need to assume care of this patient D. Promptly notify the staff development office that an instructor needs to do this procedure.

B.. Review the agency procedure for catheterization in the unit's resource area and see the assistance of another experienced nurse for help during the procedure

49. A lumbar puncture was performed on a patient without a signed informed consent form. This patient might sue for: A. Punitive damages B. Civil battery C,. Assault D. Nothing, no violation has occurred.

B.Civil battery Civil battery charges can be brought against someone performing an invasive procedure without the patient's informed consent legally documented. This patient could not sue for punitive damages or an assault.

26. As part of their right to refuse treatment, patients may prepare advance directives specifying what lifesaving treatments they do or do not wish to receive. When determining the legality of an advance directive, what applicable laws should the nurse know? A.Federal B.State C.County D Local

B.State State laws vary on the legalities of the various forms of advance directives, so the nurse needs to know the applicable state laws.

41. What role is the nurse who diligently works for the protection of patients' interests playing? A. Caregiver B. Health care administrator C. Advocate D. Health care evaluator

C. Advocate A nurse accepts the role of advocate when, in addition to general care, the nurse protects the patient's interests. Caregiver, health care administrator, and health care evaluator are not terms for the nurse who diligently works for the protection of patients.

16. A nurse who has recently been promoted to unit manager questions her immediate supervisor if there is any potential liability for her as a result of the actions of her nursing staff member. What information included in the supervisor's response would be appropriate (select all that apply) A. "An individual nurse is solely responsible for their actions" B. "As long as you are working in good faith you cannot be found liable" C" As a supervisor there is some liability if measures are not followed to ensure staff understand how to utilize the care equipment" D. "A supervisor is required tho assess the performance of their staff to ensure competency" E. "Employer liability is limited to cases in which a death occurs"

C. As a supervisor there is some liability if measures are not followed to ensure staff understand how to utilize the care equipment" D. "A supervisor is required tho assess the performance of their staff to ensure competency"

28. When a nurse becomes involved in a legal action, the first step to occur is that a document is filed in an appropriate court. What is this document called? A. Deposition B. Appeal C. Complaint D. Summons

C. Complaint Is filed in an appropriate court as the first step in litigation

35. When a nurse protects the information in a patient's record, what ethical responsibility is the nurse fulfilling? A. Privacy B. Disclosure C. Confidentiality D. Absolute secrecy

C. Confidentiality

19. Which statement characterizes criminal law? A. Criminal law applies to conduct that violates a person's rights. B. Criminal law involves an offense against an individual. C. Criminal law applies to conduct that is detrimental to society. D. The purpose of criminal law is to restitute the victim.

C. Criminal law applies to conduct that is detrimental to society. Criminal law is concerned with offenses against society in general and applies to conduct that is detrimental to society as a whole. Civil law deals with personal rights and applies to conduct that is detrimental to an individual. The purpose of criminal law is to punish the crime and to deter and prevent further crimes. Civil law's purpose is to make the aggrieved person whole again.

1. The newly licensed practical/vocational nurse (LPN/LVN) has reviewed the nurse practice act (NPA) of the state of licensure. What is the purpose of this documentation? A. Determine the quality of nursing care B. Enforce the standards of nursing care C. Define the scope of nursing practice D. Set the nurse's educational requirements

C. Define the scope of nursing practice

42. When asked to perform a procedure that the nurse has never done before, what should the nurse do to legally protect himself or herself ? A. Go ahead and do it B. Refuse to perform it, citing lack of knowledge C. Discuss it with the charge nurse, asking for direction D. Ask another nurse who has performed the procedure

C. Discuss it with the charge nurse, asking for direction The nurse cannot use ignorance as an excuse for nonperformance. The nurse should ask for direction from the charge nurse, explaining she has never preformed the procedure independently

9. The nurse's first job as an LPN/LVN is on a unit that cares for terminally ill children. What action should be taken by the nurse before helping families cope with their children's illnesses? A. Study the nurse practice act to find rules relating to the medical care of terminally ill children B. Spend time performing value clarification to aid in identifying her feelings about this new role C. Evaluate her own personal mores and customs that may affect the practice of nursing in general D. Review the state and federal laws that prescribe how a child may be treated when near death

C. Evaluate her own personal mores and customs that may affect the practice of nursing in general

37. What is the best way for the nurse to avoid a lawsuit? A. Carry malpractice insurance B. Spend time with the patient C. Provide compassionate, competent care D. Answer all call lights quickly

C. Provide compassionate, competent care

30. What are the universal guidelines that define appropriate measures for all nursing interventions? A. Scope of practice B. Advocacy C. Standard of care D. Prudent practice

C. Standard of care Standards of care define actions that are permitted or prohibited in most nursing interventions. These standards are accepted as legal guidelines for appropriateness of performance. The laws that formally define and limit the scope of nursing practice are called nurse practice acts. An advocate is one who defends or pleads a cause or issue on behalf of another. Prudent is a term that refers to careful and/or wise practice.

21. What resource would the LPN/LVNs refer to in order to know what they can and cannot do within their scope of practice? A.Interstate compact B. ANA C. The nurse practice act of their licensing state D. Their employing institution

C. The nurse practice act of their licensing state The state in which the nurse receives licensing has adopted a nurse practice act that defines the scope of nursing practice for the LPN/LVN within that state. The interstate compact is a legal agreement that allows the multistate practice of nursing. ANA is involved in developing standards of care for nursing practice. The employing institution may further limit the scope of practice for an LPN/LVN, but it is for that institution only.

2. The nurse working in a nursing home correctly recognizes that duties include patient advocacy. Which role is considered a primary duty of patient advocacy? A. To complete all nursing responsibilities on time B. To maintain the patient's right to privacy C. To safeguard the well-being of every patient D. To act as the patient's legal representative

C. To safeguard the well-being of every patient

43. The nurse is assisting a patient to clarify values by encouraging the expression of feelings and thoughts related to the situation. What is the most appropriate action for the nurse? A. Compare values with those of the patient B. Make a judgement C. Withhold an opinion D. Give advice.

C. Withhold an opinion The nurse can assist the patient in values clarification without giving an opinion

24. When caring for patients, the nurse knows that part of the ethical principles include all patients having the same right to nursing interventions. What is the term for this principle? A.Autonomy B.Nonmaleficence C.Justice D.Beneficence

C.Justice Justice in nursing means that nurses must allocate time among all the assigned patients to meet their needs. Autonomy refers to personal freedom of choice, a right to be independent and make decisions freely. Nonmaleficence means to do no harm. Beneficence means doing what is good.

Criminal Law vs. Civil Law

Criminal Law: Cases involving a violation of local, state, or federal laws (Public Law) -resolved with finding guilt or innocence -fines, incarceration, or a combination of two Civil Law: Cases involving one party attempting to seek payment or resolution of damages caused by another party. -determination of accountability or innocence

31. An LPN/LVN is asked by the RN to administer an IV chemotherapeutic agent to a patient in the acute care setting. What law should this nurse refer to before initiating this intervention? A. Standard of care B. Regulation of practice C. American Nurses' association code D. Nurse practice act

D. Nurse practice act It is the nurse's responsibility to know the nurse practice act in his or her state. Standards of care, regulation of practice, and the American Nurses' code are not laws that the nurse should refer to before initiating this treatment.

51. What is true about nurse practice acts? A. They informally define the scope of nursing practice B. They provide for unlimited scope of nursing practice C. Only some states have adopted a nurse practice act. D. The nurse must know the nurse practice act within his or her state

D. The nurse must know the nurse practice act within his or her state The laws formally defining and limiting the scope of nursing practice are called nurse practice acts. All state, provincial, and territorial legislatures in the United States and Canada have adopted nurse practice acts, although the specifics they contain often vary. It is the nurse's responsibility to know the nurse practice act that is in effect for her geographic region.

4. The patient refused to take the medication his doctor ordered for relief of pain. The LPN/LVN knows this is a patient right established by: A. The principle of beneficence B. The doctrine of negligence C. Specific nurse practice acts D. The patient self - determination act

D. The patient self - determination act

38. The nurse is caring for a patient with a do-not-resuscitate (DNR) order. Although the nurse may disagree with this order, what is his or her legal obligation? A. To question the health care provider B. To seek advice from the family C. To discuss it with the patient D. To follow the order

D. To follow the order

Code of Ethics for Nurses

NFLPN developed a code for LPN/LVN

55. Personal beliefs about the worth of an object, idea, custom, or attitude that influence a person's behavior in a given situation are referred to as__________

values Values are personal beliefs about the worth of an object, an idea, a custom, or an attitude. Values vary among people and cultures; they develop over time and undergo change in response to changing circumstances and necessity. Each of us adopts a value system that will govern what we feel is right or wrong (or good and bad) and will influence our behavior in a given situation.